bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiplex Polymerase Chain Reaction for Identification and Differentiation of Streptococcus equi subsp. zooepidemicus and Streptococcus equi subsp. equi
Authors: Alber J. , El‐Sayed A. , Lämmler C. , Hassan A. A. , Weiss R. , Zschöck M.
Published: December 2004

The closely related streptococcal species Streptococcus equi subsp. zooepidemicus and S. equi subsp. equi were identified by polymerase chain reaction using oligonucleotide primers designed according to species‐specific parts of the superoxide dismutase A encoding gene sodA. A further differentiation of both subspecies could be performed by amplification of the genes seeH and seeI encoding the exotoxins SeeH and SeeI, respectively, which could be detected for S. equi subsp. equi but not for S. equi subsp. zooepidemicus. A further simplification of the identification and differentiation of both subspecies was conducted by sodA–seeI multiplex polymerase chain reaction.
Identification of Pasteurella multocida Serogroup F Isolates in Rabbits
Authors: Jaglic Z. , Kucerova Z. , Nedbalcova K. , Hlozek P. , Bartos M.
Published: December 2004

A total of 24 Pasteurella multocida rabbit isolates obtained from 24 rabbit flocks in the Czech Republic during the period of between 2001 and 2004 were analysed by capsular PCR typing. Apart from isolates identified as serogroups A (n = 14, 58.4%) and D (n = 2, 8.3%), eight isolates (33.3%) were identified as members of serogroup F. This serogroup had been predominantly associated with poultry infections so far. The rabbit serogroup F isolates were characterized in detail by ribotyping with restriction to endonuclease MspI revealing two distinct ribotypes. Seven serogroup F isolates were assigned to ribotype 1 and one isolate was assigned to ribotype 2.
Impact of invA‐PCR and Culture Detection Methods on Occurrence and Survival of Salmonella in the Flesh, Internal Organs and Lymphoid Tissues of Experimentally Infected Pigs
Authors: Arnold T. , Scholz H. C. , Marg H. , Rösler U. , Hensel A.
Published: December 2004

This study evaluated the suitability of invA gene amplification by PCR as an effective means of detecting Salmonella species in pigs experimentally infected with S. Typhimurium DT104. A controlled infection study using 24 pigs was performed in order to compare efficacy, precision and detection rates of the invA‐based PCR method originally described by Rahn, K. De Grandis, S.A., Clarke, R.C., McEwan, S.A., Galan, J.E., Ginocchio, C., Curtiss, R. 3rd, C.L. Gyles, (Mol. Cell. Probes 1992; 6: 271–279) as a new in‐house invA‐based PCR method for the specific detection of Salmonella spp. in pork and different tissue samples of slaughter pigs. Finally, PCR results were compared with culture detection rates obtained by isolation procedures following the ISO 6579:2000, the ‘gold standard’. After slaughtering, 14 different tissue samples of each pig were investigated to verify the usefulness of the two invA‐based PCR methods in different matrices of slaughter pigs. The results demonstrate that the application of the widely used invA‐based primer pair (139 + 141) may result in questionable products if samples gained from selective enrichment in the Rappaport–Vassiliadis medium were investigated. These questionable products can lead to false‐positive results, if no additional hybridization procedure is attached or if unspecialized persons use this method in routine laboratory practice. The newly developed in‐house PCR method used is based on the 3′‐prime region of invA, especially designed and harmonized for the detection of Salmonella in different matrices of slaughtered pigs after bacterial enriched broth culture. In this study, this PCR revealed no questionable products and, furthermore, the specificity of the amplificate could be tested by means of the restriction enzyme NdeI. In comparison with the culture detection procedure, the new PCR method has a sensitivity of 100% and a specificity of 96%. Thus, this method might be used as a meaningful tool in eliminating Salmonella‐positive carcasses at slaughterhouse level and thus, keeping them out of the food chain.
Hepatitis B vaccine boosters: Is there a clinical need in high endemicity populations?
Authors: JOHN T JACOB , COOKSLEY GRAHAM
Published: December 2004

The Steering Committee for the Prevention and Control of Infectious Diseases in Asia recently conducted a survey of primary‐care physicians in Asia, which revealed that many physicians administer boosters in their clinical practice and that there is considerable variation and uncertainty among physicians regarding this practice. This paper serves as a response to physicians’ uncertainties by reviewing the literature regarding the administration of hepatitis B vaccine boosters in high endemicity areas and presenting the Steering Committee's guidelines for booster administration. While there are few data to support a need for routine hepatitis B vaccine boosters as a public health measure, they help to provide reassurance of immunity against breakthrough infection in certain risk groups. In clinical practice, primary‐care physicians must exercise their judgment regarding the need for booster vaccination on an individual basis. This paper examines the available literature on the administration and value of hepatitis B vaccine boosters, explores the differences between the public health approach and clinical practice, and provides guidelines for those who use boosters in high endemicity Asian populations. Relevant articles were identified through searches of MEDLINE (1975–2003) and the Cochrane Library, using ‘hepatitis B’ and ‘booster’ as primary search terms. Guidelines for those who decide to administer hepatitis B vaccine boosters include: boosting approximately 10–15 years after primary vaccination; boosting rather than not when monitoring of antibody levels is not feasible; boosting immunocompromised patients when the antibody to hepatitis B surface antigen titer falls below 10 mIU/mL; and boosting healthcare workers based on the endemicity of the particular country.
Impact of gemcitabine on the treatment of metastatic pancreatic cancer
Authors: ISHII HIROSHI , FURUSE JUNJI , NAGASE MICHITAKA , YOSHINO MASAHIRO
Published: December 2004

Background and Aim:  A previous randomized trial showed gemcitabine was superior to 5‐fluorouracil in overall patient survival. However, the incremental improvement in survival was minimal. It is 2.5 years since gemcitabine has become available for the treatment of pancreatic cancer in clinical practice in Japan. The current study was conducted to examine whether treatment outcomes have changed since the introduction of gemcitabine therapy.

Methods:  Ninety‐one consecutive patients with metastatic pancreatic cancer treated with systemic chemotherapy at the National Cancer Center Hospital East were surveyed. Patients admitted before April 2001 received 5‐fluorouracil, and those admitted subsequently received gemcitabine. The patients were divided into the gemcitabine group (n = 50) and the non‐gemcitabine group (n = 41), and these groups were compared for five outcomes, objective response rate, non‐progressive disease rate, carbohydrate antigen (CA)19‐9 response rate, actual survival time, and difference between estimated and observed survivals. The estimated survival time was determined using the prognostic index reported in the previous study.

Results:  Except for the objective response rate, the four other outcomes in the gemcitabine group were significantly superior to those in the non‐gemcitabine group. The frequency of non‐progressive disease, CA19‐9 response, and favorable prognosis compared with the estimated survival, were 58%, 22%, and 60%, respectively, in the gemcitabine group, and 22%, 6%, 30%, respectively, in the non‐gemcitabine group. The median survival time in the gemcitabine and non‐gemcitabine group was 5.73 and 2.87 months, respectively.

Conclusion:  It is suggested that there was a definite improvement in pancreatic cancer treatment after gemcitabine was introduced.
Australian men's experiences of living with hepatitis C virus: Results from a cross‐sectional survey
Authors: GIFFORD SANDRA M , O'BRIEN MARY L , SMITH ANTHONY , TEMPLE‐SMITH MEREDITH , STOOVÉ MARK , MITCHELL DREW , JOLLEY DAMIEN
Published: December 2004

Background and Aim:  Of the estimated 160 000 Australians currently infected with hepatitis C virus (HCV), two‐thirds are men. Little is known about their social and health needs. The present study presents results from a comprehensive survey of Australian men living with HCV.

Methods:  In 2002, a self‐administered questionnaire was completed by a largely non‐clinical sample of men living in the State of Victoria who had tested positive for HCV antibodies (n = 308). The return rate was 54%. The mean age was 38 years (standard deviation [SD] = 9.8; range 19–90 years), and 86% were ‘current’ or ‘past’ injecting drug users. The mean number of years since diagnosis was 6.6 years (SD = 5.0) and the mean self‐reported number of years since infection was 12.6 years (SD = 9.2).

Results:  Fifty percent of men reported experiencing HCV‐related symptoms, most commonly tiredness (61%) and nausea (30%). Of the sample, 43% currently saw a doctor for HCV and although 30% had ever been referred to a specialist, few had received treatment (6% interferon; 14% combination therapy). Forty percent of men reported that they believed they received less favorable treatment from health care professionals than those without HCV. Self‐assessed health status was significantly lower than Australian norms, as were SF‐12 physical and mental health scores. Scores were moderately correlated, indicating an association between the physical and mental health burden of HCV.

Conclusion:  The social, physical and mental health needs of men living with HCV are considerable. Few men in the present study had accessed specialist treatment; those who were current injecting drug users were particularly disadvantaged. Reduction of barriers to primary and specialist health care is essential to improve treatment, support and care for men with HCV.
Prevalence of gastroesophageal reflux disease and gastroesophageal reflux disease symptoms in Japan
Authors: FUJIWARA YASUHIRO , HIGUCHI KAZUHIDE , WATANABE YOKO , SHIBA MASATSUGU , WATANABE TOSHIO , TOMINAGA KAZUNARI , OSHITANI NOBUHIDE , MATSUMOTO TAKAYUKI , NISHIKAWA HIDEKI , ARAKAWA TETSUO
Published: December 2004

Background and Aim:  Epidemiological studies have shown that 10–48% of people in developed countries have gastroesophageal reflux disease (GERD) symptoms such as heartburn and acid regurgitation. The present study aimed to examine the prevalence of GERD symptoms and GERD in Japanese subjects.

Methods:  A cross‐sectional study of Japanese subjects who visited a clinic for a routine health check up was carried out. Subjects were asked to fill out a self‐report questionnaire. GERD was defined as the presence of heartburn and/or acid regurgitation at least twice per week.

Results:  Of the 6035 eligible subjects, 2662 (44.1%) reported having had heartburn and/or acid regurgitation during the past year: 124 (2.1%) daily, 275 (4.6%) twice per week, 773 (12.8%) twice per month and 1490 (24.7%) less than twice per month. Three hundred and ninety‐nine (6.6%) subjects were diagnosed as having GERD and there was no relationship between the prevalence of GERD and either sex or age. The prevalence of bothersome GERD symptoms was significantly higher in subjects with GERD than in those without GERD.

Conclusion:  Approximately 6.6% of Japanese have GERD and most persons with GERD described heartburn or acid regurgitation as bothersome.
Risk of colorectal adenomas in a multiethnic Asian patient population: Race does not matter
Authors: RAJENDRA SHANMUGARAJAH , HO JACQUELINE J , AROKIASAMY JOHN
Published: December 2004

Background:  Ethnic differences have been reported for colorectal polyps and large bowel cancer; although the supporting data is weak and insufficient to draw firm conclusions.

Aim:  We undertook this study to determine whether such racial disparity in colorectal adenomas exists in an ethnically mixed non‐migrant population. The prevalence, histology and distribution of colonic polyps were documented as well as other known risk factors for colorectal malignancy.

Methods:  In this prospective cross‐sectional study, 311 consecutive referred and self‐referred multiracial patients attending for colonoscopy over a 41‐month period in a private endoscopy center were recruited. The mean age of the study population was 51.8 ± 14 years (range 16–91). The male to female ratio was 1.1 and an ethnic breakdown as follows: 87 Malays, 115 Chinese and 109 Indians.

Results:  Sixty‐three adenomas were recorded in 36 patients: six Malays, 19 Chinese and 11 Indians. Of these adenomas, 59 were polypoid, three flat and one depressed. The majority of adenomas 42/63 (67%) were distal to the splenic flexure as were all (10/10) the Duke's A carcinomas and 6/8 (75%) of the advanced cancers. Patients with adenoma(s) compared with those without (controls) were significantly older (P = 0.005), more likely to have a family history of colorectal cancer (P = 0.005), and showed a trend towards significance for ethnic group (P = 0.09) on univariate analysis. Using logistic regression analysis, only family history (P = 0.05) and age ≥ 50 years (P = 0.011) were found to be significantly associated with adenomas.

Conclusion:  Risk factors for colonic adenoma(s) in our cohort of symptomatic multiethnic patients attending for colonoscopy do not seem to differ from those reported elsewhere and, in particular, race does not appear to be a factor.
Extrahepatic portal venous obstruction and obstructive jaundice: Approach to management
Authors: KHARE RITU , SIKORA SADIQ S , SRIKANTH GADIYARAM , CHOUDHURI GAUR , SARASWAT VIVEK A , KUMAR ASHOK , SAXENA RAJAN , KAPOOR VINAY K
Published: December 2004

Background:  Patients with long‐standing extrahepatic portal venous obstruction (EHPVO) develop extensive collaterals in the hepatoduodenal ligament as a result of enlargement of the periportal veins. These patients are also prone to develop obstructive jaundice as a result of strictures and/or choledocholithiasis. Surgical management of obstructive jaundice in such patients becomes difficult in the presence of these collaterals.

Aim:  To review the approach to management of patients with EHPVO and obstructive jaundice.

Methods:  Retrospective review of patients with EHPVO and obstructive jaundice requiring surgical and/or endoscopic management between 1992 and 2002.

Results:  Thirteen patients (nine males, aged 12–50 years) with EHPVO and obstructive jaundice were evaluated. No patient had underlying cirrhosis or hepatocellular carcinoma. Five patients (group A) had biliary stricture; three (group B) had choledocholithiasis; and five (group C) had biliary stricture with choledocholithiasis. Primary surgical management was performed in group A (portosystemic shunt in four‐strictures resolved in three; hepaticojejunostomy in one). In group B (n = 3) endoscopic stone extraction was successful in two patients. One patient underwent staged procedure (portosystemic shunt followed by biliary surgery). In group C, initial endoscopic management failed in four patients in whom it was attempted. All five patients thereafter underwent surgery (staged procedure, one; choledochoduodenostomy, one; devascularization, one; abandoned, two). Repeat postoperative endoscopic management was successful in two of the group C patients. Overall (group B and C), massive intraoperative hemorrhage occurred in three patients (one died). Postoperative hemorrhage occurred in one patient.

Conclusion:  In patients with EHPVO and obstructive jaundice, primary biliary tract surgery has significant morbidity and mortality. Endoscopic management should be the preferred modality. In patients with endoscopic failure, a staged procedure (portosystemic shunt followed by biliary surgery) should be preferred. Strictures alone may resolve after a portosystemic shunt. Endoscopic stenting may be required as an adjunct.
Alterations of the fragile histidine triad gene in hepatitis C virus‐associated hepatocellular carcinoma
Authors: ZEKRI ABDEL‐RAHMAN N , BAHNASSY ABEER A , HAFEZ MOHAMED , EL‐SHEHABY AMAL MR , SHERIF GHADA M , KHALED HUSSEIN M , ZAKHARY NADIA
Published: December 2004

Background and Aim:  The present study was conducted to address whether homozygous deletion (HZD) or transcriptional alterations of the fragile histidine triad (FHIT) gene play a role in the development and progression of hepatitis C virus‐associated hepatocellular carcinoma (HCC).

Methods:  Homozygous deletion of the FHIT gene at exons 3–9 was assessed as well as mRNA FHIT expression using reverse transcription polymerase chain reaction. The study included 23 samples of HCC, 11 on top of cirrhosis and 12 non‐cirrhotic, in addition to five cases with chronic active hepatitis (CAH), as well as seven morphologically normal tissues distant to the tumor (NDT) and 10 normal liver samples from liver transplantation donors.

Results:  Homozygous deletion was found in 18 of 23 HCC cases. The highest incidence of deletion was detected in exon 9 (52.0%) and the lowest in exon 7 (4.3%). Ten of the 18 cases (55.5%) showed deletion in more than one exon, eight in two exons, one in three exons and one in five exons. There was a significant association between HZD of exons 5 and 9 and HCC arising on top of cirrhosis (P = 0.041 and 0.006, respectively) as well as between exons 8 and 9 and the presence of CAH (P = 0.029 and 0.034, respectively). Aberrant FHIT transcripts were detected in 15 HCC cases (65.2%), 13 of them showed complete reduction of the mRNA transcripts and two showed abnormal bands. Sequence analysis of abnormal‐sized transcripts revealed that they were generated by the fusion of exons 5 and 7 as well as exons 7 and 9. In contrast, six of the seven NDT samples tested (85.6%) showed HZD in one or more exons. None of the normal liver samples from liver transplantation donors showed any changes. The highest incidence of HZD was detected in exon 9 (five of six cases representing 83.3%) and the lowest was in exon 4 (one of six cases representing 16.7%). Four cases showed the same aberrant FHIT HZD in both NDT and matched HCC.

Conclusions:  The results of the present study indicate that the FHIT gene is a frequent target in hepatitis C virus‐associated HCC and that alterations affecting this gene could be an early event in this type of neoplasm as they were detected in cirrhotic and CAH patients. However, this should be confirmed by a larger, extended study including more cases of cirrhotic and CAH patients as well as matched tumor and normal samples.
Indigenous transplant outcomes in Australia: What the ANZDATA Registry tells us
Authors: MCDONALD Stephen
Published: December 2004

SUMMARY:  While the rates of renal replacement therapy for end‐stage renal disease (ESRD) among Aboriginal Australians have increased rapidly over the past 20 years, the chances of Aboriginal Australians receiving a kidney transplant are about one‐third those among non‐Aboriginal Australians. The lower percentage of transplants from living donors for Aboriginal recipients (14%) compared with non‐Aboriginal Australians (36%) since 1997 contributes to this. Furthermore, among recipients of grafts from cadaveric donors, waiting times are longer, the number of human leucocyte antigen mismatches is significantly greater among Aboriginal (4.11 (95% confidence interval 3.83–4.39)) vs non‐Aboriginal recipients (2.95 (95% CI 2.87–3.02); P < 0.001), and sensitised recipients are more common (peak panel reactive antibody ≥ 50%, 25% among Aboriginal vs 12% among non‐Aboriginal recipients (P < 0.001).

Graft survival is poorer amongst Aboriginal Australians than non‐Aboriginal Australians – independent of whether the graft is from a living donor or deceased donor. Among primary deceased donor graft recipients, the hazard ratio (HR) for graft survival among Aboriginal recipients was 3.1 (95% CI 2.2–4.2), P < 0.001 and that for patient survival 3.6 (95% CI 2.5–5.1, P < 0.001) compared with non‐Aboriginal Australians. This higher graft‐loss rate among Aboriginal recipients of primary deceased donor grafts persists even after adjustment for the higher rate of comorbidity in this group (HR of 1.95 (1.22–3.11, P = 0.005). This is reflected in higher rates of vascular rejection among Aboriginal recipients, with a crude relative risk of 1.97 (95% CI 1.63–2.34) (P < 0.001), compared with non‐Aboriginal Australians. Despite the advantages in terms of morbidity and quality of life, it remains uncertain whether transplantation offers a mortality advantage among Aboriginal Australians.
How specialized is the plant–pollinator association betweenEucalyptus globulusssp.globulusand the swift parrotLathamus discolor?
Authors: HINGSTON ANDREW B. , GARTRELL BRETT D. , PINCHBECK GINA
Published: December 2004

Abstract The swift parrotLathamus discolor(Shaw) (Psittacidae) evolved from granivorous ancestors to become a specialized flower‐feeder in a monotypic genus. Its reproduction is dependent largely on flowers ofEucalyptus globulusLabill. ssp.globulus(Myrtaceae),the birds migrating to breed within the natural distribution of this tree. This paper investigates the extent to which this dependence ofL. discoloronE. globulusis mirrored by dependence of the tree on the bird. It was found thatL. discolorcarried significantly more eucalypt pollen within 22 mm of its bill tip than did the New Holland honeyeater,Phylidonyris novaehollandiae(Latham) (Meliphagidae), and that pollen was concentrated on the regions of the head ofL. discolorthat consistently contact stigmas. Larger pollen loads onL. discolorcan be attributed to it consuming both pollen and nectar, while honeyeaters take nectar only. The short thick bill ofL. discolornecessitates regular stigmatic contact while the long slender bills of honeyeaters are unlikely to contact stigmas as often in these bowl‐shaped flowers. These factors suggest thatL. discolorhas a greater capacity to deposit pollen on stigmas ofE. globulusthan do honeyeaters. However, the characteristics ofL. discolorthat make it such an effective pollinator ofE. globulusare also exhibited by a lorikeet (Psittacidae) that feeds on flowers ofE. globulus. The association betweenE. globulusandL. discoloris therefore only moderately specialized because the flowers are also adapted to the more recently associated lorikeet and are almost certainly also pollinated by honeyeaters.
Effect of spatial and temporal heterogeneity on granivory in the Monte Desert, Argentina
Authors: SASSI PAOLA L. , TORT JORGE , BORGHI CARLOS E.
Published: December 2004

Abstract  An important aspect of arid regions is the spatial heterogeneity resulting from differences among plant communities. There are process differences among different vegetation patches increasing variability in the functioning of the ecosystem. The purpose of this study was to estimate granivory, by studying variation of seed removal rates among patches at the local scale and variation according to seed type. We carried out experiments during four seasons in three plant communities in the Monte Desert, Argentina: ‘peladal’, mesquite forest and creosotebush. Seed trays were offered to ants, birds and rodents. Two types of commercial seeds (sunflower and millet) were used. We found that seed removal rate was significantly different among plant communities, among taxa (birds, ants and murid rodents), and among seasons, and that removal rate was higher for sunflower. Seed removal rates by murid rodents were higher than by birds or ants, and occasionally as high as those found in other deserts. The heterogeneity of seed removal patterns at the local level was as strong as that found between continents. Further studies may show similar local heterogeneity in other deserts of the world.
Penile cancer in the UK: clinical presentation and outcome in 1998/99
Authors: Ritchie Alastair W.S. , Foster Paul W. , Fowler Sarah
Published: December 2004

OBJECTIVE

To use the British Association of Urological Surgeons (BAUS) Cancer Registry data to audit a cohort of patients with penile cancer, and thus evaluate current management practices in the UK.

PATIENTS AND METHODS

In all, 243 patients were registered over an 18‐month period shortly before the publication of the UK National Institute of Clinical Excellence cancer guidelines. Clinical data, including preceding skin disorders, the clinical presentation, management, treatment‐related complications and the outcome in terms of local, nodal or distant disease recurrence, survival and cause of death, were sought from the originating clinician.

RESULTS

Data were obtained on 193 patients (79% of the initial population). One consultant reported five patients and the most from one centre was eight. A painless lump or ulcer was the commonest presentation; 45 patients had pre‐existing skin disorders. The median age was 65.5 years and 67 patients were aged < 60 years. Squamous cell carcinoma accounted for 94% of the pathology. There were wide variations in treatment for patients of similar disease stage. Twenty‐six patients had palpable regional nodes and 44 had a lymph node dissection; complications were reported in 43, including 18 of 44 having node dissection. The median follow–up was 27.7 months from the date of diagnosis. Death from penile cancer was recorded in one of 22 patients with stage 0 disease and seven of nine with stage IV disease. Positive lymph nodes had a detrimental effect on survival.

CONCLUSION

Experience in the management of penile cancer is shared by many urological surgeons in the UK. These data provide a ‘baseline’ against which to measure the outcome of specialist multidisciplinary team activity.
Hyperbaric oxygen does not accelerate latent in vivo prostate cancer: implications for the treatment of radiation‐induced haemorrhagic cystitis
Authors: Chong Kian Tai , Hampson Neil B. , Bostwick David G. , Vessella Robert L. , Corman John M.
Published: December 2004

OBJECTIVE

To assess the effects of hyperbaric oxygen (HBO2; often used to treat haemorrhagic cystitis, a known side‐effect after radiation therapy for prostate cancer and with the potential to induce tumour angiogenesis and stimulate latent recurrence) on indolent in vivo prostate cancer in a murine model.

MATERIALS AND METHODS

Human prostate LNCaP cells were injected into 60 severe combined‐immunodeficient mice; of these 24 (40%) did not develop palpable tumours after 6 weeks. They were randomized to undergo 20 sessions of either HBO2 or normobaric air in standardized conditions, and observed for another 4 weeks before the histological assessment of any palpable tumours that developed. Analysis of developed LNCaP tumours included tumour volume, microvessel density, MIB‐1, p53, p27 and racemase staining intensity.

RESULTS

HBO2 was associated with less prostate tumour progression than normobaric air (P = 0.26). During HBO2 therapy, 10 mice remained free of palpable tumours, compared with seven controls (P = 0.30). On evaluation during the 4 weeks after therapy, six mice treated with HBO2 remained free of palpable tumours, vs eight of the controls (P = 0.17). There was tumour invasion and necrosis in a two of six and four of the HBO2 group during and after therapy, respectively, vs five and seven of the controls. Tumour microvessel density, proliferative index, differentiation and apoptosis markers were similar in both groups.

CONCLUSIONS

HBO2 does not accelerate the growth of indolent prostate cancer in a murine model, suggesting that it does not increase the risk of residual prostate cancer reactivation when it is used to manage radiation‐induced haemorrhagic cystitis in patients treated by pelvic radiotherapy for prostate cancer.
Predictors of quality of life and pain in chronic prostatitis/chronic pelvic pain syndrome: findings from the National Institutes of Health Chronic Prostatitis Cohort Study
Authors: Tripp Dean A. , Curtis Nickel J. , Landis J. Richard , Wang Yan Lin , Knauss Jill S. ,   THE CPCRN STUDY GROUP
Published: December 2004

OBJECTIVES

To examine the cross‐sectional relationship of age, urinary and depressive symptoms and partner status on pain intensity and quality of life (QoL) in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

PATIENTS AND METHODS

In all, 463 men enrolled in the National Institutes of Health (NIH) Chronic Prostatitis Cohort Study from seven clinical centres (six in the USA and one in Canada) reported baseline screening symptoms using the NIH Chronic Prostatitis Symptom Index (CPSI). The CPSI provides scores for pain, urinary symptoms and QoL. In addition, a demographic profile, including age and partner (living with another) status, and a depressive symptom score were obtained. Regression modelling of QoL, adjusting for between‐centre variability, examined the unique effects of age, partner status, urological symptoms, depressive symptoms and pain.

RESULTS

Urinary scores, depressive symptoms and pain intensity scores significantly predicted QoL for patients with CP/CPPS (higher CPSI QoL scores indicated more impairment; median 8.0, range 0–12). On average, for every 1‐point increase in urinary scores, there was a corresponding increase in QoL score of 0.118 points (P = 0.001); for every 1‐point increase in pain intensity score, there was a corresponding increase in QoL score of 0.722 points (P < 0.001); and for every 1‐point decrease in depressive symptoms (lower scores equal poorer mood), the QoL score increased (poorer quality of life) by 0.381 points (P < 0.001). Age and partner status did not significantly contribute to poorer QoL. Urinary scores and depressive symptoms were significant predictors (P < 0.001) of pain in patients with CP/CPPS.

CONCLUSIONS

These data show that depressive symptoms and pain intensity significantly predict a poorer QoL in patients with CP/CPPS, and that these effects are independent of partner status, age and urinary status. In particular, pain intensity was the most robust predictor of a poorer QoL. Further data relating pain and psychological factors to CP/CPPS are highly recommended, to aid in determining specific factors for pain and its impact on QoL. These data are essential if empirically guided efforts to manage pain are to progress.
Do cigarette smokers with erectile dysfunction benefit from stopping?: a prospective study
Authors: Pourmand Gholamreza , Alidaee Mohammad Reza , Rasuli Sohrab , Maleki Ameneh , Mehrsai Abdolrasoul
Published: December 2004

OBJECTIVE

To assess whether stopping smoking can improve erectile dysfunction (ED) in smokers, as cigarette smoking is a known risk factor for ED.

PATIENTS AND METHODS

Smokers who requested nicotine replacement therapy (NRT) and complained of ED were first evaluated for hypertension, dyslipidaemia, diabetes, psychiatric disorders and drug history. The grade of ED in smokers with none of these risk factors was then determined using the five‐item version of the International Index of Erectile Function (IIEF‐5) before NRT, and the grading repeated after 1 year of follow‐up. The correlation between the exposure to smoking (pack‐years) and severity of ED was assessed before the follow‐up. The ED status between patients who stopped smoking after NRT and those who continued during the follow‐up was then compared before and after the follow‐up.

RESULTS

The severity of ED correlated significantly with the level of exposure to smoking. Age and ED status before the follow‐up were not significantly different between 118 patients who stopped (ex‐smokers) and 163 who continued smoking (current smokers). After 1 year the ED status improved in ≥ 25% of ex‐smokers but in none of the current smokers; 2.5% of ex‐smokers and 6.8% of current smokers had a deterioration in ED. Ex‐smokers had a significantly better ED status after the follow‐up (P = 0.009). Among ex‐smokers, patients with advanced ED and those who were older had less improvement.

CONCLUSION

There is a strong association between the intensity of cigarette smoking and degree of ED. Stopping cigarette smoking can improve ED in a considerable proportion of smokers. Age and the severity of ED before stopping are inversely related to the chance of improvement.
Clinical and hormonal findings in testicular maturation arrest
Authors: Ishikawa Tomomoto , Fujioka Hitoshi , Fujisawa Masato
Published: December 2004

OBJECTIVE

To clarify the pathophysiology of maturation arrest (MA), one of the most important causes of male infertility, by examining testicular morphology and biophysical and endocrine profiles of azoospermic patients with MA.

PATIENTS AND METHODS

Thirty azoospermic men were assessed; 10 were found to have Sertoli‐cell only syndrome or chromosomal abnormalities, and 20 to have MA on biopsy. The second group had their clinical variables and findings analysed retrospectively after the diagnosis of MA (mean age 32.1 years, sd 5.2). Johnsen's score, serum hormone levels (follicle stimulating hormone, FSH, luteinizing hormone, LH, testosterone, prolactin and oestradiol), testicular volume, and the diameter of the seminiferous tubules, were evaluated. Patients were categorized into groups according to Johnsen score, i.e. group 1 (<4), group 2 (≥4 and <6) or group 3 (≥6). The clinical variables were compared in each group.

RESULTS

Hormone levels in almost all patients were in the normal range. FSH was related to the stage of MA; the difference in FSH between groups 1 and 3 was significant (P = 0.006). Serum levels of LH, testosterone, prolactin or oestradiol were similar in all groups. The diameter of the seminiferous tubules was less in group 1 than in group 3 (r = 0.881, P < 0.001) and there was an inverse and linear correlation between the FSH concentration and the diameter of the seminiferous tubules (r = −0.661, P = 0.0028).

CONCLUSIONS

FSH is the most useful variable for evaluating the severity of MA, even when it is within the normal range. The finding that gonadal hormone concentrations are normal in patients with MA suggests that an abnormality other than a disturbance in the hypothalamo‐pituitary‐testicular axis is responsible for MA.
Partial nephrectomy for patients with a solitary kidney: the Memorial Sloan‐Kettering experience
Authors: Saranchuk Jeffery W. , Touijer A. Karim , Hakimian Payam , Snyder Mark E. , Russo Paul
Published: December 2004

A careful analysis of 54 patients with a solitary kidney and who had a partial nephrectomy is reported by authors from New York. They found it to be a safe procedure with an acceptable decline in renal function which stabilised during the first year. The requirement for temporary haemodialysis was low.

Authors from China report on the use of a retroperitoneoscopic approach to subcapsular nephrectomy in patients with infective or adhesive non‐functioning kidneys. Their results were excellent and they showed this to be an acceptable technique, with minimal trauma and blood loss and a quick recovery.

OBJECTIVE

To report the experience of partial nephrectomy in patients with a solitary kidney at one institution, with analysis of renal function, complications, oncological efficacy and survival.

PATIENTS AND METHODS

We identified 54 consecutive patients with a solitary kidney who had a partial nephrectomy between December 1989 and July 2003. Variables examined included patient age and gender, renal function, renal ischaemia time, surgical margin status and complications. Pathological features, e.g. tumour size, histological subtype and tumour stage, were also assessed. Disease‐free probability and overall and cancer‐specific survivals were determined.

RESULTS

The histological subtype was clear cell in 35 cases (65%), papillary in 10 (19%), oncocytoma in four (7%), chromophobe in two (4%), unclassified in one (2%) and multiple subtypes in two (2%). The median creatinine level before surgery was 14 mg/L, which increased to 16 mg/L 6 months afterward, and at 1 and 2 years after surgery it was 15 mg/L. Two patients developed end‐stage renal disease requiring haemodialysis, one soon after surgery and another 8 years after nephron‐sparing surgery. In all, 26% of patients developed at least one perioperative complication, with acute renal failure and urinary fistula being the most common. At 5 years the overall and cancer‐specific survival, and disease‐free probability were 68%, 88% and 73%, respectively.

CONCLUSIONS

Partial nephrectomy is safe in patients with a solitary kidney, with an acceptable decline in renal function and low likelihood of requiring temporary or permanent haemodialysis. After an initial decline, renal function appears to stabilize during the first year.
Can computed tomography in the protocol for renal colic be interpreted by urologists?
Authors: Connolly Stephen S. , Younis Choudhry , Meade William , Gallagher Ruth , Lovett Raymond , Brady Adrian , Fitzgerald Edward , Rogers Eamonn , Sweeney Paul
Published: December 2004

OBJECTIVE

To examine the ability of urologists to independently (with no radiology consultation) interpret non‐contrast‐enhanced spiral computed tomography (CT) in patients with acute renal colic.

PATIENTS AND METHODS

One hundred consecutive patients presenting to the emergency department with suspected renal colic and evaluated with non‐contrast spiral CT were retrospectively reviewed. The CT films of each patient were assessed separately by a first‐year urology registrar and by a consultant urologist (neither of whom were subspecialized in uroradiology or endourology). The acute presentation details were provided to mimic the emergency situation.

RESULTS

Ureteric calculi causing acute renal colic were evident in 54 patients. The consultant radiologist reported 51 ureteric calculi, and had a sensitivity, specificity and positive predictive value of 94.5%, 100% and 100%, respectively. The consultant urologist correctly identified 52 calculi, with sensitivity, specificity and positive predictive values of 96.3%, 82.7% and 86.7%. The urology registrar detected 51 stones with sensitivity, specificity and positive predictive values of 94.5%, 93.5% and 94.5%, respectively.

CONCLUSION

Non‐contrast spiral CT in patients with acute renal colic is an effective diagnostic tool which allows rapid and accurate evaluation of the urinary tract, thereby facilitating the acute management of patients with renal colic.
Percutaneous nephrolithotomy in children before school age: experience of a Pakistani centre
Authors: Mahmud Mamun , Zaidi Zafar
Published: December 2004

OBJECTIVE

To review our experience of percutaneous nephrolithotomy (PCNL) in children before school age, and determine its efficacy and safety in this age group.

PATIENTS AND METHODS

The records of children aged ≤ 5 years undergoing PCNL were reviewed. Variables assessed included stone number, size, location and type. The PCNL puncture site and number were also recorded. We reviewed stone clearance with PCNL, ancillary procedures used, complication rates and follow‐up status of the children.

RESULTS

There were 30 renal units in 29 children (median age 3.8 years, range 1.4–5). Because of poor growth the mean (sd) body weight of the children was only 12.2 (2.8) kg, which is near the 50th percentile for children of mean age 3.5 years. The median (range) stone burden was 2.35 (1.3–6) cm; 60% of the patients had single stones while 28% had more than five. There were five staghorn stones. All PCNL was primary and with one puncture, using a 17 F angled nephroscope; stones were fragmented using a pneumatic lithoclast. After PCNL stones were completely cleared in 60% of the renal units, which increased to 100% after combining it with extracorporeal shockwave lithotripsy. The median (range) follow‐up was 24.9 (4–51) months; the overall complication rate was 6%. In the long follow‐up hypertension was not detected in any child and isotopic renograms in 17 kidneys detected no new scarring or loss of renal function.

CONCLUSION

PCNL is a safe and effective for treating renal stones in very young children.
The inhibitory role of melatonin on isolated guinea‐pig urinary bladder: an endogenous hormone effect
Authors: Semerciöz Atilla , Onur Rahmi , Ayar Ahmet , Orhan Irfan
Published: December 2004

OBJECTIVE

To investigate the effects of melatonin, an endogenous hormone, on acetylcholine and KCl‐induced contractions of isolated guinea‐pig detrusor muscle.

MATERIALS AND METHODS

Detrusor smooth muscle strips isolated from guinea‐pig bladders were placed in an organ bath containing physiological saline at 37 °C and pH 7.4, constantly bubbled with 95% oxygen and 5% CO2. The effects of cumulatively applied melatonin on the acetylcholine‐ and KCl‐induced contractions of isolated bladder strips were examined using isometric contraction measurements.

RESULTS

Melatonin (100 and 300 µmol/L) significantly inhibited the peak amplitude of both acetylcholine (10 µmol/L) and KCl (30 mmol/L)‐induced contraction of the isolated bladder strips (P < 0.05). Similarly, melatonin caused a significant reduction in the contractile frequency induced by KCl (eight strips) in a concentration‐dependent manner, while having no significant effect on the frequency of contractile response to acetylcholine, even at the highest concentration (300 µmol/L) used (P = 0.58, 14 strips).

CONCLUSIONS

These results suggest that melatonin inhibits acetylcholine‐ and KCl‐induced contractions in isolated bladder strips from guinea pigs. The endogenous nature of melatonin, with its low side‐effect profile, makes it a potentially useful agent to be considered in the medical management of the overactive bladder.
Urine dendritic cells: a noninvasive probe for immune activity in bladder cancer?
Authors: Beatty John D. , Islam Sabita , North Margaret E. , Knight Stella C. , Ogden Christopher W.
Published: December 2004

OBJECTIVES

To test the hypothesis that dendritic cells (DC), antigen‐presenting cells with the potential to stimulate primary T‐cell responses, may appear in the urine of patients with bladder cancer, and that their characteristics may reflect those of DC in cancer tissue.

PATIENTS AND METHODS

Cells from digested tissue of transurethral resection specimens from eight patients and urine from 18 with bladder cancers were analysed using flow cytometry, immunohistochemistry and electron microscopy. Urine samples from 12 patients were also analysed during intravesical bacillus Calmette‐Guérin (BCG) therapy.

RESULTS

Immature DC positive for major histocompatibility complex class II antigens, negative for markers of other leukocyte lineages and with low levels of co‐stimulatory markers, were identified in CD45‐positive cells isolated immediately from cancer tissue or amongst cells migrating from tissue fragments after overnight culture. Immature‐phenotype DC were also identified in the urine of patients with bladder cancer. Their identity was confirmed by immunohistochemistry and electron microscopy. Using these methods, DC were monitored from the bladder during BCG installation for bladder cancer in 12 patients for a mean of 10 months. Of six patients who developed a recurrence of their bladder cancer over this period, all but one showed a lower percentage of DC in their urine at the end of their initial treatment.

CONCLUSION

We identified DC in the urine of patients with bladder cancer for the first time. We speculate that variability in the percentage of urinary DC may reflect changes in immunological activity at the tumour site; prospective studies are required to evaluate the relevance of these DC counts and characteristics to clinical outcome.
Diffusion properties of transurethral intraprostatic injection
Authors: Plante Mark K. , Gross Andrew L. , Folsom Jeffrey B. , Zvara Peter
Published: December 2004

OBJECTIVES

To evaluate the location and extent of diffusion that occurs when liquid is injected transurethrally into the prostate gland, by correlating real‐time fluoroscopy and gross pathology, and to quantify the variables that influence intraprostatic diffusion during chemoablation of the prostate.

MATERIALS AND METHODS

A solution of diatrizoate meglumine (HypaqueTM, Nycomed, Princeton, NJ) gentamicin and methylene‐blue dye (HGM) was injected transurethrally into the prostate in six dogs, using a passive‐deflection needle injection system. The intraprostatic diffusion characteristics were evaluated during each injection using real‐time C‐arm fluoroscopy, and following each injection by gross examination of methylene blue staining within the prostatic tissues. HGM back‐flow into the urethra at the time of injection was assessed by measuring gentamicin levels in the collected bladder irrigant after each injection, using a standard dilution formula.

RESULTS

There was variability in the intraprostatic diffusion both fluoroscopically and grossly. The needle occasionally assumed a straighter trajectory than its intended curve. Intraprostatic diffusion was detected in 12 of 36 injections (33%). Using standard manipulations of various devices increased the intraprostatic diffusion in these injections to almost 80%. There was less intraprostatic diffusion when the injection resistance was either extremely high or absent. There was no extraprostatic extravasation of HGM beyond the prostatic capsule.

CONCLUSION

Current methods of transurethral intraprostatic injection are variable for both the diffusion of HGM solution and in needle deployment. The gross diffusion patterns with the HGM solution were consistent with the diffusion patterns documented in our previous research using absolute ethanol. These and other factors may partly explain the variability of the lesions produced with ethanol injection. Therefore, more research is needed to further elucidate the diffusion characteristics of solutions injected intraprostatically using the transurethral approach.
Seeing farmers for the trees: Community forestry and the arborealisation of agriculture in northern Thailand1
Authors: Walker Andrew
Published: December 2004

Abstract:  The campaign for community forestry in upland areas of northern Thailand reflects an ‘arborealised’ perspective on upland agriculture. Arborealisation – which I define as the process whereby upland livelihoods are recast as forest livelihoods – is evident in the main elements of NGO and academic advocacy for the resource rights of upland peoples. As a result of this arborealised perspective, securing rights to forest resources has come to be seen as the key to enhancing the livelihood security of upland farmers. However, the emphasis of the proposed community forest legislation on communally managed forest resources means that it will do little to enhance the tenure security of farmers in relation to agricultural land.
Divided communities and contested landscapes: Mobility, development and shifting identities in migrant destination sites in Papua New Guinea
Authors: Koczberski Gina , Curry George N.
Published: December 2004

Abstract:  Internal conflicts at the local and national levels in several South Pacific countries have revealed the fragility of national unity and the difficulties nations face in governing and managing their own economic development. In Papua New Guinea, the focus of this paper, an uncertain economic future for many rural and urban communities, and rising inequalities in income opportunities and access to resources, have coincided with greater intolerance of migrants at sites of high in‐migration by customary landowners and provincial and local authorities. This paper draws on fieldwork undertaken in the major oil palm growing regions of Papua New Guinea where migrants from densely populated regions of the country have settled on state land alienated from customary landowners. We examine how struggles over land, resource control and development are polarising migrant and landowner identities resulting in increasing tensions and episodic communal violence. A settler identity is emerging based on a narrative of nation building and national development, while an ethno‐regional identity amongst customary landowners is undermining the citizen rights of migrants and challenging the role and authority of the state in land matters.