bluuebunny/crossref_metadata_2025 huggingface dataset:
Sequence analysis of a rainbow trout cDNA library and creation of a gene index
Authors: Rexroad III C.E. , Lee Y. , Keele J.W. , Karamycheva S. , Brown G. , Koop B. , Gahr S.A. , Palti Y. , Quackenbush J.
Published: February 2004

Expressed sequence tag (EST) projects have produced extremely valuable resources for identifying genes affecting phenotypes of interest. A large-scale EST sequencing project for rainbow trout was initiated to identify and functionally annotate as many unique transcripts as possible. Over 45,000 5′ ESTs were obtained by sequencing clones from a single normalized library constructed using mRNA from six tissues. The production of this sequence data and creation of a rainbow trout Gene Index eliminating redundancy and providing annotation for these sequences will facilitate research in this species.
Identification of Chromosomes Associated with Dental Caries Susceptibility Using Quantitative Trait Locus Analysis in Mice
Authors: Nariyama Megumi , Shimizu Kunihiko , Uematsu Teruki , Maeda Takahide
Published: February 2004

Dental caries is a multifactorial, infectious disease with little known about the host genetic factors influencing susceptibility. This study aimed to identify the major candidate chromosomes for dental caries susceptibility and to detect the relevant regions within these. Quantitative trait locus (QTL) analysis was performed on genetic crosses of C3H/HeJ (caries-resistant) and C57BL/6J (caries-susceptible) mice inoculated with Streptococcus mutans serotype c. In a genomewide scan, three suggestive QTLs were detected on chromosomes 1, 2, and 7, one significant QTL was found on chromosome 2, and one highly significant QTL was detected on chromosome 8. The likelihood ratio statistic (LRS) was raised around the marker D1Mit21 in the middle region of chromosome 1, between D2Mit255 and D2Mit311 in the distal region of chromosome 2, and the region distal to D7Mit31 on chromosome 7. A significant QTL was located between the markers D2Mit237 and D2Mit101 on chromosome 2. The LRS was highly significantly raised between markers D8Mit208 and D8Mit280 on chromosome 8, and exceeded a highly significant level between markers D8Mit211 and D8Mit280. These results suggest that major gene(s) responsible for dental caries susceptibility or resistance are located in one or more of these regions.
Influence of Weight on Removal of Co-Adhering Bacteria from Salivary Pellicles by Different Modes of Brushing
Authors: van der Mei H.C. , Rustema-Abbing M. , Bruinsma G.M. , de Jager M. , Gottenbos B. , Busscher H.J.
Published: February 2004

This study compared removal of pairs of co-adhering and non-co-adhering oral actinomyces and streptococci from salivary pellicles by manual, rotating/oscillating electric and sonic toothbrushes, applying weights up to 240 g. First, actinomyces were allowed to adhere to a pellicle in a parallel plate flow chamber, after which streptococci suspended in saliva were perfused through the chamber at 33°C. On average, 34–39% of the adhering bacteria were adhering as single organisms. For co-adhering and non-co-adhering pairs, 33 and 10% of the adhering bacteria were involved, respectively, in aggregates comprising more than 10 organisms. Brushing by hand removed 82% at low weight (40 g), which was less than by electric (93%) or sonic (92%) brushing, while for all modes of brushing bacterial removal increased with increasing weight to 95–99%. For a non-co-adhering pair, subsequent exposure of brushed pellicles to a streptococcal suspension yielded only 2–16% of bacteria involved in large aggregates, regardless of the mode of brushing. For the co-adhering pair, however, de novo streptococcal adhesion to hand-brushed pellicles yielded 34–57% of bacteria involved in large aggregates, while electric and sonic brushing left 22–35% of the bacteria involved in large aggregates. De novo streptococcal adhesion for the co-adhering pair increased with increasing weight for the electric and sonic brush in contrast to the manual brush. Since a strong influence of co-adhesion is evident in de novo streptococcal adhesion, despite nearly complete removal of all actinomyces, these observations suggest that the three modes of brushing leave footprints to which streptococci preferentially adhere.
Efficacy of Occlusal Plaque Removal in Erupting Molars: A Comparison of an Electric Toothbrush and the Cross-Toothbrushing Technique
Authors: Nourallah A.W. , Splieth C.H.
Published: February 2004

The aim of this prospective crossover study was to compare the efficacy of two methods of plaque removal on partially erupted occlusal surfaces, which comprise about 80% of the sites affected by caries in schoolchildren. After a baseline examination, 16 children (aged 5–7 years) and their parents were instructed in cleaning the occlusal surface of an erupting molar either with an electric toothbrush or with a manual toothbrush in the cross-brushing technique. After 2 weeks, the proportion of the occlusal surface covered by plaque was measured again using the occlusal plaque index, a new, highly reproducible method (intraclass correlation coefficient >0.90). For the next 2 weeks, they used the other technique. In the multifactorial variance analysis, the individual child and parents were the most important factor for the amount of plaque present. Secondly, both methods resulted in about 50% less plaque on occlusal surfaces compared to baseline (29.2%) with a slightly but significantly smaller mean value for the electric toothbrush (14.7%, manual cross-brushing technique 16.7%; p = 0.025).
Colonization of Streptococcus mutans and Streptococcus sobrinus Genotypes and Caries Development in Children to Mothers Harboring Both Species
Authors: Lindquist B. , Emilson C.G.
Published: February 2004

The major route of early acquisition of mutans streptococci in humans is a vertical transmission from mother to child. The purpose of this longitudinal study was to examine the acquisition, distribution and persistence of Streptococcus mutans and Streptococcus sobrinus in children whose mothers harbored both species and to study the caries incidence in relation to colonization of these bacteria. Fifteen mother-child pairs were followed during the child’s first 7 years. Stimulated salivary samples were taken from the mothers and the children. Plaque samples were also collected from the teeth and the tongue of the children. The samples were analyzed by cultivating techniques together with genomic fingerprinting and hybridizing. The caries experience was evaluated on the sampling occasions and retrospectively using the records of caries registrations from the community clinics. During the 7-year period 10 of the 15 children acquired mutans streptococci. Only 4 of them were colonized by both S. mutans and S. sobrinus despite the fact that their mothers harbored both species. In 2 of the children S. sobrinus was found later than S. mutans. A total of 26 genotypes were found in the children and 9 of them were identical to their mothers. New genotypes and a gain-loss pattern were noted especially in the children but also in their mothers. The groups of teeth first positive for the two species were the deciduous molars. The caries experience was low during the study period with 8 children showing no caries.
Effects of Drying Time and the Presence of Plaque on the in vitro Performance of Laser Fluorescence in Occlusal Caries of Primary Teeth
Authors: Mendes F.M. , Hissadomi M. , Imparato J.C.P.
Published: February 2004

The diode laser fluorescence device was introduced to diagnose caries lesions in occlusal and smooth surfaces. Despite promising results, much variation has been found in the protocol of utilization. The goal of this study was to evaluate the influence of dental plaque and drying time on the laser fluorescence (DIAGNOdent) performance in occlusal sites of primary molars. For the drying time study, 63 suspected occlusal sites in primary molars were used. The same sites were evaluated in four different conditions: (1) moist teeth, (2) teeth dried for 3 s with a 3-in-1 syringe, (3) teeth dried for 15 s, and (4) dehydrated teeth. For the plaque experiment, we selected 28 occlusal sites. After the baseline laser fluorescence readings, plaque collected from children was placed on the suspected site. New laser fluorescence measurements were performed. For both studies, we compared the laser fluorescence values, as well as sensitivity, specificity, accuracy, and area under ROC curve. For different drying times, the more dehydrated the teeth, the higher the values. Nevertheless, the performance of the method did not change significantly, except for dehydrated teeth. In the presence of plaque, the laser fluorescence values were reduced, and the evaluated parameters were worse than with no plaque. In conclusion, the hydration state of the teeth did not change the results significantly, but the presence of plaque worsened the performance of the laser fluorescence method.
Fingernails and Toenails as Biomarkers of Subchronic Exposure to Fluoride from Dentifrice in 2- to 3-Year-Old Children
Authors: Corrêa Rodrigues Maria Heloísa , de Magalhães Bastos José Roberto , Rabelo Buzalaf Marília Afonso
Published: February 2004

This work evaluated the use of fingernails and toenails as biomarkers of subchronic exposure to fluoride (F) from fluoride dentifrice (FD) in 2- to 3-year-old children. Ten 2- to 3-year-old children used a placebo dentifrice (without F) for 28 days, FD (1,570 ppm F as monofluorophosphate) for the following 28 days, and then placebo dentifrice for an additional 28 days, then returned to their usual dentifrices. Fingernails and toenails were clipped every 2 weeks, during the experimental period and for an additional 22 weeks. Nail F was analyzed by electrode following hexamethyldisiloxane-facilitated diffusion. There were no significant differences between fingernail and toenail F concentrations. Mean peak F concentrations occurred 16 weeks after starting the use of FD. Results suggest that fingernails and toenails may be suitable biomarkers of subchronic exposure to F from FD in small children.
Caries-Inhibiting Effect of Professional Fluoride Gel Application in Low-Caries Children Initially Aged 4.5–6.5 Years
Authors: van Rijkom H.M. , Truin G.J. , van ‘t Hof M.A.
Published: February 2004

It was the purpose of the study to investigate the caries-reducing effect of semi-annual professional fluoride gel application in a low-caries child population initially aged 4.5–6.5 years during a 4-year follow-up period. In a double-blind randomised controlled trial (n = 773) the effect of sodium fluoride gel on D3MFS and d3mfs was compared with a placebo gel. The mean caries reduction of professionally applied fluoride gel after 4 years in subjects with baseline caries experience D3MFS = 0 as well as d3mfs = 0 was 0.08 D3MFS (SE = 0.06) and 0.36 d3mfs (SE = 0.22). The prevented fraction for D3MFS and d3mfs was 26% (SE = 16%) and 20% (SE = 11%), respectively. It was concluded that in the investigated low-caries 4.5- to 6.5-year-olds, fluoride gel treatment showed a statistically significant (tested one-sided) caries-inhibiting effect on D3MFS, which was considered not clinically relevant, and no significant effect on d3mfs.
The Effect of Chewing Urea-Containing Gum on Plaque Acidogenic and Alkaligenic Parameters
Authors: Smith C.A. , Higham S.M. , Smith P.W. , Verran J.
Published: February 2004

The aim of this double-blind crossover study was to determine the effect of chewing urea-containing gum on selected microbiological plaque properties. Eleven subjects chewed either urea-containing or urea-free placebo gum 3 times daily, each for 4 weeks, with at least a 4-week separation between regimes. After each chewing regime, plaque was sampled from all available surfaces, and inoculated into media indicative of acid or base production. In addition, interdental pH measurements were taken using touch Beetrode electrodes following sucrose and sorbitol mouthrinses, and sucrose mouthrinses followed by urea rinse, urea gum, or placebo gum. No significant differences in plaque acidogenic and alkaligenic properties were found between the urea and placebo gum regimes. Urea rinsing, urea gum and placebo gum all reduced the depth and duration of the pH fall following a sucrose mouthrinse. They also enhanced a rise in pH above the resting pH, but although urea gum produced a larger increase than placebo gum, the difference was not significant.
Caries Incidence and Lesion Progression from Adolescence to Young Adulthood: A Prospective 15-Year Cohort Study in Sweden
Authors: Mejàre I. , Stenlund H. , Zelezny-Holmlund C.
Published: February 2004

The objectives were (1) to assess caries development, including the incidence and rate of lesion progression, in a Swedish cohort from adolescence to young adulthood and (2) to compare the caries incidence rates in adolescents with those of young adults. The original material consisted of 536 children aged 11–13 years at baseline. This cohort had been followed through annual bitewing radiographs to 21–22 years of age. In 1998–1999, 250 of these individuals were re-examined at the age of 26–27, and the new caries data were added to the original data. The results showed that fewer new enamel lesions developed on approximal surfaces during young adulthood than during adolescence; the caries incidence rates for enamel lesions decreased from 4.3 in the age group 12–15 years to 2.7 new caries lesions/100 surface-years in the age group 20–27 years. The same applied to the rate of lesion progression, where the corresponding values from the enamel-dentin border to the outer dentin were 32.5 for the youngest and 10.9 new lesions/100 surface-years for the oldest age group. The caries incidence of outer dentin lesions on approximal surfaces was low but increased from 0.2 in the age group 12–15 years to 0.9 new outer dentin lesions/100 surface-years in the age group 20–27 years. The incidence rates varied considerably between different tooth surfaces. Also for occlusal surfaces, fewer new dentin lesions developed during young adulthood than during adolescence; the incidence was 2.0 new dentin lesions/100 surface-years in the youngest age group and 0.7 during young adulthood. At the age of 13, the proportion of DFS of occlusal surfaces predominated over DFS of approximal surfaces but at the age of 26–27 the proportions of occlusal and approximal DFS were almost equal.
Sucrose Intake since Infancy and Dental Health in 10-Year-Old Children
Authors: Ruottinen S. , Karjalainen S. , Pienihäkkinen K. , Lagström H. , Niinikoski H. , Salminen M. , Rönnemaa T. , Simell O.
Published: February 2004

The dental health of children in western countries has improved without a concomitant decrease in the mean sucrose consumption. Our aim was to analyse the association of long-term sucrose consumption with dental health in children representing the highest (n = 33, 18 boys) and the lowest 5 percentiles (n = 33, 21 boys) of sucrose intake, in a study where food consumption was prospectively recorded from infancy to 10 years of age. The sum of decayed, missing and filled teeth in the primary (dmft) and permanent (DMFT) teeth was assessed. Children’s sucrose intake in the high intake group was constantly higher than in their counterparts (p < 0.001), and already exceeded 10% of energy intake (E %) at 2 years of age. The mean ± SD of the dmft + DMFT scores was higher in the high than in the low sucrose intake group (3.9 ± 3.9 and 1.9 ± 2.5, respectively; p = 0.032). We conclude that a persistently high sucrose intake increases the risk of dental caries in children.
Caries Experience and Background Factors in 4-Year-Old Children: Time Trends 1967–2002
Authors: Stecksén-Blicks C. , Sunnegårdh K. , Borssén E.
Published: February 2004

In cross-sectional studies conducted in 1967, 1971, 1976, 1980, 1987, 1992, 1997 and 2002, 4-year-old children in Umeå, a city in northern Sweden, were examined for dental caries and background factors such as oral hygiene habits, use of fluorides, and sugar consumption. The same methods and criteria have been used in each of the studies from 1967 to 2002. The number of children with caries had declined from 87% in 1967 to 42% in 1987, but then the decline levelled out. In 2002, 46% of the children had caries with a mean dmfs value of 2.0 ± 3.6. Six percent of the children had 10 or more dmfs. Immigrant children had a higher caries prevalence (p < 0.01). A significant difference in the dmfs values was found in children according to tooth-brushing frequency (p < 0.01). Although the consumption of sugary products between meals increased between 1987 and 1997, no changes were noted from 1997 to 2002. In conclusion, no important changes in caries prevalence have taken place during the last 15 years. The frequency of tooth-brushing and immigrant background had a significant association with caries prevalence.
Assessment of Caries Risk in Preschool Children
Authors: Pienihäkkinen Kaisu , Jokela Jorma , Alanen Pentti
Published: February 2004

The study aimed to assess the additional caries-predictive value of visible plaque, gingival bleeding, and the reported use of fluorides and candies, when combined with the information about mutans streptococci (MS) and incipient carious lesions. The subjects were 2 years of age at the baseline examination (n = 226), and they were all given conventional prevention during the 3-year follow-up period. None of the studied single risk indicators reached an accuracy of 80% in predicting the 3-year caries increment. At best, the accuracy was 75% for the MS strip. Use of candies and incipient caries lesions had additional caries-predictive value (multiple logistic regression analysis). The combined use of these three risk indicators resulted in an accuracy of 81%. The present results indicate that in 2-year-old children, the combination of two or three risk indicators (MS strip, incipient caries lesions, and use of candies) might have caries-predictive power enough for clinical implications.
Second Transurethral Resection of Superficial Transitional Cell Carcinoma of the Bladder: A Must Even for Experienced Urologists
Authors: Zurkirchen M.A. , Sulser T. , Gaspert A. , Hauri D.
Published: February 2004

Introduction: As even experienced urologists have a high percentage of persisting carcinoma after transurethral bladder tumour resection (TUR-B) the importance of a routine second resection in the management of transitional cell carcinoma (TCC) of the bladder is defined. Patients and Methods: The medical records of all patients treated with TUR-B at our institution between January 1989 and September 2000 were reviewed. 214 patients with pTa and pT1 carcinoma undergoing a second resection 4–6 weeks later were included in the analysis. The rate of persisting carcinoma in the second resection was compared to the actual tumour stage and grade, the patient’s age, sex and the experience of the urologist performing the resection. Results: Of the 214 patients 99 had pTa and 115 pT1 carcinoma. The rate of persisting tumour in the second resection was 27% in pTa and 37% in pT1 carcinoma. This rate was independent of the patient’s age and sex. Urologists in training had an equally low rate of persisting carcinoma in the second resection compared to senior urologists (p = 0.08). Conclusions: Routine second resection of superficial transitional cell carcinoma of the bladder should be part of the treatment even in larger operative experience.
Survival Rates after Radical Cystectomy according to Tumor Stage of Bladder Carcinoma at First Presentation
Authors: May Matthias , Helke Christian , Nitzke Thomas , Vogler Horst , Hoschke Bernd
Published: February 2004

Introduction: The aim of this study was to establish to what extent the survival rates of muscle-invasive bladder carcinoma are influenced by the tumor stage at initial presentation. Patients and Methods: This study examined the clinical course of 230 patients who underwent radical cystectomy for bladder carcinoma from 1992 to 2002. The patients were divided into three groups according to the histological results of the initial and final transurethral tumor resection (TURB). In group 1 (n = 41) radical cystectomy was carried out for a superficial bladder carcinoma which had a high likelihood of progressing. Group 2 (n = 57) consisted of patients who displayed a superficial tumor stage when they first presented and developed progressive muscle-invasive bladder carcinoma under conservative treatment. Group 3 (n = 132) was made up of patients who were already at the muscle-invasive tumor stage in the course of primary TURB. The histopathological characteristics of all transurethral tumor resections and radical cystectomy were recorded. Progression-free survival and overall survival in the three groups were then compared. Results: The average patient age when cystectomy was carried out was 63.9 (35–80) years and the average follow-up period was 38 months. An average of 2.3 (1–16) transurethral tumor resections were carried out before radical cystectomy (median = 1). Progression-free survival and overall survival of all 230 patients was 54 and 50%, respectively, after 5 years. The best result was a 74% progression-free 5-year survival rate with organ-confined lymph node-negative tumors (n = 106) which was statistically significant (p = 0.0004) compared to the progression-free 5-year survival rate of 50% for non-organ-confined, lymph node-negative tumors (n = 64). Lymph node-positive patients achieved a progression-free survival rate of 21% after 5 years regardless of the tumor infiltration. Patients in group 1 achieved a progression-free 5-year survival rate of 77% and an overall survival rate of 63% after 5 years. In group 2 patients achieved a progression-free survival rate of 51% after 5 years and an overall survival rate of 50%. In the case of primary muscle invasion (group 3), progression-free survival and overall survival were 49 and 46%, respectively, after 5 years. There was no significant difference between groups 2 and 3 with regard to their progression-free or overall survival rates (p > 0.35). However, both groups displayed a significantly poorer progression-free and overall survival rate compared with group 1 (p < 0.01). Conclusion: Our results show that superficial bladder carcinoma with tumor progress to muscle invasion does not have a better prognosis after radical cystectomy than initial muscle-invasive bladder carcinoma. Survival rates in this group can only be improved by singling out patients on the basis of risk factors at an earlier stage and carrying out a cystectomy.
CA19-9 as a Serum Marker for Poor Prognosis in Urothelial Carcinoma
Authors: Sashide Kazuhiko , Isobe Hideyuki , Wakumoto Yoshiaki , Hanazawa Kisaburo , Fujita Kazuhiko , Fujime Makoto
Published: February 2004

Introduction: To evaluate the role of serum carbohydrate antigen 19-9 (CA19-9) in the prognosis and follow-up evaluation of patients with urothelial carcinoma, the authors studied the association of the serum level and positive rate with clinical features such as infiltration and metastasis in 164 patients admitted to the authors’ department. Patients and Methods: This study included 164 cases of patients with urohelial carcinoma. The absolute value of the serum CA19-9 level and its positive rate were tested. Simple variant analysis and logistic regression analysis were used for estimation of statistical significance. Kaplan-Meier’s test and Cox’s proportional hazard model were used for analysis of survival. Results: Significant differences in the serum CA19-9 levels were found with regard to the following parameters: the presence or absence of metastasis, clinical stage, depth of invasion, and degree of differentiation. The positive rate displayed a significant difference only for the presence or absence of metastasis. With regard to the presence of metastasis, serum CA19-9 was a significant risk factor along with depth of invasion in logistic regression analysis. Comparison of the survival rate indicated the prognosis to be significantly poor in the positive group and serum CA19-9 was regarded to be a prognostic risk factor in analysis via the regression model. Conclusions: Serum CA19-9 is thought to serve as a significant marker for advanced cancer and tumors with highly malignant potential and is useful for predicting prognosis of the disease.
Examination of Tumorigenesis of Precursor Lesions in Bladder Cancer by in situ Hybridization
Authors: Krause Steffen , Feil Gerhard , Beiter Thomas , Pressler Harald , Schrott Karl M. , Bichler Karl-Horst
Published: February 2004

Through examinations using fluorescence in situ hybridization (FISH) of chromosomes 1 and 9, we tried to obtain more information on dysplasia and carcinoma in situ (Cis) in relation to the oncogenesis of bladder cancer. 63 paraffin sections (dysplasia grades I–III and Cis) were evaluated, and 8 negative sections functioned as a control group. For FISH, DNA samples of CEP 1 and 9 (α satellites) were chosen. Gains (aneuploidy) or losses (monosomy) of chromosomal material were determined microscopically. Dysplasia grades I–III showed a 5–18% aberration in chromosome 1 aneuploidy and a 19–29% aberration in monosomy 9. Cis revealed 27% aneuploidy of chromosomes 1 and 9. Although at present dysplasia grade III and Cis of the bladder are viewed as histopathologically identical, we examined both molecular genetic differences in chromosome 9. As referred to in the literature we found the same genetic aberrations for dysplasias (grades I–III) and noninvasive papillary bladder tumors as well as for Cis and solid invasive bladder cancer.
New Cut-Off Point between T1 and T2 Renal Cell Carcinoma – Necessary for a Better Discriminatory Power of the TNM Classification
Authors: Wunderlich H. , Dreihaupt M. , Schlichter A. , Kosmehl H. , Reichelt O. , Schubert J.
Published: February 2004

Purpose: We evaluated the pathological features of tumor size, lymph node and distant metastases, cell type, growth pattern, infiltration pattern, histological grade, local invasion and venous involvement of organ-confined renal carcinomas. The aim of this study was the re-evaluation of the TNM classification and the tumor cut-off point between T1 and T2 for renal cell carcinomas from the 1987 to the 1997 versions. Materials and Methods: (1) Patients with renal cell carcinoma who had been operated between October 1992 and August 2001 were evaluated. 437 of 691 patients showed T1 and T2 tumors. These organ-confined tumors have been divided into five groups: group 1: tumor-size of 20 mm or less (n = 16), group 2: 21–30 mm (n = 79); group 3: 31–40 mm (n = 83; group 4: 41–70 mm (n = 184), and group 5: more than 70 mm in diameter (only T2, n = 75). Follow-up ranged from 0 to 100 months (average 28.63 months). (2) Of 15,347 autopsies performed in Jena between 1985 and 1996, 272 renal cell carcinomas were revealed. In 145 of these 272 cases renal cell carcinomas were limited to the kidney. These 145 tumors were divided accordingly into 5 groups: group 1: 20 mm or less (n = 33), group 2: 21– 30 mm (n = 31); group 3: 31–40 mm (n = 29); group 4: 41–70 mm (n = 42), and group 5: T2 (n = 10). Clinicopathological criteria examined were lymph node and distant metastases, cell type, growth pattern, infiltration pattern, histological grade, local invasion and venous involvement. To identify the optimal cut-off point between T1 and T2 disease the χ2 test was used. Results: (1) In the clinical series only 1.8% (n = 8) of all cases showed lymph node metastases. Distant metastases were shown in 57 cases (13.04%); within group 1: 0%, group 2: 7.59%, group 3: 1.20%, group 4: 15.76%, group 5: 28%. The tumor grading was statistically correlated with tumor size. (2) In the pathological series 94 of the evaluated 145 patients were downstaged from T21987 to T11997. Lymph node and distant metastases were well correlated with tumor size. Lymph node metastases were seen in 0, 12.9, 31, 29.3 and 40% (group 1 to group 5) and distant metastases in 12.1, 25.8, 41.4, 47.7 and 60%. There were no statistically significant differences between T21997 and T13–7 cm. The tumor grading was statistically correlated with tumor size (grade 1: in 66.7, 25.8, 17.2, 9.5 and 0%). Conclusion: Our data suggest that the current cut-off diameter between T1 and T2 renal cell carcinomas (7 cm) is too high. Lowering the cut-off level will result in better discriminatory power of the TNM classification. From our data, we conclude that the cut-off diameter should be lowered to 3.5 cm (p < 0.001).
Impact of Imaging and Thrombus Level in Management of Renal Cell Carcinoma Extending to Veins
Authors: Gupta Narmada P. , Ansari M.S. , Khaitan Anurag , Sivaramakrishna M.S. , Hemal Ashok K. , Dogra P.N. , Seth A.
Published: February 2004

Objectives: To evaluate the role of newer imaging modalities in the diagnosis and evaluation of management according to extent of renal vein (RV) or inferior vena cava (IVC) thrombi in patients with renal cell carcinoma. Material and Methods: Fifty-nine patients with renal cell carcinoma and tumor thrombus extension into the RV or IVC were studied. Diagnosis was based on contrast-enhanced CT, magnetic resonance imaging or color-Doppler ultrasonography. Surgical treatment was contemplated in 42 suitable patients and complete resection could be done in all but 3 cases. Results: There were 48 males and 11 females with mean age of 51.8 years. Isolated RV involvement was seen in 27 cases whereas IVC extension was present in 32 cases. The thrombus extent was infrahepatic in 62.5% (20/32) patients with IVC extension. With the newer imaging modalities like contrast-enhanced CT, color-Doppler ultrasound and/or magnetic resonance imaging, correct diagnosis of the extent of the thrombus was possible in 95% of the patients. The accuracy of color-Doppler ultrasound was same as magnetic resonance imaging in the evaluation of the extent of the thrombus. In the present series a median follow-up of 4 years revealed a high incidence of local and distant recurrences and decreased survival in patients presenting with advanced disease, who had venous wall invasion. Conclusions: The extent of RV or IVC thrombi can be accurately diagnosed with contrast-enhanced CT scan and in case of doubt color-Doppler ultrasound is a good alternative to magnetic resonance imaging. Management can be planned according to the level of the tumor thrombus. Invasion of the venous wall was found to be a bad prognostic factor affecting survival.
A Simple Mathematical Approach to Calculate Blood Loss in Radical Prostatectomy
Authors: Hurle Rodolfo , Poma Rossana , Maffezzini Massimo , Manzetti Alberto , Piccinelli Alessandro , Taverna Gianluigi , Bellavita Piermario , Graziotti Pierpaolo
Published: February 2004

Introduction: The aim of this study was to apply a simple mathematical approach to calculate blood loss in 126 patients undergoing radical retropubic prostatectomy (RRP). Materials and Methods: Perioperative red blood cell loss (RBCL) was estimated by adding the difference in circulating red blood cells from before to after surgery to the allogeneic red blood cells transfused in the same period. Results: Mean preoperative hematocrit was 45 ± 4% and mean perioperative RBCL was 574 ± 297 ml, corresponding to a mean equivalent whole blood loss (WBL) of 1,479 ± 831 ml. Twenty of 126 patients (15.9%) received 42 units of allogeneic packed red blood cells (PRBC), for a mean of 2.1 ± 1.2 U/patient. The transfusion rate was higher in patients with a preoperative hematocrit of 40% or less (45 vs. 13%, p = 0.014). Conclusions: Anatomical RRP is still associated with appreciable operative blood loss. Owing to the high preoperative hematocrit values, the allogeneic blood transfusion rate is low and the transfusion requirement of the majority of patients is limited to about 2 units of PRBC. Preoperative autologous blood augmentation strategies may not be routinely needed for patients with a basal hematocrit of >40%.
Pneumatic Lithotripsy through Pyelotomy Incision during Open Surgery for Staghorn Calculi
Authors: Ünsal Ali , Cimentepe Ersin , Saglam Remzi , Balbay M. Derya
Published: February 2004

Introduction: Our purpose was to remove large-volume staghorn calculi with less morbidity and maximum ease without an anatrophic nephrolithotomy, with the use of a pneumatic lithotriptor during pyelolithotomy to disintegrate the branches of stones extending into the calyces and retained calyceal fragments. Patients and Methods: Sixteen patients (17 renal units) with large-volume staghorn stones were evaluated with blood urea nitrogen (BUN), creatinine levels, urinalysis, and culture, excretory urography (IVP), and 99mtechnetium dimercaptosuccinic acid (DMSA) renal scintigraphy preoperatively. Patients were treated with a pneumatic lithotriptor at the time of open pyelolithotomy. Bilateral surgery was performed in 1 patient. The mean follow-up period was 12 (range 6–24) months. The patients were re-evaluated postoperatively at 6 months with BUN and serum creatinine measurements, urinalysis and culture, IVP, and renal scintigraphy with DMSA. Data were analyzed by one-way ANOVA test. p < 0.05 was considered statistically significant. Results: After treatment, 15 of 17 renal units (88%) were rendered stone-free while residual fragments remained in two patients. Average operation time was 190 min (range 135–285) with a mean blood loss of 226 ml (range 140–425). No patient required blood transfusion. Average length of hospital stay was 4.2 days (range 3–7). Six months after surgery, mean BUN and creatinine levels were decreased from 31.2 to 28.2 mg/dl (p = 0.248) and from 1.3 to 1.1 mg/dl (p = 0.001), respectively. Renal scintigraphy with DMSA revealed an increase in ipsilateral average renal function from 39 to 43% (p = 0.043). IVP also revealed a decrease in pelvicalyceal dilatation in almost all patients with a well-functioning kidney and without any stone recurrence. No complications were encountered postoperatively except for an episode of high fever in 1 patient. Conclusion: Avoiding incision of the renal parenchyma and arterial clamping, without significant bleeding and the nephron loss seem to be the advantages of this technique. Kidney function can be preserved with this simple and easily applicable method, which may be an alternative procedure to anatrophic nephrolithotomy for the majority of patients with staghorn calculi requiring open surgery.
Intravesical Vanilloids and Neurogenic Incontinence: Ten Years Experience
Authors: Lazzeri Massimo , Spinelli Michele , Zanollo Alberto , Turini Damiano
Published: February 2004

Introduction: In this study we critically review our ‘10-year’ experience with intravesical vanilloids (capsaicin and resiniferatoxin) in the treatment of neurogenic incontinence, addressing the issue of their introduction into daily clinical practice. Materials and Methods: From July 1992 to June 2001, 54 patients suffering from detrusor hyperreflexia, due to spinal cord injuries, received intravesical instillation of capsaicin, and from January 1995 to June 2001, 47 patients received intravesical instillation of resiniferatoxin (RTX) in order to treat bladder dysfunction and symptoms. All patients presented detrusor hyperreflexia refractory to oral and/or intravesical oxibutynin and they displayed high-voiding pressure associated with frequent urine leakage. Capsaicin was used at a concentration of 10 mM; RTX was tested in two different concentrations: 10 nM and 10 µM. The outcome was considered according to simple parameters: (i) the number of patients who reported an improvement in clinical status (patient dry between clean intermittent catheterization) and urodynamic status (a bladder capacity 50% higher than pretreatment capacity, lasting more than 3 months after the instillation); (ii) the number of patients who continued intravesical therapy; (iii) the number of instillations they received; (iv) the length of the interval between 2 consecutive instillations, and (v) alternative therapies when vanilloids failed. Results: The topical intravesical instillation of capsaicin produced an improvement in symptoms and urodynamic parameters, in 29 patients (53.7%) after 3 months. In these 29 patients only 7 (24.13%) continued to received capsaicin in June 2001. The mean follow-up was 32.28 ± 14.20 (range 8–52) months, the mean number of instillations was 6.14 ± 2.54 (range 2–10) and the mean interval between the 2 consecutive instillations was 7.14 ± 2.60 (range 4–12) months. The topical intravesical instillation of RTX produced an improvement in symptoms and urodynamic parameters in 73.33% of patients (a total of 45 patients) who received 10 µM. 18 of them (54.54%) continued to received RTX in June 2001. The mean follow-up was 27.88 ± 10.95 (range 11–49) months, the mean number of instillations was 4.33 ± 1.60 (range 2–8). The mean interval between 2 consecutive instillations was 9.61 ± 2.99 (ranged 4–16) months. Conclusion: The results obtained using RTX seem to be very promising with regard to efficacy and tolerance, particularly in comparison with capsaicin. Even if the number of patients who received capsaicin and RTX remains small, the intravesical vanilloid receptor agonist RTX could offer an attractive alternative to oral medications in the treatment of neurogenic incontinence.
Percutaneous Therapy of Varicocele: Effects on Semen Parameters in Young Adults
Authors: Polito Jr M. , Muzzonigro G. , Centini R. , Candelari R. , Antico E. , Boscaro M. , Mantero F. , Ricciardo-Lamonica G. , Balercia G.
Published: February 2004

Background: In spite of many years of debate, the impact of varicocele on male infertility is still controversial since its pathogenetic role on the impairment of semen quality has never been fully demonstrated. Methods: In the present work, a series of 426 young adult males undergoing percutaneous treatment of varicocele were studied and semen parameters were evaluated at baseline and 12 months of follow-up. Results: A significant increase in sperm cell concentration and a decrease in immotile spermatozoa were found after varicocele repair, but we failed to detect any significant positive change in progressive motility as well in sperm morphology after treatment. Similar results were also obtained when semen parameters were correlated with the degree of varicocele. Conclusion: Since a spontaneous improvement in semen quality has been mathematically established as a model of regression toward the mean, we conclude that the correction of varicocele in young adults is not a major indication when semen alteration is the only clinical problem.
Electronic Data Base Systems Support the Evaluation of Male Infertility Factors, Example Cryptorchidism
Authors: Paasch U. , Thieme C. , Grunewald S. , Glander H.-J.
Published: February 2004

Background: A new data base system was applied to analyse our patient group with two aims: (a) to analyze the effects of former cryptorchidism on the fertility of our infertility patients in comparison with the data of the literature and (b) to evaluate this system in a clinical study. Materials and Methods: Using the electronic data base Winsperm 2000®, 1,648 infertility patients, 79 patients with testicular cancer and 201 healthy semen donors were examined. Results: A history of cryptorchidism, treated at 6.8 ± 3.3 years of life, was found in 10.1% of our infertility patient group. The routine spermiogram parameters, as well as basal hormone concentration of FSH, LH and testosterone, differed significantly from those of the healthy semen donor group. Comparison between patients with former unilateral and bilateral cryptorchidism differed significantly only in total sperm count. 27.7% of patients with a history of unilateral and 5.4% of patients with a history of bilateral cryptorchidism showed a sperm concentration within the normal range (p < 0.01). Azoospermia was detected in 13.1% of patients with unilateral cryptorchidism and in 29.7% of patients with former bilateral cryptorchidism (p < 0.05). The patients responding to our conception questionnaire realised a total conception rate of 46.1% in the ‘non-cryptorchidism group’ and of 20.6% in the ‘cryptorchidism-group’ (p < 0.05), whereas the conception rates did not differ between former unilateral and bilateral cryptorchidism (p > 0.05). Sixteen (20.3%) of the 79 patients with testicular neoplasm were previously treated for cryptorchidism. Conclusion: The results of our patient group underline the significance of former cryptorchidism for infertility and testicular neoplasm. The new data base system facilitates rapid data retrieval and examination.
A Novel Surgical Approach to Subinguinal Varicocelectomy: Artery and Lymphatic Isolation Technique
Authors: Fisch Harry , Johnson Christopher W. , Bingham Jonathan B. , Anastasiadis Aristotelis G.
Published: February 2004

Clinically relevant varicoceles require surgical management through one of several techniques. We introduce an innovative technique for varicocelectomy via a subinguinal approach that allows identification and preservation of the arteries and lymphatics. This method allows the safe excision of the varicocele, while minimizing the risk of complications.
Mini-Invasive Management of a Rare Complication of Percutaneous Stone Treatment: Entrapped Nephrostomy Tube
Authors: Tasca A. , Cacciola A.
Published: February 2004

A case of entrapped nephrostomy tube in a 61-year-old woman who underwent percutaneous nephrolithotomy and subsequent multiple ESWL for a left staghorn stone is presented. A nephrostomy track was created alongside the Malecot catheter and the overgrown tissue which was bridging the wings of the tube was incised with a Sachse urethrotome. To prevent this complication the wings of the Malecot should freely expand in the renal collecting system and the catheter should stay in situ for no more than 3 weeks.
Unusual Double Primary Neoplasia: Adrenocortical and Ureteral Carcinomas in Werner Syndrome
Authors: Takazawa Ryoji , Ajima Junichi , Yamauchi Akimasa , Goto Makoto
Published: February 2004

Adrenocortical and ureteral carcinomas were observed in a 50-year-old Japanese woman with Werner syndrome (MIM No. 27770). The syndrome is an autosomal recessive disorder characterized by premature aging and an increased risk of rare cancers, which are often multiple. This is the first reported association of adrenocortical carcinoma in Werner syndrome.
Renal Cell Cancer in Presacral Ectopic Kidney: Preoperative Diagnostic Imaging Compared to Surgical Findings
Authors: Terrone C. , Destefanis P. , Fiori C. , Savio D. , Fontana D.
Published: February 2004

The occurrence of renal cell carcinoma is an exceptional phenomenon in an ectopic kidney. We describe a patient with renal cell cancer of the pelvic kidney who underwent radical nephrectomy at our institute. Preoperatively the patient underwent paramagnetic medium-enhanced magnetic resonance that provided an accurate description of the ectopic renal vessels. During surgery the anatomy of the vessels appeared exactly as described by the MR examination. Histological examination revealed a pT2N0GIV renal cell cancer. Nine months later the patient underwent control examinations, and no delayed complications had occurred. In our experience magnetic resonance provided an exact description of the ectopic kidney vascularization as confirmed by the surgical findings. Preoperative knowledge is important both for the surgeon during the dissection of the vessels and to plan correct lymphadenectomy on the basis of the vessel source identified at imaging.
Primary Transitional Cell Carcinoma of the Prostate Presenting as a Rectal Ulcer
Authors: Wadhwa P. , Mandal A.K. , Singh S.K. , Goswami A.K. , Sharma S.C. , Joshi K. , Sharma S.K.
Published: February 2004

Primary transitional cell carcinoma of the prostate is a rare clinicopathological entity. It is an aggressive tumor with a poor prognosis. Presentation is usually late, with obstructive voiding complaints. Radical surgery offers locoregional control of the disease. We report a case with an atypical presentation of bleeding per rectum and associated obstructive voiding symptoms. Examination revealed a rectal ulcer overlying an enlarged prostate and fixed to it. Histopathology showed a picture of transitional cell carcinoma of the prostate infiltrating the rectum. Imaging studies revealed an enlarged prostate with altered echo pattern with locoregional spread, infiltrating the rectum. Bladder involvement and distant metastases were not evident. External beam radiotherapy achieved good local control. At 3 months of follow-up, the patient was free of urinary symptoms and his rectal ulcer had healed. The patient declined subsequent treatment.
The Potential Use of Stem Cells for Cochlear Repair
Authors: Parker Mark A. , Cotanche Douglas A.
Published: February 2004

In light of the currently defined characteristics of stem cells, a re-evaluation of hair cell regeneration in birds suggests that there may be a stem cell population located in the inner ear. It is yet to be determined if the mammalian cochlea contains stem cells, but the presence of a mammalian vestibular stem cell population would not appear to be out of the realm of possibility. This paper reviews the latest advances in stem cell biology and suggests that stem cells may be an appropriate biological tool to be used for cochlear repair. The potential use of several types of stem cells, including embryonic, neural and hematopoietic stem cells, as agents for cochlear repair is examined.
Diagnosis of Sensorineural Hearing Loss with Neural Networks versus Logistic Regression Modeling of Distortion Product Otoacoustic Emissions
Authors: Ziavra Nausica , Kastanioudakis Ioannis , Trikalinos Thomas A. , Skevas Antonios , Ioannidis John P.A.
Published: February 2004

We investigated whether modeling with artificial neural networks or logistic regression of distortion product otoacoustic emissions (DPOAE), across diverse frequencies, may achieve an accurate diagnosis of sensorineural hearing loss (SNHL) of cochlear origin. 256 ears (90 with SNHL and 166 with normal hearing) were evaluated with pure-tone audiometry, impedance audiometry, speech audiometry and DPOAE. Ears were split into training (n = 176) and validation (n = 80) sets. Input variables included gender, age, examination time, DPOAE intensity at f2 frequencies 593, 937, 1906, 3812 and 6031 Hz, and respective values corrected for noise levels. In the validation data set, an average network had an area under the receiver operating characteristic curve (AUC) of 0.86 (accuracy 84%). Logistic regressions including all these variables or those selected by backward elimination had AUC values of 0.91 and 0.92, respectively (accuracy 85% both). Eleven of 12 trained networks had better specificity than the backward elimination logistic regression, and the backward elimination logistic regression had a better sensitivity than 11 of the 12 networks. Both modeling approaches correctly identified all ears with sudden hearing loss, congenital hearing loss, head trauma, nuclear jaundice and ototoxicity, and 2–3 of 5 ears with acoustic trauma, but missed 1–3 of 3 ears with Ménière’s disease and 4–6 of 8 ears with abnormal pure-tone thresholds on audiometry which had no accompanying findings. For SNHL exceeding 45 dB HL on a pure-tone threshold, sensitivity was 83% (15/18) by neural networks and 84 or 94% (16/18 or 17/18) by logistic regression. Both neural-network-based analysis and logistic regression modeling of the DPOAE pattern across a range of frequencies offer promising approaches for the objective diagnosis of moderate and severe SNHL.