bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation by exercise testing of children with mild and moderate valvular aortic stenosis
Authors: Yilmaz Gonca , Özme Şencan , Özer Sema , Tokel Kürşat , Çeliker Alpay
Published: March 2003

Abstract Background: The aim of the present paper was to determine the factors related to sudden death in aortic stenosis.

Methods
: The factors related to sudden death were investigated in 40 asymptomatic children with mild and moderate aortic stenosis by treadmill testing.

Results
: The QT interval of aortic stenosis cases were significantly longer than those of healthy children with increasing heart rates during exercise.

Conclusions
: A longer QT interval of aortic stenosis cases compared to normal children during exercise is the first sign of myocardial ischemia and leads to fatal ventricular arrhythmias and sudden death. For this reason we recommend that exercise testing should be performed frequently in aortic stenosis patients and that close follow up is necessary for patients with long QT segments that can be a marker for severe arrhythmias.
Echocardiographic evaluation of the ductal morphology in patients with refractoriness to lipo‐prostaglandin E1 therapy
Authors: Takeda, Nobuhiro , Hiraishi, Satoshi , Misawa, Hitoshi , Agata, Yotarou , Horiguchi, Yasunori , Fujino, Nobuyuki , Hirota, Hamao , Kawamura Seiji , Ogawa Natuko
Published: March 2003

Abstract

Background
: Lipo‐prostaglandin (PG)E1 is effective at lower doses and has fewer side effects than PGE1‐cyclodextrin (CD). Previous studies, however, have suggested that some patients show refractoriness to lipo‐PGE1 in the course of treatment. The present paper examines: (i) whether such cases can be predicted by examining the ductal morphology before and 24 h after the start of lipo‐PGE1 infusion; and (ii) whether PGE1‐CD dilates the ductus arteriosus in patients with refractoriness to lipo‐PGE1.

Methods
: The ductal morphology was evaluated with two echo indices, such as minimal and minimal plus maximal intraluminal diameters of the ductus. Two‐dimensional echocardiography was performed in 24 patients with ductus‐dependent congenital heart disease. The two echo indices were measured before and 24 h after lipo‐PGE1 infusion and also at least twice per week until surgery.

Results
: In 19 of 24 patients, ductal patency was maintained until surgical treatment (group A). The remaining five patients (21%) showed ductal closure during the course of the lipo‐PGE1 therapy (group B). There were no significant differences between the two groups, in either the maximal or minimal diameters, which were examined before and 24 h after treatment. In the five patients of group B, lipo‐PGE1 was replaced with a relatively high dosage of PGE1‐CD (50–100 ng/kg per min), resulting in good ductal patency until surgery.

Conclusions
: Patients with refractoriness to lipo‐PGE1 therapy could not be predicted from initial intraluminal diameters of the ductus using echocardiography. Therefore, serial echocardiographic examinations are important to detect early findings of ductal closure. In addition, PGE1‐CD is still useful as back‐up therapy in such patients.
Pulmonary complications in patients with staphylococcal sepsis
Authors: Çaksen Hüseyİn , Öztürk Mustafa Kürşat , Üzüm Kazim , Yüksel Şaban , Üstünbaş Hasan Basrİ
Published: March 2003

Abstract Background: The aim of the present study was to determine the pulmonary findings in patients with sepsis caused by Staphylococcus aureus.

Methods
: The clinical and laboratory findings of 32 cases (82%) of pulmonary involvement (secondary pneumonia) of 39 patients with sepsis caused by S. aureus were studied retrospectively. The criteria for the diagnosis of sepsis were clinical evidence of infection plus hyperthermia/hypothermia, tachycardia, tachypnea and white blood cell abnormalities. Secondary pneumonia was diagnosed in patients who presented with staphylococcal disease at one or more non‐pulmonary sites and who developed radiologic evidence of pulmonary involvement during the course of illness.

Results
: Of the 32 patients, 23 were male and nine were female; the male to female ratio was 2.5/1. The ages of the patients ranged from 2 months to 14 years (7.87~4.71 years). Bronchopneumonic infiltration was bilateral in 18 patients and unilateral in 14 patients (20 patients (62.5%) had lobar consolidation). Pleurisy was noted in 12 (37.5%) patients; it was on the right side in five patients, on the left in five patients and bilateral in two patients. In contrast, pneumatocele and pneumothorax were observed in seven (21.9%) and four (12.5%) patients, respectively. Closed chest tubes were placed through a closed thoracotomy in five children who developed dyspnea, orthopnea with imminent respiratory failure and mediastinal shift. As well as the pulmonary involvement, arthritis was noted in 13 patients, osteomyelitis in 11 patients, rash in six patients, pericarditis in five patients and renal failure in one patient. Staphylococcus aureus was isolated from blood culture in all except for seven cases. While S. aureus was isolated from blood culture in all of the 12 patients with pleurisy, it was isolated from pleural fluid in only two (16.6%) patients. Six of 32 patients died; the mortality rate was 18.75%.

Conclusions
: It was found that the rate of pulmonary involvement was as high as 82% in sepsis caused by S. aureus, and the pulmonary findings, including bronchopneumonic infiltration and lobar consolidation, were frequently seen in S. aureus pneumonia, causing a mortality rate of 18.75%.
Thrombocytopenia: An important indicator for the application of partial exchange transfusion in polycythemic newborn infants?
Authors: Acunas Betül , Çeltik Coskun , Vatansever Ülfet , Karasalihoglu Serap
Published: March 2003

Abstract Background: The conventional therapeutic approach in polycythemic newborn infants is to apply partial exchange transfusion (PET) when hematocrit value exceeds 70% or when the infant develops symptoms with the exception of plethora.

Methods
: In order to investigate the possibility of using platelet count as a simple criterion implying the PET requirement, we retrospectively reviewed polycythemic newborn infants with respect to the relationship between thrombocytopenia and severity of symptoms, and the association of platelet count and the PET performance. Thrombocytopenia has been defined as a platelet count <150 000/μL.

Results
: We studied 18 polycythemic infants with thrombocytopenia (group 1, 35%) and 34 without it (group 2, 65%). Perinatal asphyxia, gestational toxemia and intrauterine growth retardation, which are the three common causative factors leading to polycythemia, were not significantly different in the two groups. No correlation existed between platelet counts and hematocrit values within each group, but there was a very significant difference between the two groups in terms of severity of clinical findings (P<0001); no difference in terms of moderate findings and moderately significant difference with respect to mild symptoms and asymptomatic situation (P<0.05). Partial exchange transfusion was performed in all patients in group 1, while only 12 infants in group 2 (32%) received transfusion and the difference was statistically significant (P<0.05). A significant rise in platelet counts has been achieved only in group 1, while hematocrit values decreased significantly in both groups following PET.

Conclusions
: This study emphasizes the relationship between thrombocytopenia and the severity of clinical findings and PET performance rate in polycythaemic newborn infants, implying that thrombocytopenia is a possible marker of hyperviscosity, the results of which warrant further investigation.
Rotavirus infection among infants with diarrhea in Pakistan
Authors: Nishio Osamu , Matsui Kiyohiko , Oka Tomohiro , Ushijima Hiroshi , Mubina Agboatwalla , Dure‐Samin Akran , Isomura Sin
Published: March 2003

Abstract Rotavirus was examined in 818 diarrheal stool samples collected in Karachi, Pakistan, from 1990 to 1997. Rotavirus was detected in 112 samples (13.7%). The predominant serotypes were G1 and G4 and G3 was not detected. The predominant type changed between years. Rotavirus was found in all seasons and most infections were found in children aged less than 2 years.
Six novel mutations of the fibrillin‐1 gene in Korean patients with Marfan syndrome
Authors: Oh Myung Ryurl , Kim Jung Sim , Beck Nam Seon , Yoo Han Wook , Lee Heung Jae , Kohsaka Takao , Jin Dong Kyu
Published: March 2003

Abstract Background: Mutations in the FBN1 gene, encoding fibrillin‐1, result in Marfan syndrome (MFS). According to previous reports, the mutations in FBN1 share certain characteristics in each family with variable penetrance and overlapping symptoms, even in the same genotype. In the present study, we report six novel mutations and evaluate the clinical significance of these nucleotide changes.

Methods
: To screen for nucleotide changes in all 65 exons of the FBN1 gene in 38 unrelated Korean patients, we performed polymerase chain reaction, single‐strand conformational polymorphism (SSCP) and sequencing for the shift of the band in SSCP.

Results
: We identified six mutations: a 2253 del 7 b.p., N1043S, C1254S, L1421F, C1895R and S2662P.

Conclusions
: These results suggest that many different mutations are responsible for MFS in the Korean population.
Laparoscopic surgery in neonates and infants weighing less than 5 kg
Authors: Iwanaka Tadashi , Arai Mari , Ito Mitsuhiro , Kawashima Hiroshi , Imaizumi Satohiko
Published: March 2003

Background
: Laparoscopic surgery in small infants is still an uncommon procedure in Japan. The present study was conducted to evaluate the advantages and disadvantages of laparoscopic surgery in neonates and infants weighing less than 5 kg.

Methods
: Between July 1997 and November 1999, 54 infants underwent laparoscopic surgery. They were evaluated for length of operation, intra‐ and postoperative complications, changes in intra‐operative body temperature, time to postoperative feeding, length of hospital stay and changes in serum levels of C‐reactive protein (CRP), creatinine phosphokinase (CPK) and interleukin (IL)‐6 on days 0, 1 and 4. These parameters in the laparoscopic pyloromyotomy (LP) and laparoscopic fundoplication groups were compared with those in the open pyloromyotomy (OP) and open fundoplication groups, respectively, which were performed during the same period.

Results
: Three laparoscopy cases were converted to open procedures. One case of fundoplication had panperitonitis due to failed gastrostomy and required long‐term parenteral nutrition. Time to postoperative feeding and length of hospital stay in the LP group were significantly shorter than in the OP group. In LP group, intra‐operative body temperature did not markedly decrease during CO2 pneumoperitoneum. Although serum levels of CRP, CPK and IL‐6 were elevated in all groups on postoperative day 1, there were no significant differences between the groups.

Conclusions
: Better quality of life after laparoscopy is a significant advantage over conventional surgical procedures. This advantage not only outweighs the incidence of intra‐ and postoperative complications in small infants, but further emphasizes the need to improve laparoscopic techniques to avoid complications.
Plasma levels of granulocyte elastase–α1‐proteinase inhibitor complex in children with hemolytic uremic syndrome caused by verotoxin‐producing Escherichia coli
Authors: Ishikawa Naoko , Kamitsuji Hidekazu , Murakami Tomohiko , Nakayama Akifumi , Umeki Yayoi
Published: March 2003

Abstract

Background
: Activated neutrophils play an important role in the pathogenesis of renal injury in humans and in experimental models of hemolytic uremic syndrome (HUS). To evaluate the clinical significance of the circulating granulocyte elastase–α1‐proteinase inhibitor complex (GEPIC), which is a marker of neutrophil activation, we investigated the plasma concentrations of GEPIC in children with hemolytic uremic syndrome (HUS) associated with verotoxin‐producing Escherichia coli (VTEC), VTEC gastroenteritis without HUS and in normal controls.

Methods
: Of 22 children (1–19 years of age; mean age 5.5 years) with VTEC infection, nine were diagnosed with HUS. Plasma GEPIC, soluble thrombomodulin (sTM) and thrombin–antithrombin‐III complex (TAT) levels were measured by ELISA.

Results
: The number of polymorphonuclear leukocytes and the levels of plasma GEPIC in patients with HUS were significantly higher than those in non‐HUS (9850~5091 vs 5278~3327 /μL, P<0.05; 432.1~211.7 vs 188.3~117.0 ng/mL, P<0.01) or control subjects (9850~5091 vs 4728~1977 /μL, P<0.05; 432.1~211.7 vs 105.9~51.1 ng/mL, P<0.001). Furthermore, plasma GEPIC levels showed a positive correlation with sTM (r=0.522; P<0.01), a marker of endothelial cell injury, and TAT (r=0.594; P<0.01), a marker of thrombin activity.

Conclusions
: These results suggest that an increase in circulating GEPIC levels in patients with VTEC‐associated HUS may be related to endothelial injury, which may possibly lead to a more severe episode of this disease.
Coping and social support of parents with a diabetic child
Authors: Seppänen Salla , Kyngäs Helvi , Nikkonen Merja
Published: March 2003

The purpose of this study is to describe and understand the parental coping and the social support received by the parents of diabetic children. The parental coping process was followed for a 4‐week period after the diagnosis of diabetes. The parents of two girls, whose diabetes was diagnosed in early childhood, served as study subjects. Data were collected by interviewing and observing the parents over four separate periods. The data were analyzed by the time series and content analysis methods. Six phases of parental coping were identified: disbelief, lack of information and guilt, learning to care, normalization, uncertainty and reorganization. In the different phases of parental coping, the parents’ experience of stress, coping strategies and sense of control varied. In the phase of disbelief, the parents tried to reject the child’s diabetes by questioning the diagnosis. The initial information given to the parents regarding their child’s diabetes proved to be important for parental coping. In the phase of lack of information and guilt, the parents sought reasons for their child’s diabetes and felt guilty about it. As coping responses, the parents sought support from each other and from people who had experienced the same. In the learning to care phase, they recognized the demands caused by diabetes and took responsibility for the child’s care. The parents appreciated supervision based on their problems. In the normalization phase, the parents prepared to return home with the diabetic child. Getting back to normal life was one of the most effective parental coping responses. In the uncertainty phase, the care to be given to the diabetic child changed the daily routines of the family. In the reorganization phase, the parents adapted to the diagnosis of diabetes and to the care of their diabetic child. The parents felt that the life of the family normalized and was able to be controlled.
Types and sources of social support for people afflicted with cancer
Authors: Berterö Carina M
Published: March 2003

Abstract The social support network of adults afflicted with cancer related to sexual organs and the breasts was assessed in this study. Two hundred and eighteen respondents completed the Norbeck Social Support Questionnaire. The social support network of adults with cancer was found to include the following: spouses/partner, family, friends, other non‐professionals and professionals. The average number of people in each network was about eight. Overall, the respondents reported a high amount of perceived total functional support concerning affect, affirmation and aid. The difference between being male or female and being married or not was statistically significant. There was no difference in the perception of support between married and unmarried respondents. The majority of the respondents were married. Women scored higher in emotional support than did men, and this difference was statistically significant. Having children and grandchildren also showed significant differences according to social support. The duration of the relationship with network members ranged from less than 6 months to more than 5 years.
Databases: Accuracy and readiness for use
Authors: Buffum Martha D.
Published: March 2003

Abstract Decisions for improving health care rely on data often contained in databases. A database is a compilation of information, often a group of variables, that is stored electronically in a computerized system. It can be specific to one organization, a group of several facilities, or a nationwide effort. Databases comprise elements specific to the endeavour. Types of databases include clinical, administrative, research, or combinations of these. The purpose of electronic storage of specific data and the uses for the results of database analyses need consideration regarding accuracy, validity, and reliability. All databases are accurate to the extent that each element and each point of data collection and entry are valid and reliable. The purposes of this paper are to explore methods for determining accuracy of the data in a database, reliability and validity of database elements, and to determine when a database is ready for use.
Gender differences in the factors related to physical activity among adults with diabetes
Authors: Navuluri Ramesh B.
Published: March 2003

Abstract A descriptive correlational study was conducted to determine the gender differences in the relationship between health‐related hardiness, patient attitude toward compliance, and self‐care adherence to physical activity among 155 adults with diabetes. The two subcomponents of health‐related hardiness, control and commitment/challenge, were included as separate variables. The correlations between commitment/challenge and self‐care adherence to physical activity, and between total health‐related hardiness and self‐care adherence to physical activity, were significant among men (n = 52). The correlation between patient attitude toward compliance and self‐care adherence to physical activity was significant among women (n = 103). Clinically, when compliance with self‐care adherence to physical activity is the goal, a male patient may need hardiness instructions, while a female patient may need interventions to promote attitude toward compliance. Future research may include studying the relationships between other self‐care practices such as diet management, medication compliance, and glucose monitoring and the variables of health‐related hardiness and patient attitude toward compliance, which may help health‐care professionals in appropriate care planning aimed at promoting self‐management of diabetes.
Temperature effect of a disinfectant in operative field during surgery under local anesthesia
Authors: Kuwamura Yumi , Morimoto Tadaoki , Tamura Ayako , Itihara Takako , Minagawa Takako , Katai Kanako , Haku Mari , Takeuchi Mieko , Tada Toshiko
Published: March 2003

Abstract There are few reports on the efforts made by nursing staff to improve the operating environment so as to alleviate the anxiety of patients during surgery under local anesthesia. We examined the effect of applying a warm disinfectant over the operative field in reducing the anxiety and stress of patients. In experiment 1, we conducted a preliminary study in healthy subjects to investigate the psychosomatic effects of different temperatures of fluid applied to the skin. Experiment 2 was conducted in patients who were undergoing surgery under local anesthesia, and we studied the differences in the psychosomatic influences caused by disinfectants at different temperatures. A preliminary study revealed significant differences in the surface temperature of the skin immediately after application of ‘cold water’, ‘regular water’ and ‘warm water’. There were significant differences in feeling after application of the various temperatures. In experiment 2, the scale points for anxiety in the State–Trait Anxiety Inventory condition increased significantly before and after disinfecting with a cold disinfectant (15°C). Moreover, a significant difference was observed in the feeling of coldness compared with ‘warm’ (40°C) disinfectant. In conclusion, the temperature of a disinfectant to be used on an operative field for a patient under local anesthesia should be ‘warm’. This is useful for reducing the anxiety and stress of the patient.
Participatory Learning Model: A Partnership of Enhancing Care of The Aging Population
Authors: Jamjan La‐iad , Boonvas Kwanta
Published: March 2003

28–29 March 2000 Yamaguchi University School of Medicine, Ube, Japan (Local Organizers: Junko Yoneda and Susumu Tomonaga, Yamaguchi University)
Using a model to evaluate nursing education and professional practise
Authors: Kapborg Inez , Fischbein Siv
Published: March 2003

Abstract The concept of evaluation is becoming increasingly ambiguous and a lot of processes may be called evaluation without any clear definitions. A theoretical frame of reference may function as a compass in an evaluation context when collecting, analysing and interpreting data as well as drawing conclusions. The purpose of the present study was to present and discuss the applicability of an educational interaction model for the evaluation of nursing education programs and the professional competence of nurses. The model combines different dimensions in the educational process, using both a student and an educational perspective. It is not uncommon for evaluations to concentrate on one dimension only, which tends to give an insufficient picture of the process of interaction. Examples are provided from nurse students/nurses education and professional practise to show that the relationship between students’ abilities and educational factors, in the form of intentional goals and educational frameworks, have an influence on educational outcome.
Prevention of ventilatory disturbance while in the face‐down position after macular hole surgery
Authors: Matsuda Masako , Yoneda Junko , Nakamura Miwa , Yamashita Yuko , Hirano Yumiko , Kawamura Rie , Nishida Teruo
Published: March 2003

Abstract The aim of the present study was to assess the effects of the face‐down position on ventilatory function after macular hole surgery. The transcutaneous carbon dioxide tensions (tcPCO2) were measured in five patients who had undergone intraocular tamponade and in 17 normal subjects. The tcPCO2 measurements were done in patients following vitrectomy in the sitting position and in the prone position with their faces down over the semi‐closed spaces of the conventional mats. In normal subjects, minute ventilatory volumes (V.E) were measured simultaneously with tcPCO2 in the sitting position and prone position. The newly introduced face‐down mats (new mats) for the prone position were also tested in the normal subjects. In normal subjects, VE in the prone position with the conventional mats was significantly lower than that found in the sitting position (5.06 ± 1.55 vs 6.06 ± 1.64 L/min; P < 0.002). The tcPCO2 in the prone position was significantly higher than that in the sitting position (41.7 ± 2.1 vs 38.0 ± 1.9 mmHg; P < 0.0001). In post‐vitrectomy patients, tcPCO2 in the prone position with the conventional mats was significantly higher than that in the sitting position (41.4 ± 1.7 vs 38.6 ± 2.2 mmHg; P < 0.02). The tcPCO2 in the prone position in normal subjects was significantly lower using new mats than that when using conventional mats. The use of conventional mats during a prone position, increased the tcPCO2 values when compared to the tcPCO2 values obtained during the sitting position in patients following vitrectomy. This could be due to either a decrease of the VE caused by limited thoracic movement or rebreathing of the exhaled gas over the semi‐closed space, or both. The new mats might be useful in alleviating the increase of tcPCO2 by eliminating the rebreathing of the exhaled gas.
External beam radiation monotherapy for prostate cancer
Authors: Akakura Koichiro , Furuya Yuzo , Suzuki Hiroyoshi , Komiya Akira , Ichikawa Tomohiko , Igarashi Tatsuo , Tanaka Masashi , Murakami Shino , Ito Haruo
Published: March 2003

Background
: To clarify the implications and limitations of external beam radiation monotherapy for localized prostate cancer, the long‐term outcomes and prognostic factors were investigated.

Methods
: Between 1976 and 1994, 91 patients with untreated prostate cancer were treated with external beam radiation therapy alone. Thirty‐two were classified as T1b, eight were T2a, four were T2b and 47 were T3. Pelvic lymphadenectomy was carried out in 69 cases; 57 were staged as pN0, eight were pN1, four were pN2 and 22 were pNX. Linac X‐rays were used in 55 cases, fast neutron in 15 and a combination of the two in 21. No other therapy was given until relapse and when relapse was evident endocrine therapy was started.

Results
: The observation period ranged from 3 to 206 months with a median of 78 months. Local control rate and disease‐free, cause‐specific and overall survivals at 10 years were 74.0, 49.6, 74.2 and 39.2%, respectively. By univariate analysis, T category, pN category and histologic grade were significant prognostic indicators for disease‐free survival. Multivariate analysis revealed that T category was an independent prognostic factor. In T2b and T3 diseases, pN0/1 patients demonstrated significantly better disease‐free survival than pNX.

Conclusions
: A favorable long‐term outcome was achieved by external beam radiation monotherapy in patients with minimally extended prostate cancer (T1b and T2a). For locally advanced disease (T2b and T3), staging pelvic lymphadenectomy would be useful for the selection of patients.
Endocrine cell distribution and expression of tissue‐associated antigens in human female paraurethral duct: Possible clue to the origin of urethral diverticular cancer
Authors: Ogihara Sigemasa , Kato Haruaki
Published: March 2003

Background
: To investigate (i) what determines the histologic differences seen among female urethral diverticular cancers and (ii) the possible embryologic origin of the female paraurethral duct, we performed a distribution analysis of endocrine cells and a comparative study of tissue‐associated antigens in the female paraurethral duct.

Methods
: Six human female urethras were obtained from surgical and autopsy cases including two cases of urethral diverticular cancer (columnar/mucinous type adenocarcinoma). The urethral and paraurethral epithelia were examined histologically and immunohistochemically.

Results
: Immunoreactive endocrine cells predominated and carcinoembryonic antigen (CEA) was strongly expressed in the larger portion of the paraurethral duct close to the urethral lumen. Conversely, prostate‐specific antigen and prostatic acid phosphatase were positive only in the smaller distal duct. In two cases of adenocarcinoma including endocine cells, cancer cells were strongly positive for CEA.

Conclusions
: This study suggests that the proximal and distal parts of the paraurethral duct have different histologic characteristics and that the pathologic differences seen among female diverticular cancers may result from their cancer‐genesis from different parts of the paraurethral duct.
Preclinical Cushing’s syndrome: Report of seven cases and a review of the literature
Authors: Morioka Masaaki , Fujii Tomohiro , Matsuki Takakazu , Jo Yoshimasa , Kobayashi Tatsuya , Tanaka Hiroyoshi , Ohashi Teruhisa , Kondo Katsuyoshi
Published: March 2003

Background
: Adrenal adenomas showing autonomous cortisol secretion without specific endocrine symptoms are sometimes discovered in patients with adrenal incidentalomas. This entity has been described as subclinical or preclinical Cushing’s syndrome (PCS), but the endocrine data of reported cases have varied and the diagnostic criteria of PCS have been uncertain.

Methods
: We report seven Japanese cases of PCS due to a unilateral, solitary adrenal adenoma with examination of the endocrine data of these patients. The diagnostic parameters of subtle hypercortisolism and the risk of postoperative adrenal insufficiency and surgical indications are discussed and reviewed.

Results
: In the present cases, the most frequently found biochemical parameters of autonomous cortisol secretion were a low adrenocorticotropic hormone (ACTH) level (100%) and insufficient suppression of cortisol by low‐dose dexamethasone (85.7%). Unilateral accumulation of radiopharmaceuticals in tumors was also frequently observed (100%). A postoperative hydrocortisone supplement was given to six of the seven patients for 5–122 days. It was not given to case 4, because a moderate response of 11‐deoxycortisol to metyrapone was identified. Plasma ACTH levels and the diurnal rhythm of plasma cortisol rapidly recovered within 3 weeks postoperatively in six of the seven cases.

Conclusion
: This entity is heterogeneous and various degrees of cortisol excess have been observed. It should be diagnosed in the wide spectrum and the risk of adrenal insufficiency after surgery should be evaluated by dynamic tests such as the corticotropin‐releasing hormone (CRH) test. Based on the results of the present study and a review of the literature, PCS patients may not require hydrocortisone supplement therapy for a long period.
Prognostic value of tumor‐associated macrophage count in human bladder cancer
Authors: Hanada Toshikatsu , Nakagawa Masayuki , Emoto Akio , Nomura Takeo , Nasu Nobuyoshi , Nomura Yoshio
Published: March 2003

Background
: We determined the tumor‐associated macrophage (TAM) count to investigate its importance in predicting clinical outcome or prognosis in patients with bladder cancer.

Methods
: The TAM count and microvessel count (MVC) were determined immunohistochemically in 63 patients with bladder cancer, including 40 superficial bladder cancers and 23 invasive bladder cancers. To examine the relationship between TAM count and clinical outcome or prognosis in bladder cancer, cystectomy rates, distant metastasis rates, vascular invasion rates and 5 year survival rates were compared between patients with low (< 67) and high (≥ 67) TAM counts.

Results
: The TAM count in invasive bladder cancers (154.22 ± 11.98) was significantly higher than in superficial bladder cancers (49.05 ± 7.76; P < 0.0001). The MVC in invasive bladder cancers (71.55 ± 10.44) was also significantly higher than in superficial bladder cancers (47.02 ± 5.57; P < 0.05). There was a positive correlation between TAM count and MVC (r = 0.30; P = 0.02). Immunohistochemical staining using CD68/horseradish peroxidase monoclonal antibody showed more infiltrating cells in invasive than superficial bladder cancers. Patients with a high TAM count (≥ 67) showed significantly higher rates of cystectomy, distant metastasis and vascular invasion than those with a lower TAM count (< 67). The 5 year survival rate estimated using the Kaplan– Meier method was significantly lower in patients with a high TAM count than in those with a low TAM count (P < 0.0001).

Conclusions
: Our results suggest that determination of TAM count in bladder cancer tissues is of value to predict the clinical outcome or prognosis and to select appropriate treatment strategies in patients with bladder cancer.
Cowper's syringocele causing voiding disturbance in an adult
Authors: Awakura Yasuo , Nonomura Mitsuo , Fukuyama Takuo
Published: March 2003

Abstract
Background
: A 21‐year‐old man presented with a sudden onset of miction pain and post‐void dribbling. The diagnosis was Cowper's syringocele due to the findings of retrograde urethrography and urethroscopy.

Methods/Results
: The patient underwent transurethral unroofing of the syringocele. The present case is of interest because Cowper's syringocele is usually diagnosed in male infants and children and is rarely found in adults.

Conclusion
: This lesion should be included in the differential diagnosis of voiding disturbances in adults.
Characterization of a newly established cell line derived from human adrenocortical carcinoma
Authors: Ueno Munehisa , Nakashima Jun , Akita Masumi , Ban Shin‐Ichi , Nakanoma Takashi , Iida Masahiro , Deguchi Nobuhiro
Published: March 2003

Abstract Background: ACT‐1, a new cell line of human adrenocortical carcinoma, has been established and successfully maintained in culture. This study examined the biological characteristics of the cells.

Methods: The tumor cells were isolated from a surgical specimen of the tumor thrombus and cultured in monolayer.

Results: Histologically, the primary tumor was composed of a solid proliferation of large polygonal cells. A part of the atrophic adrenal cortex remained at the periphery of the tumor. The cultured ACT‐1 cells were spindle‐shaped in morphology and grew exponentially with an approximate population doubling time of 24 h. A chromosomal analysis revealed a modal number of 61 with consistent structural abnormalities of add(3)(q11), add(9)(p11), and add(16)(q11). The expression of 3β‐hydroxysteroid dehydrogenase was observed in the ACT‐1 cells as well as in normal human adrenal glands.

Conclusions: The ACT‐1 cell line provides a reproducible model system which gives good insight into the oncogenesis of adrenocortical carcinoma.
Granular cell tumor of the urinary bladder
Authors: Yoshida Toru , Hirai Shinji , Horii Yasuki , Yamauchi Tamio
Published: March 2003

Abstract A case of granular cell tumor of the urinary bladder is reported. A 48‐year‐old Japanese man with a bladder tumor underwent transurethral resection of the tumor and microscopic examination showed a granular cell tumor. Immunohistochemical staining for neuron specific enolase and S100 protein was positive, and it was suggested that the granular cell tumor was derived from Schwann cells.
Laparoscopic ureteroureterostomy for retrocaval ureter
Authors: Ameda Kaname , Kakizaki Hidehiro , Harabayashi Toru , Watarai Yoshihiko , Nonomura Katsuya , Koyanagi Tomohiko
Published: March 2003

Abstract Two cases of retrocaval ureter are reported that were successfully treated by a laparoscopic approach. Case 1 was a 20‐year‐old woman who presented with symptoms of a right ureter stone. Case 2 was a 23‐year‐old woman who had suffered from recurrent right flank pain with gross hematuria. A transperitoneal approach was used for case 1, and a retroperitoneal approach was used in case 2. Both were successfully treated with laparoscopic ureteroureterostomy using an intracorporeal suture technique. Laparoscopic surgery should be the first choice for retrocaval ureter not only because of the minimal invasiveness but also because of the cosmetic advantage compared to conventional open surgery. Further technical and instrumental advances are essential for intracorporeal suturing.
Inhibition of calcium oxalate precipitation by bile salts
Authors: Saso Luciano , Grippa Eleonora , Gatto Maria Teresa , Silvestrini Bruno
Published: March 2003

Abstract Background: Both urinary and biliary stones can contain calcium. Bile salts (BA), which are known to bind Ca2+, are commonly used to dissolve the latter but not the former.

Methods: The effect of physiologic BA on calcium oxalate (CaOx) precipitation was evaluated by a recently developed method.

Results: The Ca2+ binding properties of BA were confirmed by small but significant decreases in pH observed following addition of CaCl2 to bile acids solutions. More importantly, BA inhibited CaOx precipitation with effective concentrations of approximately 10−3 mol/L. The clinical relevance of the latter observation is presently unknown but it is of note that in the same in vitro assay, the activity of BA appeared comparable to that of citric acid, the most common drug for urolithiasis. Although BA do not reach mmol/L levels in urine, they are known to change the physicochemical properties of this fluid, possibly slowing down the crystal growth process. However, the hypothetical therapeutic use of BA in former stone patients would present at least two major problems: (i) hepatotoxicity and (ii) lithogenic activity, due to hyperoxaluria subsequent to increased intestinal absorption of oxalate.

Conclusion

The ability of BA in effectively binding calcium ions and in inhibiting the precipitation of CaOx appears of interest from both a physiopathologic and a pharmacologic point of view, even if it does not currently seem exploitable for prophylactic or therapeutic purposes.
Extraperitoneal bladder rupture secondary to rectal impalement
Authors: Tanuma Yasushi , Horita Hiroki , Kadono Masao
Published: March 2003

Impalement injury to both the urinary bladder and the rectum is a rare occurrence. A 45‐year‐old man was referred to our hospital because he had been stabbed through the internal femoral skin by a steel bar. Retrograde cystography and computed tomography failed to demonstrate bladder rupture. We carried out cystoscopy (CS) because of the existence of gross hematuria and found a penetrating wound in the posterior wall. Colon fiberscopy revealed two wounds in the rectum, one of which communicated with the bladder. A diagnostic laparoscopy revealed no associated injuries in the peritoneal cavity. Vesicorectal injury was diagnosed and treatment included transanal closure of fistulas and indwelling ureteral and urethral catheters. Postoperative CS revealed complete closure of the injury.
Need for sling surgery in patients with large cystoceles and masked stress urinary incontinence
Authors: Yamada Takumi , Ichiyanagi Nobutaka , Kamata Shigeyoshi , Sakai Yasuyuki , Nagahama Katsushi , Tanizawa Akiko , Watanabe Toru , Horiuchi Susumu , Saitoh Hiroshi
Published: March 2003

Background:

We studied the need for sling surgery in patients who suffered from large cystoceles and masked stress urinary incontinence.

Methods:

Twenty patients who had large cystoceles but neither evidence nor history of stress incontinence were enrolled in this study. The cystocele was reduced using a reducing device. Masked urinary incontinence was identified by a 60 m pad weighing test and a stress test. The cystocele was reduced using a pessary ring in 14 patients, or a vaginal pack formed of two rolls of ordinary 28 × 28 cm gauze in six patients. Ten of 20 patients were diagnosed with masked stress urinary incontinence and were treated with anterior colporrhaphy and a suburethral sling procedure. The other 10 patients were continent after use of a cystocele reducing device and were treated with anterior colporrhaphy alone. Average follow‐up periods of the patients with or without masked stress urinary incontinence were 51.2 months (range, 24.0–72.0 months) or 57.6 months (range, 27.0–70.0 months), respectively.

Results:

One of the 10 patients diagnosed with masked stress incontinence had mild stress urinary incontinence postoperatively. None of the 10 continent patients had stress incontinence after anterior colporrhaphy alone.

Conclusions:

Reducing devices of protruding cystocele were clinically useful in the detection of masked stress incontinence. Sling surgery was effective to prevent emerging stress urinary incontinence for patients who suffered from cystocele and masked stress incontinence.
Lymphangioma of the kidney
Authors: HONMA ICHIYA , TAKAGI YOSHIO , SHIGYO MASANORI , SUNAOSHI KENICHI , WAKABAYASHI JUNICHI , HARADA OI , MIYAO NORIOMI
Published: March 2003

Lymphangiomas are rare benign tumors that are congenital malformations of the lymphatic system. Most cases present in children as a soft, cystic mass in the neck and the axilla. Primary renal lymphangioma is exceedingly rare, with only 35 cases reported so far. We report a case of primary lymphangioma arising from the kidney. A 59‐year‐old man was referred for evaluation of a right renal mass found in an abdominal ultrasonography during a health checkup. Abdominal ultrasonography and computed tomography (CT) revealed a 3.2 × 2.9 cm multiloculated cystic mass in the upper pole of the right kidney. We could not deny malignant disease such as cystic renal cell carcinoma with any diagnostic modalities. The patient was brought to surgery. During the surgical procedure, the tumor was suspected to be lymphangioma of the kidney as a result of a frozen‐ section histopathological evaluation. Therefore enucleation of the tumor was performed. Pathological evaluation of the specimen revealed lymphangioma arising from the kidney. The patient is free of disease after a 3‐month follow‐up period.
Adrenal metastasis from renal cell carcinoma: Significance of adrenalectomy
Authors: ITO AKIHIRO , SATOH MAKOTO , OHYAMA CHIKARA , SAITO SEIICHI , SHINTAKU ICHIRO , NAKANO OSAMU , AOKI HIROSHI , HOSHI SENJI , ORIKASA SEIICHI
Published: March 2003

Background
: The present study examined adrenal metastasis resulting from renal cell carcinoma (RCC), with the aim of assessing the need for routine ipsilateral adrenalectomy during radical nephrectomy.

Methods
:

Ipsilateral and contralateral adrenal metastases were investigated in 256 patients with RCC who had undergone radical nephrectomy from 1977 to 1996 at the Tohoku University School of Medicine.

Results
:

Twelve of the 256 patients (4.7%) had adrenal metastasis. Ten of these 12 patients had progressed to disseminated disease with very poor prognosis. Two patients who had solitary adrenal metastases remained disease‐free for 21 and 7 years. Four patients showed metastases to the contralateral adrenal gland. Adrenal metastases in seven of 12 patients were identified by pre‐ or postoperative computed tomography (CT), and in another five macroscopically during surgery.

Conclusions
:

Adrenalectomy was regarded as a possible curative treatment for patients with solitary adrenal metastasis. However, the incidence of this kind of metastasis was minimal and contralateral adrenal metastases may occur in RCC cases. We therefore believe that adrenalectomy should only be performed if radiographic evidence reveals metastases in the adrenal gland or if gross disease is present at the time of nephrectomy.
Failure to maintain the suppressed level of serum testosterone during luteinizing hormone‐releasing hormone agonist therapy in a patient with prostate cancer
Authors: Kinouchi Toshiaki , Maeda Osamu , Ono Yutaka , Meguro Norio , Kuroda Masao , Usami Michiyuki
Published: March 2003

A 75‐year‐old man with metastatic prostate cancer had been treated with goserelin acetate, and prostate specific antigen (PSA) had decreased, but 11/2 years after beginning the treatment of goserelin acetate, PSA was markedly elevated and serum testosterone was at normal level. After castration the serum testosterone was at castrate level and PSA decreased. In the present case, leuprorelin acetate 1‐month depot suppressed the luteinizing hormone level in 1 month, even after the patient underwent castration.
Survey of incidence of urological cancer in South Korea: A 15‐year summary
Authors: Cheon Jun , Kim Choung‐Soo , Lee Eun Sik , Hong Sung Joon , Cho Yong‐Hyun , Shin Eui Chul , Lee Won Chul , Yoon Moon Soo
Published: March 2003

Background: Although the pattern of cancer incidence in South Korea is not the same as that of western countries, urological cancer will become one of the major cancers in South Korea in the near future. The pattern of cancer in South Korea is becoming steadily similar to that in western countries. It is, therefore, important to understand the epidemiological features of cancer. Surveillance of cancer incidence and mortality trends provides clues to etiology and helps to assess the effects of improved diagnostic, screening and intervention measures.

Methods: The subjects of the study were 13 208 patients living in South Korea, newly diagnosed with urological cancer during the period of 1985–1999. The data were analyzed by age, sex, geography and period of diagnosis (1985–1989; 1990–1994; 1995–1999).

Results: Bladder cancer was the most common urological cancer in South Korea (6867 cases, 52.0%). The incidence of prostate cancer and renal cell carcinoma was similar. Male patients outnumbered female patients by a ratio of 5.4 : 1. In both sexes, the peak incidence of urological cancer in South Korea was noted in the 70+ age group. The geographic distribution of urological cancer across seven residential areas was similar. The incidence rate of all urological cancer (except urethral and penile cancer) had increased remarkably, especially in the last several years. The crude incidence rate of urological cancer among Koreans in South Korea was estimated to be 46.55 per 100 000 males, 8.64per 100 000 females and 27.67 per 100 000 across both sexes.

Conclusion: Although this survey is not definitive, these data should be useful in showing general patterns or changes of incidence of urological cancer in South Korea. The elevated incidence of urological cancer noted in our survey also indicates the need for continued promotion of urological cancer screening programs. Moreover, these results may be useful in indicating directions for future research of urological cancer.
Randomized trial of trigger point injection for renal colic
Authors: IGUCHI MASANORI , KATOH YOSHINARI , KOIKE HIROYUKI , HAYASHI TAIJI , NAKAMURA MASATO
Published: March 2003

Abstract Background: Many drugs have been utilized for the treatment of renal colic, but to date no drugs that relieve pain quickly and completely have been developed. Thus, we conducted a prospective trial to evaluate the effects of trigger point injection on renal colic. In this study, we used a local injection of lidocaine to the trigger point of patients experiencing renal colic, and evaluated the efficacy in patients using the visual analog scale.

Methods: Sixty patients with renal colic were enrolled in this study and divided into two groups by a simple randomization: (i) the butylscopolamine group (n = 30, intravenous injection of butylscopolamine bromide and sulpyrine); and (ii) the lidocaine group (n = 30, local anesthesia to the trigger point with lidocaine).

Results: Renal colic had disappeared completely at the end of the trigger point injection in 15/30 patients and the average time required to produce a 50% improvement in symptoms was 9 min in all patients in the group. In the lidocaine group, only one patient needed an additional anodyne treatment after 60 min and none of the 29 patients whose pain disappeared within 60 min needed further anodyne treatment within 24 h. These results were all significantly superior to those of the conventional treatment. No side‐effects and complications were observed.

Conclusion: Trigger point injection, in our experience, is an easy, safe and effective method for the amelioration of renal colic. It was significantly superior to the combination of intravenous butylscopolamine and sulpyrine.