bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of resistant anal fissure with advancement anoplasty
Authors: Kenefick N. J. , Gee A. S. , Durdey P.
Published: March 2003

Objective  The primary aim of this study was to assess the outcome of advancement anoplasty in the treatment of chronic anal fissure, resistant to conventional therapy. The secondary aim was to evaluate the anal resting pressure in these patients with resistant fissures.

Patients and methods  Over a five‐year period eight patients (2 male, median age 55 years, range 20–74) with resistant anal fissure were referred from 6 centres. They had endured symptoms for a median of 8 years (range 2–20) and had undergone a median of 2 previous surgical procedures (range 1–3), including lateral sphincterotomy and anal dilatation. Anorectal physiological testing was performed on all patients who then underwent advancement anoplasty. The outcome was analysed retrospectively.

Results  Pre‐operative anorectal physiological testing showed a significantly lowered median maximal anal resting pressure of 42 mm H2O (range 12–72 mm H2O, normal range > 60 mm), P = 0.03. All patients underwent advancement anoplasty. At a median of seven months follow‐up (range 2–22) seven of eight patients had healed their fissure and were asymptomatic. The median healing time was four months (range 2–6).

Conclusion  Patients with chronic anal fissure, resistant to conventional therapy, may be successfully treated by advancement anoplasty. Healing time however, may be prolonged. In this series patients had a decreased anal resting pressure rather than anal hypertonia.
Telomerase expression of malignant epithelial cells correlates with Dukes' stage in colorectal cancer
Authors: Ghori A. , Usselmann B. , Ferryman S. , Morris A. , Fraser I.
Published: March 2003

Background  The ribonucleoprotein telomerase has been proposed as a potential prognostic marker for malignancy. Whether telomerase activity of clinical specimens correlates with other clinico‐pathological variables, however, remains controversial. This is at least in part due to the varying contribution that nonmalignant cells will make to the net activity when extracts are assayed for telomerase activity. We therefore designed experiments to assay telomerase activity of isolated malignant cells of primary colorectal cancers.

Methods  Thirty colorectal cancer and 20 corresponding specimen taken from macroscopically normal regions of the colon were mechanically disaggregated and digested with collagenase, DNase and hyaluronidase. The epithelial cell population was separated using Ber‐EP4 pan‐epithelial antibody and Magnetic Activated Cell Sorting technique. Haematoxylin and eosin staining was used to assess the proportion of recovered epithelial cells which were malignant. Telomerase activity was assayed by the Telomeric Repeat Amplification Protocol, which was quantified by PhosphorImager with Image Quant software.

Results  Epithelial cells of three of 20 normal mucosa specimens were telomerase positive with weak activity (mean 3.7 TPGs, Total Product Generated, range 1.4–5.1TPGs). In the cancer group the vast majority (>95%) of the epithelial cells recovered were malignant by cytological criteria. Epithelial cells were telomerase positive in all the cancers, with a wide range of telomerase activity values (mean 22.7 TPGs, range 0.19–308 TPGs). Telomerase activity correlated with Dukes' stage (r = 0.52, P = 0.004, Spearman's rank).

Conclusions  Pathological stage correlates with telomerase activity of the malignant cell population of the primary tumour in colorectal cancer. This suggests that telomerase activity increases during the progression of a cancer and may have implications for the design of anticancer (antitelomerase) agents.
Scintigraphic assessment of colostomy irrigation
Authors: Christensen P. , Olsen N. , Krogh K. , Laurberg S.
Published: March 2003

Objective This study aims to evaluate colonic transport following colostomy irrigation with a new scintigraphic technique.

Materials and methods To label the bowel contents 19 patients (11 uncomplicated colostomy irrigation, 8 complicated colostomy irrigation) took 111In‐labelled polystyrene pellets one and two days before investigation. 99mTc‐DTPA was mixed with the irrigation fluid to assess its extent within the bowel. Scintigraphy was performed before and after a standardized washout procedure. The colon was divided into three segments 1: the caecum andascending colon; 2: the transverse colon; 3: the descending and sigmoid colon. Assuming ordered evacuation of the colon, the contribution of each colonic segment to the total evacuation was expressed as a percentage of the original segmental counts. These were added to reach a total defaecation score (range: 0–300).

Results In uncomplicated colostomy irrigation, the median defaecation score was 235 (range: 145–289) corresponding to complete evacuation of the descending and transverse colon and 35% evacuation of the caecum/ascending colon. In complicated colostomy irrigation it was possible to distinguish specific emptying patterns. The retained irrigation fluid reached the caecum in all but one patient.

Conclusion Scintigraphy can be used to evaluate colonic emptying following colostomy irrigation.
Long‐term oral administration of dehydroepiandrosterone has different effects on energy intake of young lean and obese male Zucker rats when compared to controls of similar metabolic body size
Authors: Richards R. J. , Porter J. R. , Svec F.
Published: March 2003

Aim: The effects of dehydroepiandrosterone (DHEA) on appetite and weight in the Zucker rat have been examined by many investigators who have reported appetite suppression and metabolic effects. However, these studies compared the treated animals to controls of a similar age. Since animals of different sizes consume different amounts of food, perhaps the treated animals should be compared to controls of a similar size. We studied the effects of DHEA on energy intake and weight gain and analysed the effects by age and metabolic body size.

Methods: Lean (n = 21) and obese (n = 16) male Zucker rats were fed plain chow or chow containing 6 g DHEA/kg chow (0.6% wt/wt) from age 4 wk to 20 wk. Daily energy intakes and body weights were determined at least once weekly.

Results: As expected, the lean and obese rats given DHEA exhibited less daily energy intake (kJ/d) and less weight gain than their respective controls of the same age. The lean rats given DHEA did not exhibit any difference in daily energy intake when determined relative to body weight (b.w.) (kJ × d–1× g b.w.–1) compared to lean controls of the same metabolic body size, while the obese rats given DHEA exhibited less daily energy intake relative to b.w. (kJ × d–1× g b.w.–1) compared to obese control of the same metabolic body size.

Conclusions: Though DHEA reduced total energy intake among the lean and obese Zucker rats, only the obese rats exhibited less energy intake relative to b.w. compared to controls of the same metabolic body size. Thus, DHEA may exert different effects on energy intake relative to b.w. in lean and obese Zucker rats and perhaps the lean Zucker rat is a better model for evaluating the metabolic effects of DHEA since it does not exhibit any effect on energy intake relative to b.w. compared to rats of the same metabolic body size.
Plasma endothelin in postmenopausal women with type 2 diabetes mellitus and metabolic syndrome: a comparison of oral combined and transdermal oestrogen‐only replacement therapy
Authors: Saltevo J. , Puolakka J. , Ylikorkala O.
Published: March 2003

SUMMARY

Aim  Type 2 diabetes and metabolic syndrome are major cardiovascular risk factors in postmenopausal women, but the role of vasoconstrictive endothelin‐1 (ET‐1) in these conditions is not known. We studied the levels of ET‐1 and the effect of postmenopausal hormonal therapy on ET‐1 levels in postmenopausal women.

Methods  We compared plasma levels of ET‐1 in 22 postmenopausal type 2 diabetic women and 14 postmenopausal women with metabolic syndrome with plasma levels in 10 healthy postmenopausal control women. The basal values for ET‐1 were measured for all groups. These women were then randomised to receive in a double‐dummy, crossover trial: either oral continuous oestradiol (2.0 mg) + norethisterone acetate (1.0 mg) per day or continuous transdermal oestrogen‐only (50 μg/day) for 3 months. Between the active therapy there were 3‐month wash‐out periods. ET‐1‐values were measured again at the end of each treatment period.

Results  The type 2 diabetic women had significantly (p < 0.003) elevated ET‐1 levels (4.8 ± 1.0 pg/ml) whereas those with metabolic syndrome (4.4 ± 1.7 pg/ml) had non‐significantly (NS) elevated ET‐1 levels compared to controls (3.6 ± 0.3 pg/ml). Both oral and transdermal hormone replacement therapy (HRT) failed to affect plasma ET‐1 except in 14 hypertensive women from the diabetes and metabolic syndrome groups who were on angiotensin convertase enzyme (ACE) inhibitors. These women's ET‐1 levels before oral HRT (4.6 ± 1.1 pg/ml) fell to 4.1 ± 0.9 pg/ml (p < 0.05).

Conclusions  Type 2 diabetes in postmenopausal women is associated with elevated ET‐1 levels. Oestrogen replacement therapy does not affect the levels of ET‐1 in postmenopausal women with type 2 diabetes or metabolic syndrome.
Lack of postprandial leptin peaks in patients with type 2 diabetes mellitus
Authors: Poretsky L. , Lesser M. , Brillon D.
Published: March 2003

Leptin production by the adipocyte is acutely stimulated by insulin in vitro. In normal individuals, postprandial insulin peaks are not accompanied by corresponding changes in circulating leptin. Postprandial regulation of leptin in individuals with type 2 diabetes, to our knowledge, has not been previously examined in detail. We examined the effect of meals on circulating leptin levels in six patients with type 2 diabetes who were not treated with insulin and in seven normal individuals. After informed consent was obtained, all subjects were admitted to the General Clinical Research Center for 6 days. They consumed four meals daily (breakfast, lunch, dinner and snack). Eighteen blood samples were drawn between 7 .40 a.m. and midnight for the determination of serum leptin, insulin and glucose levels. Postprandial peaks were clearly identifiable for glucose and insulin levels both in normal subjects and in those with type 2 diabetes. However, no postprandial peaks of leptin levels were present. Correlation analysis demonstrated a lack of correlation between leptin levels and the levels of glucose or insulin. We conclude that, in spite of the presence of postprandial insulin peaks, there are no acute changes in circulating leptin levels postprandially in patients with type 2 diabetes who are not on insulin therapy. In this regard, in‐vivo regulation of leptin by meals in patients with type 2 diabetes is similar to that in normal individuals.
Effects of rosiglitazone and oleic acid on UCP‐3 expression in L6 myotubes
Authors: Costello A. , Gray S. , Donnelly R.
Published: March 2003

Aims: The regulation of uncoupling protein‐3 (UCP‐3) expression in muscle remains unclear, specifically in relation to dietary and drug treatments. The present study evaluated the effects of oleic acid and rosiglitazone on UCP‐3 mRNA expression in differentiated L6 myotubes.

Methods: L6 myocytes were cultured and differentiated prior to exposure to rosiglitazone 10 µmol/l, oleic acid 100 µmol/l, or the combination, for 24 h, prior to semiquantitative evaluation of UCP‐3 mRNA relative to GAPDH mRNA by RT‐PCR.

Results: Exposure to oleic acid produced a significant increase in UCP‐3 mRNA (0.012 ± 0.007 vs. 0.0011 ± 0.0006 for untreated cells, relative to GAPDH mRNA, p < 0.001). Rosiglitazone alone had no effect on UCP‐3 expression and nor did the glitazone affect oleic‐acid‐induced upregulation of UCP‐3.

Conclusions: In L6 myotubes, 24‐h exposure to oleic acid produced a 10‐fold increase in UCP‐3 mRNA expression, but rosiglitazone had no effect. Oleic‐acid‐induced upregulation of UCP‐3 was not affected (positively or negatively) by glitazone exposure.
Ultrastructure of gill cilia and ciliary rootlets of Chaetoderma nitidulum Lovén 1844 (Mollusca, Chaetodermomorpha)
Authors: Lundin Kennet , Schander Christoffer
Published: March 2003

Cilia and associated structures on the gill lamellae on the ctenidum of Chaetoderma nitidulum were studied. The gill cilia are very long and have a whip‐like narrow portion distally, where only three microtubule doublets continue to the distal tip. In the transition zone between the cilium and the centriolar triplet section of the basal body there is a dense plate, an aggregation of granules and a ciliary necklace with four strands. Further down there is a short cross‐striated basal foot and two conical cross‐striated ciliary rootlets. The first rootlet is flattened and directed forward. It connects distally with the basal feet of other adjacent cilia. The second rootlet is rounded in cross‐section and vertically directed. The epithelial structures of Chaetoderma show similarities with other Mollusca. We found no structural characters that could support the current hypothesis of a close relationship of Xenoturbella to the Mollusca.
The ventral skin glands, new additional cloacal glands in Proteus anguinus (Caudata, Proteidae). I. Female
Authors: Guillaume Olivier
Published: March 2003

Guillaume, O. 2000. The ventral skin glands, new additional cloacal glands in Proteus anguinus (Caudata, Proteidae). I. Female. —Acta Zoologica (Stockholm) 81: 213–221

Cloacae of female Proteus anguinus were examined by light and electron microscopy. Females possess spermathecae and anterior ventral glands such as Necturus females. However, female P. anguinus possess new additional cloacal glands of unknown homology. These tubular glands secrete on the ventral epidermis of the cloacal area. Considering these characteristics, it is proposed that they will be called the ventral skin glands.
Morpho‐functional characterization of haemocytes of the compound ascidian Botrylloides leachi (Tunicata, Ascidiacea)
Authors: Cima Francesca , Perin Andrea , Burighel Paolo , Ballarin Loriano
Published: March 2003

A morpho‐functional study of the colonial ascidian Botrylloides leachi haemocytes was carried out to propose their classification, relationships and specializations. This characterization was obtained by (i) investigations of both living and aldehyde‐fixed cells by light and electron microscopy; (ii) cytochemical and cytoenzymatic assays; (iii) lectin‐affinity assays; (iv) phagocytosis and haemagglutination assays; and (v) anti‐CD34 immunocytochemical assay for vertebrate haematopoietic stem cells. Results indicate that the haemoblast is a circulating stem cell and there are at least five haemocyte differentiation pathways, the last two of which have never been described in botryllids: (i) phagocytic line (hyaline amoebocytes and macrophage‐like cells) share ultrastructural features, the same hydrolytic enzymes and WGA lectin binding, and are involved in yeast phagocytosis and erythrocyte rosette formation; (ii) cytotoxic line (granular amoebocytes and morula cells) with vacuoles containing oxidative enzymes and polyphenolic substrates; (iii) vacuolated cell line (pigment cells and nephrocytes) involved in catabolite storage; (iv) compartment cell line (compartment amoebocytes and compartment cells) able to agglutinate erythrocytes and characterized by vacuoles with a moderately electron‐dense content, positive to arylsulphatase activity and binding DBA, UEA‐I, HPA lectins; and (v) granular cell line includes trophic cells, able to infiltrate the gut epithelium, showing a cytoplasm filled of PAS‐positive vacuoles with arylsulphatase, chloroacetylesterase and β‐glucuronidase activities.
Testicular structure and semicystic spermatogenesis in a specialized ovuliparous species: Scorpaena notata (Pisces, Scorpaenidae)
Authors: Muñoz Marta , Casadevall Margarida , Bonet Sergi
Published: March 2003

Study of the histology and ultrastructure of the testes of Scorpaena notata reveals some unusual features in the most basic form of oviparity, termed ovuliparity. Distribution of spermatogonia and subsequent stages of development are consistent with an intermediate type of testes, somewhere between the restricted and unrestricted types. Spermatogenesis is semicystic, a feature rarely found in fish, which may account for the high vacuole count found both in the various spermatogenic phases and in the Sertoli cells. Sertoli cells cover the interior of the testicular lobes and have an initial phase of secretion. They go on to penetrate the lobular lumen and become phagosomes. The spermatozoon has a relatively long midpiece and is surrounded by large quantities of seminal fluid. The sperm makes its way from the central sperm duct to a series of peripheral ducts, where the sperm line up with their heads toward the epithelium and their tails toward the lumen. All indications are that this orientation facilitates the release of sperm onto the gelatinous mass of eggs, and that this could be linked to this type of semicystic spermatogenesis. Results obtained confirm that S. notata is a specialized ovuliparous species.
Chloride cell responses to long‐term exposure to distilled and hard water in the gill of the armored catfish, Hypostomus tietensis (Loricariidae)
Authors: Fernandes Marisa N. , Perna‐Martins Sonia A.
Published: March 2003

The morphological changes in the gill chloride cells of the armored catfish, Hypostomus tietensis, were investigated after 15 days’ exposure to either distilled or hard water. The thickness of the water–blood barrier in the lamellae increased significantly in fish kept in distilled water due to the high proliferation of chloride cells. The apical surface of about 68% of chloride cells was sharply reduced by the development of an apical crypt with a sponge‐like surface, although no change in the chloride cell fractional area was found. In contrast, H. tietensis kept in Na+, Cl− and Ca2+ rich water displayed no significant changes in the number of chloride cells or in their apical surface morphology compared with the control fish. Chloride cell response to ion challenge in H. tietensis suggested the involvement of different strategies to maintain homeostasis in ion‐poor water, which may be related to the life history of species.
Influence of the bridging effect by sequential laser application on tissue ablation in an ex vivo model, taking organ perfusion into account
Authors: Köhrmann K.U. , Vöhringer P. , Henkel T. , Michel M.S. , Alken P.
Published: March 2003

Objective To improve the efficacy of interstitial laser coagulation of tissue by causing a ‘bridging’ effect, using a sequential multiple‐probe procedure on an ex vivo kidney model, as only a limited area of tissue is destroyed with a single probe and the coagulation takes longer when multiple punctures are used.

Materials and methods A laser beam was generated using a Nd:YAG laser and applied to kidney tissue by a diffuser tip (quartz glass cap 2 × 19 mm). For sequential laser application (SLA), three probes were placed through punctures into kidney tissue, at 5 or 10 mm apart. The laser energy was applied in different time‐energy combinations through the three probes. The effect of SLA was compared with that from one probe delivering the optimal PowerMode 180 protocol (Dornier, Germering, Germany), which represents the standard energy protocol for the clinical treatment of parenchymal organs using this laser device. An isolated porcine kidney was chosen for laser coagulation under different conditions of perfusion. The ablative efficacy was defined as the volume of necrosis per minute.

Results Applying various time‐energy combinations to isolated unperfused porcine kidney caused extensive tissue ablation (5.6 mL). In trials with saline and blood perfusion for improved cooling, the necrotic volume was 2.5 and 3.9 mL, respectively (with no carbonization, 3.2 mL). Compared with a single‐probe procedure, the ablation efficacy was 10 times better with SLA coagulation. This improvement was initiated by the bridging effect: coagulation in neighbouring areas affects perfusion and convection to an extent that induces the formation of bridges of necrosis between the probes.

Conclusion Tissue ablation is markedly improved by interstitial laser coagulation using a sequential multiple‐probe technique.
Cisplatin‐induced in vivo differentiation of human embryonal carcinoma
Authors: Mizutani Y. , Sato N. , Kawauchi A. , Nonomura N. , Fukushima M. , Miki T.
Published: March 2003

Objective To investigate the differentiation of embryonal carcinoma (EC) by cisplatin, and the underlying mechanism, as untreated metastases of nonseminomatous germ cell tumours rarely consist of fully differentiated mature somatic tissues, but such mature metastases are more common after various treatments, including chemotherapy.

Materials and methods The TTSC‐3 human testicular EC line heterotransplanted into nude mice was used as a target. After treating tumour‐bearing mice with intraperitoneal injections of varying doses of cisplatin, the histopathology of the tumours was assessed and various gene expressions in the tumours determined by cDNA‐array technology.

Results When cisplatin at 1 mg/kg/week was injected intraperitoneally into TTSC‐3‐bearing mice, there was no effect on tumour growth. However, injecting cisplatin at 5 mg/kg/week induced a marked regression of the tumour. In contrast, cisplatin at 3 mg/kg/week had a modest inhibitory effect on tumour growth and induced tumour dormancy. Histological examination showed that 5 weeks after injecting cisplatin (3 mg/kg/week), primitive mesenchymal‐like cells increased, and 10 weeks afterward cartilage and well‐developed glands (teratoma) were apparent; at > 15 weeks afterward there were no EC cells visible. cDNA probes from reverse‐transcribed mRNAs of TTSC‐3 treated with cisplatin or saline for 10 weeks were compared to identify genes differentially expressed in cisplatin‐treated TTSC‐3. Of 1176 different human cDNA transcripts in cisplatin‐treated TTSC‐3, three genes (tumour necrosis factor receptor 1, caspase 8 and Apaf1), which are associated with apoptosis, were expressed markedly more than after saline injection.

Conclusions The intermediate dose of cisplatin inhibited tumour growth of EC by inducing differentiation and enhancing apoptosis‐related gene expression. These findings suggest that cisplatin may play a significant role in the differentiation of EC in vivo.
Effects of electropermeabilization after the administration of anticancer drugs on transitional cell carcinoma
Authors: Yanai H. , Kubota Y. , Nakada T.
Published: March 2003

Objective To assess in vitro and in vivo the potential utility of electropermeabilization (EP) as an anticancer drug delivery system for the treatment of transitional cell carcinoma (TCC).

Materials and methods To analyse the effects of EP on the internalization of adriamycin and bleomycin by cells, aliquots of a suspension of YTS‐1 carcinoma cells (derived from a human TCC line) were mixed with a solution of adriamycin or bleomycin and then exposed immediately to an electric field (1000 V/cm, 1 Hz, 100‐µs square wave, eight pulses). After a 2‐h incubation the concentration of each drug in the cells was measured by high‐performance liquid chromatography (for adriamycin) and by bioassay (for bleomycin). The concentrations of drugs in the cells were compared with untreated cells. To analyse the effects of EP on cytotoxicity, the same treatments were applied to a suspension of cells plus adriamycin or bleomycin and then the cells incubated for 6 h with tritiated thymidine ([3H]‐TdR), monitoring the incorporation of [3H]‐TdR into the cells. Cells with no electrotreatment acted as controls. To assess the effects on tumours in vivo, YTS‐1 cells were transplanted subcutaneously into nude mice; when the tumours had reached 7 mm in diameter, EP was applied (using electrical pulses as before, 10 min after the direct injection of bleomycin into the tumour). Tumours were then measured regularly and compared with sham‐treated tumours, tumours treated with electric pulses alone, and tumours treated with bleomycin alone. Survival was also compared.

Results There were no significant differences in the levels of adriamycin between cells with and with no EP, whereas there was a marked difference for bleomycin. Growth inhibition by adriamycin with and with no EP was similar, while the growth‐inhibitory effects of bleomycin were almost doubled. There was a reduction in tumour size only in the group treated with bleomycin plus electric pulses and two of five tumours disappeared completely. Survival in this group was also significantly better than in the other groups.

Conclusion EP after administering bleomycin might be an effective treatment for TCC.
Management of urethrocutaneous fistula after hypospadias repair: 10 years' experience
Authors: Elbakry A.
Published: March 2003

Objectives To report the outcome of managing urethrocutaneous fistula after hypospadias repair over 10 years.

Patients and methods Forty‐seven patients (mean age 7.6 years, range 2–18) underwent repair of 57 urethrocutaneous fistulae after hypospadias surgery. The fistula was single in 37 patients and multiple in 10; 42 fistulae were small (< 4 mm) and 15 large (> 4 mm). Twenty‐one fistulae were at the corona, 15 at the anterior shaft, 16 at the mid‐shaft and five were penoscrotal. The interval between primary hypospadias repair and the first attempt at fistula repair was 6–12 months. Small fistulae were repaired using a multilayer simple closure technique, and large fistulae repaired using rotational and advancement skin flaps. Suprapubic urinary diversion was used in all patients with large fistulae or small multiple fistulae (25 patients); an overnight urethral catheter was used in the remaining patients.

Results Simple closure was successful in 30 of 42 small fistulae (71%); eight were successfully closed by secondary closure, while four needed a third closure. Rotational and advancement skin flaps were successful in 13 of 15 large fistulae; one required secondary flap repair and one was closed simply. Most recurrences (78%) were of coronal fistulae; there was recurrence in four of 25 (16%) patients in whom suprapubic diversion was used, in contrast to 10 of 22 (45%) with no suprapubic diversion.

Conclusions Although simple closure of a fistula is easy and not time‐consuming it is followed by a significantly higher rate of recurrence than when skin flaps are used. Rotational and advancement flaps are the optimal methods for repairing fistulae after hypospadias, particularly for large and coronal fistulae. Thus, the appropriate indication for simple closure is small fistulae at the penile shaft. Suprapubic diversion is important in those with large or multiple fistulae.
Does cystoscopy correlate with the histology of recurrent papillary tumours of the bladder?
Authors: Herr H.W.
Published: March 2003

Objective To correlate the cystoscopic appearance of recurrent papillary bladder tumours with the histology after transurethral resection, and thus ascertain whether cystoscopy can reliably identify low‐grade, noninvasive papillary tumours suitable for outpatient fulguration.

Patients and methods In all, 150 recurrent papillary tumours of the bladder identified at outpatient flexible cystoscopy were classified as either low‐grade and noninvasive (TaG1), high‐grade and noninvasive (TaG3), or invasive (T1G3) tumours, and correlated with urine cytology and histology of tumour stage and tumour grade after transurethral resection.

Results Cystoscopy classified 84 of the 150 papillary tumours as TaG1 and 66 as either TaG3 or T1G3. Cystoscopy correctly predicted the histology of 78 of 84 (93%) TaG1 tumours, 71 of 72 (98%) TaG1 tumours associated with a negative urine cytology, and 92% of TaG3 or T1G3 tumours.

Conclusions A skilled urologist can identify noninvasive, low‐grade recurrent papillary bladder tumours on follow‐up cystoscopy that do not require biopsy and that may be treated by outpatient fulguration alone.
Increased morbidity after circumcision from a hidden complication
Authors: Atikeler M.K. , Onur R. , Gecit I. , Senol F.A. , Cobanoglu B.
Published: March 2003

Objective To describe a late complication of circumcision and to elucidate the role of surgical materials or any foreign body in the development of a subcutaneous mass in circumcised boys.

Patients and methods From May 1998 to March 2001, 646 boys were circumcised and 523 (mean age 6.5 years, range 0–13) re‐examined for the possible development of a subcutaneous mass. Twenty‐six (5%) of the re‐examined patients had such a mass under the penile skin; it was removed in all patients under local anaesthesia and examined histopathologically.

Results The mean (sd, range) delay after circumcision before developing or detecting the mass was 3.2 (0.7, 1–7) months. All patients were asymptomatic but there was purulent discharge in four. On removing the mass, histopathology showed the development of granulation tissue with foreign‐body giant cells.

Conclusion There may be minor complications after circumcision which cannot be avoided even when the procedure is undertaken by surgeons. Awareness of such complications occurring long after circumcision may aid in the early detection of this asymptomatic mass and prevent a more severe outcome.
Experience with demucosalized ileum for bladder augmentation
Authors: Lima S.V.C. , Araújo L.A.P. , Vilar F.O. , Mota D. , Maciel A.
Published: March 2003

Objective To assess the use of demucosalized ileum for bladder augmentation, following the same principles previously used with the sigmoid colon.

Patients and methods Eleven patients with bladder exstrophy or a neurogenic bladder had their bladders augmented with demucosalized ileum instead of the sigmoid colon, but following the same technique. The use of a Foley catheter with an inflated balloon greatly facilitated the dissection of the mucosa from the muscle. A silicone model, inserted in the bladder, was used to avoid shrinkage of the patch. An animal model was also used for total bladder replacement following the same principle.

Results The mean (range) follow‐up was 15.4 (2–25) months. There was a significant increase in bladder compliance in all patients. A bladder of good shape and compliance was obtained in the animal model, with epithelial growth detected in all cases.

Conclusions Demucosalized ileum can be used safely for bladder augmentation in the same way as with the sigmoid colon. The distension of the isolated patch greatly facilitates dissection between the mucosa and muscle. The animal model supported this method of bladder replacement.
Ductal carcinomas of the prostate: a clinicopathological and immunohistochemical study
Authors: Oxley  , Abbott  , Gillatt  , Maciver
Published: March 2003

Objectives

 To confirm the expression of prostate specific antigen (PSA) and prostatic acid phosphatase (PAP) in ductal carcinomas of the prostate, and to analyse p53, Ki67, oestrogen (ER) and androgen (AR) receptors in these tumours.

Materials and methods

 Paraffin‐embedded samples from 12 patients with ductal carcinoma of the prostate were assessed for pattern, mitotic count and the presence of a microacinar carcinoma component. There were six pure ductal and six mixed microacinar and ductal carcinomas. Sections were stained immunohistochemically for the expression of PSA, PAP, Ki67, p53, AR and ER. Clinical data were obtained from case notes.

Results

 Six of the ductal tumours had a papillary pattern whilst the others had a cribriform appearance. The mitotic rates in the ductal areas were high in the tumours from eight of the 12 patients. PSA and PAP immunohistochemistry were positive in all the cases. No ER immunoreactivity was found in any of the patients. Ten of the ductal tumours showed strong reactivity with AR, the other two were weakly positive; two of the tumours were strongly positive for p53 protein. All the ductal carcinomas expressed Ki67, three having >25% nuclear marking. One patient who was strongly positive for p53 and had a high Ki67 score survived only one year after diagnosis. Survival ranged from 1 to 13 years after diagnosis.

Conclusion

 This study confirms the expression of PSA and PAP in ductal carcinomas of the prostate. The percentage of tumours expressing p53 was similar to that published for high‐grade microacinar carcinomas. The results for Ki67 suggest that ductal tumours have higher scores than microacinar tumours, but further studies are required to ascertain if this is significantly different. As half the patients with ductal tumours had co‐existent microacinar tumours, we advise transrectal prostatic biopsies in patients diagnosed with pure ductal carcinomas on transurethral resection specimens, to exclude high‐grade microacinar carcinomas. The presence of AR and the lack of ER in all the ductal carcinomas confirms that these tumours are prostatic in origin and should be treated with anti‐androgen therapy.
Prediction of pathological stage and clinical outcome in prostate cancer: an improved pre‐operative model incorporating biopsy‐determined intraductal carcinoma
Authors: Cohen  , Chan  , Edgar  , Robinson  , Dodd  , Hoscek  , Mundy
Published: March 2003

Objective

 To relate the predictive value of serum prostate specific antigen (PSA) levels, histological grade and intraductal carcinoma (IDC‐P, a possible marker of poor prognosis) to pathological stage and subsequent clinical outcome, and thus derive an improved predictive model to aid the decision to initiate potentially curative therapy in localized prostate cancer.

Materials and methods

 Fifty‐nine radical prostatectomy specimens were histologically graded, allocated a pathological stage and the tumour volume determined by image analysis. Pre‐operative (needle biopsy) tumour grade, the presence or absence of IDC‐P, and serum PSA levels were correlated with the pathological stage. This was used to define the sequence and values that would be incorporated into a predictive model for pathological stage and clinical outcome.

Results

 There were close correlations between cancer volume and tumour grade (P=0.004) and between cancer volume and serum PSA level (P=0.003). However, in tumours with IDC‐P, serum PSA level did not correlate with tumour volume of IDC‐P (P>0.9). IDC‐P was an independent variable that significantly improved the prediction of pathological stage and tumour volume, and furthermore, was closely related to (r=0.53, P=0.001) and accurately predicted treatment failure.

Conclusions

 The model which best predicted pathological stage and clinical outcome involved first identifying those cancers with IDC‐P as having the poorest outcome. Cancers without IDC‐P were then separated into low‐ and high‐risk groups on the basis of serum PSA levels below and above 10 ng/mL, and those in the high‐risk group further stratified using Gleason grading. Furthermore, the use of a sequential consideration of pre‐operative variables including IDC‐P allowed cases to be grouped which, after radical surgery, closely correlated with clinical outcome.
A study of reflux in patients with an ileal orthotopic bladder
Authors: Waidelich  , Rink  , Kriegmair  , Tatsch  , Schmeller
Published: March 2003

Objective

 To determine whether there is vesico‐ureteric reflux during voiding in patients who had undergone an ileal bladder substitution after cystectomy.

Patients and methods

The study comprised 15 patients (13 men and two women) who had undergone radical cystectomy and construction of a Studer ileal neobladder. At 1–24 months (median 4) after the operation indirect radionuclide cystography (IRC) was performed after isotopic renography (using 99 m‐technetium mercapto‐acetyltriglycine) and voiding cysto‐urethrography (VCUG).

Results

None of the patients had reflux during voiding, either on IRC or on VCUG. Renal function and morphology remained stable in all patients. Despite bacteriuria occurring in four patients, no episode of pyelonephritis was reported.

Conclusion

There was no vesico‐ureteric reflux during voiding in patients with a Studer ileal bladder substitution. However, long‐term follow‐up is needed to finally determine whether an antirefluxive ureteric implantation is required to protect the upper urinary tract in patients with ileal low‐pressure bladder substitutions.
Transcutaneous electrical stimulation of thigh muscles in the treatment of detrusor overactivity
Authors: Okada  , Igawa  , Ogawa  , Nishizawa
Published: March 2003

Objective

 To investigate the clinical effects on detrusor overactivity of a new method of transcutaneous reciprocal electrical stimulation of the thigh muscles.

Patients and methods

 Nineteen patients with detrusor overactivity, comprising 14 with detrusor hyper‐reflexia (DH) and five with idiopathic detrusor instability (IDI), were studied. Electrical stimulation was applied alternately to the quadriceps and hamstring muscles of one or both legs through surface electrodes for 20 min. The treatment was given once a day for 14 days and then the patients were evaluated urodynamically.

Results

 All 19 patients tolerated the therapy well and none reported any adverse effects. The mean maximum cystometric capacity increased significantly (P<0.05) after treatment. In 11 of the 19 patients, the maximum cystometric capacity was increased by >50% of the pretreatment value; this occurred in eight of 14 of those with DH and in three of five of those with IDI. In six of the 11 who responded in this way, there was a clinical improvement in their urinary incontinence and frequency for several weeks to 3 months after the period of therapy. A second 14‐day treatment was also effective in all four patients who underwent a repeat trial.

Conclusion

 This method of transcutaneous electrical stimulation can inhibit DH as well as IDI with no adverse effects. The suppressive effect on detrusor overactivity may persist for several months and repeat trials appear to be effective. Thus, we believe that this new stimulation technique should be tried as an alternative to other types of electrical stimulation and augmentation cystoplasty.
Prevalence of lower urinary tract symptoms in Finnish men: a population‐based study
Authors: Koskimäki  , Hakama  , Huhtala  , Tammela
Published: March 2003

Objective

 To determine the prevalence of lower urinary tract symptoms (LUTS) in Finnish men, using a population‐based cross‐sectional survey.

Subjects and methods

 In 1994, a modified Danish prostatic symptom score system (DAN‐PSS‐1) questionnaire on the occurrence and severity of LUTS was mailed to all men (3143) born in 1924, 1934 or 1944 living in the city of Tampere or 11 rural and semi‐rural municipalities in the same county.

Results

 After exclusions, 68% of the men were ultimately included in the study. LUTS were common and increased with age so that the prevalence of at least one symptom was 89% in the whole population (84% among 50‐year‐old, 91% among 60‐year‐old and 94% among 70‐year‐old men). Most of the symptoms were mild, with post‐micturition dribbling and nocturia the most prevalent symptoms, and stress incontinence the least prevalent.

Conclusions

 The high incidence of LUTS may indicate a high prevalence of benign prostatic enlargement secondary to benign prostatic hyperplasia, but other causes are also involved. With the increase in the mean age of the general population, the number of individuals with LUTS is likely to increase and must be considered when resources are planned for medical care.
Urodynamic patterns in infants with normal lower urinary tracts or primary vesico‐ureteric reflux
Authors: Yeung  , Godley  , Dhillon  , Duffy  , Ransley
Published: March 2003

Objective

 To compare bladder function in infants with primary vesico‐ureteric reflux (VUR) and those with normal lower urinary tracts.

Patients and methods

 The study comprised 42 patients (36 males) with VUR (grades III to V) and 21 (16 males) without VUR (mean age in both groups, 6 months). Intravesical catheters were placed suprapubically under general anaesthesia and, after at least 24 h, natural‐filling urodynamics were monitored for three or more filling and voiding cycles.

Results

 Various urodynamics patterns were defined: for infants without VUR these were either normal or normal‐immature (discoordinated micturition) and none showed features indicating abnormal bladder function. By comparison, 24 of 42 infants with VUR showed abnormal urodynamic patterns (57%, 95% confidence interval 41% to 72%, P<0.001). Seven (17%) were defined as unstable with small voided volumes, five (12%) had inadequate voiding dynamics, 10 (24%) showed a markedly dyssynergic pattern and two (5%) had obstructive patterns. The unstable, inadequate and obstructive patterns occurred only in boys. Detrusor activity during the filling phase occurred in 14 infants (13 boys) with VUR and in only one without VUR, when it was trivial. Post‐void residual volumes of >30% capacity were seen only in the VUR group (in 24 patients). There were 18 infants with VUR that showed the normal or immature urodynamics patterns, but for the 14 males the voiding pressures were higher than for those without VUR (mean maximum detrusor pressure, 161 and 117 cmH2O, respectively; P<0.02).

Conclusions

 There is an association between abnormal urodynamic variables and a diagnosis of primary VUR in young infants (notably males) that may have important implications for concepts about the genesis and persistence of VUR.
Microvessel density as a prognostic marker for transitional cell carcinoma of the bladder
Authors: Hawke  , Delahunt  , Davidson
Published: March 2003

Objective

 To investigate the prognostic significance of mean vascular density (MVD) in a variety of transitional cell carcinomas (TCC) obtained by biopsy and cystectomy, and thus determine the importance of vascular density as a prognostic indicator for vesical TCC.

Patients and methods

 Tumour vasculature was visualized using factor VIII immunohistochemistry. The MVDs of tumours from 42 cystectomy specimens were correlated with patient survival over a maximum follow‐up of 156 months. The results were also compared with those obtained from initial bladder biopsy in a subset of 29 patients.

Results

 Twenty‐five patients had died over a mean follow‐up of 32 months. The MVDs from cystectomy specimens ranged from 29 to 229 vessels per medium‐power field (0.94 mm2 ) while that for biopsies before cystectomy ranged from 51 to 155 vessels. The MVD for both cystectomy and biopsy specimens showed a significant association with survival, but this was absent in a multivariate analysis that included tumour stage and grade, and there was a poor correlation between the MVD of cystectomy‐ and biopsy‐derived tumours.

Conclusion

 The assessment of tumour vascularity appears to be of little clinical importance for vesical TCC.
Urological consequences of incomplete cord lesions in patients with myelomeningocele
Authors: Keshtgar  , Rickwood
Published: March 2003

Objectives

 To determine the urological consequences of incomplete cord lesions in patients with myelomeningocele and a neuropathic bladder.

Patients and methods

 From a total of 407 patients with myelomeningocele and a neuropathic bladder, 31 (8%) were identified as having a combination of sacral sensory or motor sparing and positive conus reflexes. Their case‐notes were reviewed with reference to spinal neurology, patterns of micturition, including the degree of spontaneous continence, findings on imaging and urodynamic studies, and forms and outcomes of any treatment given.

Results

 The anatomical distribution of the lesions was thoracic (two), thoracolumbar (three), lumbar (six), lumbosacral (four) and sacral (11). The mean age at presentation was 9.5 years (range 3.5–19.5) and the mean follow‐up 4.5 years (range 0.5–10.5). At presentation, 14 patients had urinary incontinent episodes both day and night, 10 by day only, seven by night only, and the upper urinary tracts were dilated in eight (26%). Nineteen were ambulant unaided and 10 with aid of crutches or calipers, whilst two were wheelchair‐bound. Only one patient had faecal incontinence. A urodynamic examination in 18 patients showed competent sphincteric mechanism and detrusor hyper‐reflexia in all, and detrusor sphincter dyssynergia in 11. The methods of treatment included oxybutynin and/or clean intermittent catheterization alone or in combination. Thirty patients are currently reliably dry by day and 26 also by night. Five patients have undergone surgical treatment for vesico‐ureteric reflux, three a Mitrofanoff procedure and two augmentation cystoplasty.

Conclusion

 Although patients with congenital incomplete cord lesions and positive conus reflexes may gain some measure of urinary continence spontaneously, they are at serious risk of developing upper urinary tract complications. The treatment of urinary continence is simple and effective because there is a competent sphincter mechanism. These patients require life‐long supervision even if they require no treatment for urinary incontinence.
A wall‐incorporated valve for preserving continence:
Authors: Elbakry  , Gohar  , Khalaf
Published: March 2003

Objective

 To describe a new continent valve incorporated as part of the wall of a urinary reservoir constructed from bowel.

Materials and methods

 The technique was evaluated experimentally in 12 dogs; 40 cm of the distal ileum were isolated and the proximal 30 cm detubularized. The adjacent distal 7 cm of the intact ileum (valvular segment) was tailored around an 18 F catheter. The opened ileum plus the valve were doubly folded to form a pouch and the valvular segment incorporated as part of the pouch wall. The pouch was anastomosed to the trigone after subtotal cystectomy; the ureters were not manipulated. The pressure profile of the valve and ascending cystography were assessed 20 weeks after surgery and the inner layer of the valve examined histopathologically after the animals were killed.

Results

 None of the 12 dogs showed leakage through the valve at maximum filling on ascending cystography. The urodynamic assessment verified the reliability of the valve in maintaining continence and there were no problems catheterizing the valve. The histopathological examination showed that the valve was covered by intestinal mucosa.

Conclusions

 The new continent valve is technically easy to construct; the procedure is not time‐consuming, staples are unnecessary and the mesenteric vascular pedicle is not manipulated. A shorter ileal segment is used in constructing this valve than is required for the intussuscepted valve. The wall‐incorporated valve seems to provide a reliable and easily catheterizable continent stoma.