bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognosis of testicular teratoma differentiated
Authors: STEVENS M.J. , NORMAN A.R. , FISHER C. , HENDRY W.F. , DEARNALEY D.P. , HORWICH A.
Published: November 2008

Objective To determine whether the clinical course of patients with testicular teratoma differentiated (TD) and those with testicular teratoma undifferentiated justify a different follow‐up protocol.

Patients and methods Between 1979 and 1989, 16 adult patients with testicular TD were treated at the Royal Marsden Hospital. These represented 2.7% of the 592 testicular teratoma patients seen during this period. With the exception of a propensity to involve the right testis (76%), there were no differences in clinical presentation between TD and non‐TD histological subtypes.

Results The mean follow‐up was 55 months (range 7–137). Seven of the 16 patients had Stage I disease and were entered into surveillance programmes; one relapsed at 7 months. Ten men were treated with cisplatin or carboplatin‐based chemotherapy for metastases, of whom three had had prior chemotherapy at other hospitals and were referred after relapse. In the seven previously‐untreated chemotherapy group two patients failed. In the concurrent era, 375 patients with other subtypes of metastatic testicular nonseminoma were treated with chemotherapy and 47 (12.5%) failed (Progress Free Survival chi square (ξ2) = 2.73, P= 0.01). Although no difference in progression‐free survival was demonstrated between TD and non‐TD patients, the former had a worse overall survival probability (ξ2= 9.02, P= 0.003); this may be an artefact due to the small number of events.

Conclusion Despite the apparently more benign histology, it is recommended that the management of adult TD should not deviate from the general principles established for other histological subtypes of testicular teratoma.
Efficacy of the combination of nilutamide plus orchidectomy in patients with metastatic prostatic cancer. A meta‐analysis of seven randomized double‐blind trials (1056 patients)
Authors: BERTAGNA C. , GÉRY A. DE , HUCHER M. , FRANÇOIS J. P. , ZANIRATO J.
Published: November 2008

Objective To review the efficacy of the combination of the anti‐androgen nilutamide (Anandron®) plus orchidectomy in patients with stage D prostate cancer who had received no previous treatment.

Patients and methods The results of seven randomized double‐blind trials were analysed. In these studies patients were followed up until progression of disease or withdrawal for other reasons. Bone pain, urinary symptoms, performance status, levels of prostatic acid phosphatase (PAP) and alkaline phosphatase (AP) were evaluated before treatment and after 1, 3, 6, 12 and 18 months of treatment. Bone scans and X‐rays were taken every 6 months. The best objective response, the time of progression and the time of death were recorded. The changes from baseline in symptoms and levels of tumour markers at month six and the percentages of objective regressions in the two treatment groups were compared using the Cochran‐Mantel‐Haenszel test stratified by study. Peto's method was used for the analysis of time to progression and of survival.

Results Of the 1191 patients enrolled in all the original trials, 1056 were eligible. In the group of patients treated with nilutamide 50% had complete or partial regression of disease compared with 33% of those who were given a placebo (P<0.001); bone pain and levels of PAP and AP were improved or returned to normal significantly more frequently (P< 0.01); the odds of disease progression were significantly reduced (odds ratio 0.84, P=0.05); the odds of death from cancer and from other causes were reduced but the difference was not statistically significant.

Conclusions The combination of nilutamide and orchidectomy has a beneficial effect on pain of metastatic origin, levels of tumour markers, the objective response of disease and the time to disease progression. This treatment combination might also improve survival.
Correction of recurrent stress urinary incontinence by needle urethropexy with a vaginal wall sling
Authors: PIDUTTI R. W. , GEORGE S. W. , MORALES A.
Published: November 2008

Objective To review the results of a modification of the transvaginal needle urethropexy as a treatment for patients developing recurrence after surgical correction of stress urinary incontinence (SUI).

Subjects and methods Twelve women who had undergone previous surgery for SUI and had developed recurrence of the symptoms were treated by a needle urethropexy technique which employed an island of in situ vaginal skin as a sling to support the bladder neck and urethra.

Results After a mean follow‐up of 17.3 months, eight of the patients obtained excellent results, three experienced improvement and one was a failure.

Conclusions The vaginal wall sling needle urethropexy was a simple technique to perform and carries a low morbidity. The results are similar to those of the more elaborate traditional sling procedures reported in the literature.
Ejaculation in men: a dynamic endorectal ultrasonographical study
Authors: GIL‐VERNET J. M. , ALVAREZ‐VIJANDE R. , GIL‐VERNET A. , GIL‐VERNET J. M.
Published: November 2008

ObjectiveTo study the ejaculatory mechanisms in men using a dynamic endorectal ultrasonographical approach.

Subjects and methodsSeven recordings were made of a young healthy volunteer during ejaculation, scanning the longitudinal plane from the bladder neck to the bulbous urethra.

ResultsThe study demonstrated the existence of a preejaculatory phase characterized by a notable decrease in echogenicity of the inner prostate gland, due to the contraction of the pre‐prostatic sphincter 13‐2 5 s before ejaculation. Several stages were recorded including an ejaculatory stage with an initial prostatic emission phase lasting 2–20 s and a posterior emission phase through the ejaculatory ducts lasting 3–14 s, with a seminal stoppage of 3–8 s. and finally a urethro‐vesical reflux of a minimal fraction of the ejaculate over 5–9 s. The bladder neck and inner gland returned to their resting configuration between 10 and 90 s after ejaculation.

ConclusionsEndorectal ultrasonographical imaging during ejaculation, a recently developed diagnostic procedure, may provide a new approach to ejaculation‐related problems.
Vasectomy reversal — microsurgery for best results
Authors: FOX M.
Published: November 2008

Objective To determine whether microsurgery achieves a better result in vasectomy reversal than other macroscopic techniques.

Patients and methods A series of 103 consecutive patients with a median age of 36 years (range 26–58) who underwent microsurgical vasovasostomy was studied. The method employed was a modification of a two‐layer anastomotic technique. In the first 49 patients 8/0 Vicryl was used to create a two‐layer anastomosis whereas in 54 patients 10/0 Ethilon was used.

Results Sperm were present in the ejaculate in 85% of patients who underwent bilateral vasovasostomy. The rate increased to 94% in those in whom 1010 Ethilon had been used as the suture material but the difference was not statistically significant. In half of the patients sperm concentration, quality and motility improved over the 12 months following reversal. The fertility rate, measured between 8 months and 5 years after vasovasostomy, was 64% if the vasectomy had been performed within 10 years and fell to 39% if 10 years or more had elapsed. In the 10 patients who had undergone a failed reversal attempt elsewhere four had sperm in the ejaculate and two of these patients became fertile.

Conclusion The additional time and effort required for microsurgical approach to vasovasostomy were worth‐while to obtain patency and fertility rates which were superior to those of other techniques.
Frequency of H‐ras mutations in human bladder cancer detected by direct sequencing
Authors: BURCHILL S. A. , NEAL D. E. , LUNEC J.
Published: November 2008

Objective To determine the frequency of mutations of the H‐ras gene in transitional cell carcinomas of the human urinary bladder using direct DNA sequencing based on the polymerase chain reaction (PCR) method and to compare the results with those of other methods. In addition, the relationship of the mutation frequency to tumour stage and grade was examined.

Patients and methods Bladder tumour samples, taken by cystoscopic resection from 50 patients with newly diagnosed transitional cell carcinoma of the urinary bladder, were analysed by PCR‐based direct DNA sequencing for point mutations in the H‐ras gene at codon 12.

Results Point mutations were found in 9 of 50 tumours examined (18%). The most frequent mutation (8/9) was a G to T transversion converting GGC to GTC, which would result in a glycine to valine substitution. The remaining mutation was a G to A transition altering GGC to GAC, producing a glycine to aspartic acid substitution, which has not previously been reported in bladder cancer. In all tumour samples examined the wild‐type allele (GGC) was also evident. Variation in the proportion of wild‐type to mutated sequence was found within tumour samples. No relationship between mutations and tumour grade and stage was apparent.

Conclusion The frequency of H‐ras mutations detected in this first large scale study using the highly sensitive and rapid PCR‐based sequencing method was comparable to that reported by earlier studies with the nude mouse tumorigenesis variation of the 3T 3 transfection assay. H‐ras mutations can be early events in the development and progression of a significant proportion of human bladder cancer cases.
DNA ploidy, serum prostate specific antigen, histological grade and immunohistochemistry as predictive parameters of lymph node metastases in T1‐T3/M0 prostatic adenocarcinoma
Authors: Berner A. , Waere H. , Nesland J.M. , Paus E. , Danielsen H.E. , Fosså S.D.
Published: November 2008

Objective To evaluate whether DNA ploidy and immunohistochemistry performed in primary prostatic carcinoma specimens give predictive information on regional lymph node metastasis in addition to T category, histological grade and serum prostate specific antigen (PSA).

Patients and methods Pre‐treatment TURP specimens from 80 patients with prostatic carcinoma T0‐T3/M0 disease were retrospectively evaluated by means of DNA ploidy and histological grade, and immuno‐staining for PSA, prostatic acid phosphatase (PAP), neuron‐specific enolase (NSE) and p53 protein. Pelvic lymph node dissection was performed in all patients. Serum PSA was determined in 76 of the 80 patients before pelvic staging lymphadenectomy. Thirty‐two (40%) of the 80 patients had pN+ disease.

Results Thirty‐six patients (46%) had serum PSA values below the upper reference limit (≤ 10 μg/L). By univariate analysis the pN category correlated with the serum PSA level (P<0.001), histological grade (P<0.001), tissue PSA (P<0.001), tissue PAP (P<0.04), T category (P<0.005) and DNA ploidy (P<0.02). Multivariate analysis revealed that the serum PSA level was the most powerful independent prognosticator, followed by the T category, tissue PAP and tissue PSA. Histological grade and DNA ploidy did not reach the level of significance in the multivariate analysis.

Conclusion These data suggest that tissue PAP and tissue PSA predict the pN status in patients with T0‐T3/M0 prostate carcinoma, in addition to serum PSA and T category. Neuroendocrine differentiation and p53 protein seem to have no predictive ability.
Treatment of catheter‐associated Candiduria with fluconazole irrigation
Authors: Simşek Ü. , Akinci H. , Oktay B. , Kavrama I. , Özyurt M.
Published: November 2008

Objective To examine the safety and efficacy of fluconazole in patients with a permanent nephrostomy or suprapubic catheter in the prevention of candiduria.

Patients and methods Twenty patients with a nephrostomy or suprapubic catheter who had at least two positive urine cultures with a minimum of 15 000 col/mL Candida counts were studied. The catheters were irrigated with fluconazole solution prepared as 1 mg/mL with normal saline. Repeated urine cultures were obtained.

Results In 17 patients Candida was eradicated from the urine by the third to sixth day of irrigation. No side‐effects were noted.

Conclusion Fluconazole as an irrigant is effective and safe in the treatment of catheter‐associated candiduria, which can be eliminated without changing the catheter.
Surgery of lung metastases in renal cell carcinoma
Authors: Cozzoli A. , Milano S. , Cancarini G. , Zanotelli T. , Cunico S. Cosciani
Published: November 2008

Objective To examine the impact on survival of pulmonary resection in the treatment of renal cell carcinoma that has metastasized to the lung.

Patients and methods From June 1986 to July 1991, 19 patients were submitted to synchronous or asynchronous lung metastasectomy. Histological examination confirmed the presence of lung metastases from renal cell carcinoma in 16 cases (six synchronous and 10 asynchronous with a mean disease‐free interval of 23 months). In the other three cases, histological examination revealed tuberculomas, chondroid ham‐artoma and foci of anthracosis.

Results To date, among the six patients with synchronous lung métastases, three have died, two are progressing and one has no evident disease after a mean survival of 24 months. Among the 10 patients who underwent surgical resection of metachronous lung metastases, one has died, three are progressing and six have no evident disease (mean survival time, 43 months).

Conclusion While the presence of synchronous lung metastases is an unfavourable prognostic factor even after surgical removal (five out of six patients died or are in progression shortly after metastasectomy), the results after surgery of asynchronous lung metastases are encouraging, although the real efficacy of this treatment is still to be confirmed.
Analysis of early failures after intravesical instillation therapy with bacille Calmette‐Guerin for carcinoma in situ of the bladder
Authors: Merz V.W. , Marth D. , Kraft R. , Ackermann D.K. , Zingg E.J. , Studer U.E.
Published: November 2008

Objective To analyse the clinical and therapeutic consequences of early treatment failure after bacille Calmette‐Guérin (BCG) instillation therapy for carcinoma in situ of the bladder.

Patients and methods A total of 115 patients with carcinoma in situ (Tis) of the bladder were treated by intravesical instillation of living BCG vaccine (Immun BCG Pasteur F). Twenty five patients had primary Tis and 90 had secondary Tis with synchronous or prior superficial papillary tumours. All papillary tumours were resected before instillation of BCG. All patients completed one series of 6 weekly instillations of 120 mg BCG.

Results Twenty‐two of 25 patients (88%) with primary Tis responded completely, with negative cytology and cystoscopy findings within a median follow‐up period of 44 months. Three of the 25 (12%) had cytological evidence of disease within 9 months of therapy and were considered to be early treatment failures. One patient had muscle‐invasive bladder cancer, one had Tis and invasive cancer of the prostatic urethra, and the last, in whom a second BCG course also failed, had Tis of both ureters. Seventy of 90 patients (78%) with secondary Tis had a complete response after treatment with BCG, with repeated negative cytology and cystoscopy examinations within a median follow‐up time of 40 months. Twenty of the 90 (22%) with secondary Tis had positive cytology within 9 months after BCG therapy and were considered early treatment failures. Five of these 20 had a cystectomy, three for persistent Tis of the bladder and two for a solid urothelial carcinoma of the prostate. The remaining 15 early failures received a second course of BCG. Four of these 15 patients responded and the remaining 11 failed the second course. The 11 failures included two patients with multifocal T1 G3 bladder cancers, four with invasive bladder cancer, two with solid urothelial carcinomas of the prostatic urethra, and three with Tis of the upper urinary tract.

Conclusions According to these data, early treatment failure after 6 weekly instillations of 120 mg Immun BCG Pasteur F is an alarming signal which requires immediate re‐assessment of the patient to exclude a muscle‐invasive bladder cancer or an extravesical carcinoma in situ, either in the upper urinary tract or in the prostatic urethra.
Persistent polyuria after posterior urethral valves
Authors: Dinneen M.D. , Duffy P.G. , Barratt T.M. , Ransley P.G.
Published: November 2008

Objective To assess urinary concentrating ability, urine production and glomerular filtration rates in a cohort of boys with previously treated posterior urethral valves.

Patients and methods Urinary concentrating capacity was assessed in 51 boys aged 5.4–9.9 years with previously treated posterior urethral valves. They all completed urinary frequency/volume charts, permitting calculation of 24 h urine volumes. The osmolal‐ity of an overnight urine collection was measured and, if <800 mOsm/kg (n= 40), an intramuscular injection of desaniino‐cys‐l‐8‐d‐arginine vasopressin was given to determine the maximum concentrating ability. The glomerular filtration rate (GFR) was estimated from the plasma clearance of 51Crethylenediamine tetra‐acetic acid following a single intravenous injection.

Results The mean 24 h urine volume was 1025+448 (sd) mL. The mean overnight urine flow rate was 28.4±17.9 mL/h. Urinary concentrating capacity was impaired (<800 mOsm/kg) in 30 (59%) of the boys and <300 mOsm/kg in eight (16%). The mean GFR was 81+38 mL/min/1.73 m2 SA. Significant correlations were noted between the GFR, the maximum urine concentration and the 24 h urine volume.

Conclusion Persistent polyuria after valve ablation occurs in boys with posterior urethral valves. This has implications both in terms of urinary continence and on‐going renal impairment.
Blood coagulation proteins and urolithiasis are linked: crystal matrix protein is the Fl activation peptide of human prothrombin
Authors: Stapleton A.M.F. , Ryall U.L.
Published: November 2008

Objectives To determine the relationship between prothrombin and crystal matrix protein (CMP). CMP is the predominant protein found in the organic matrix of calcium oxalate (CaOx) crystals generated from human urine and is a 31 kDa glycoprotein, whose N‐terminal amino acid sequence shares homology with human prothrombin.

Materials and methods CaOx crystallization was induced in ultraflltered (UF) human urine containing either plasma or serum derived from the same healthy donor, by the addition of sodium oxalate. The crystals were demineralized and the resulting protein extracts analysed by sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS‐PAGE) and Western blotting, using antibodies raised against human prothrombin and the C‐terminus of prothrombin fragment 1 + 2 (Fl+2).

Results Prothrombin was detected in extracts of crystals precipitated from the UF urine in the presence of plasma, while CMP was completely absent. Crystals precipitated from UF urine supplemented with serum contained relatively large amounts of Fl+2 and a protein with the same electrophoretic mobility as CMP. Analysis of a standard preparation of Fl + 2 which also contained prothrombin fragment 1 (Fl) as a minor contaminant, showed a protein with electrophoretic and staining properties comparable to CMP.

Conclusion CMP is a urinary form of Fl, a degradation product of prothrombin possessing the domain rich in y‐carboxyglutamic acid, which may have undergone some molecular modification either before or after its release into the urine.
Are neuroendocrine cells of practical value as an independent prognostic parameter in prostate cancer?
Authors: Allen F.J. , Velden D.J.J. Van , Heyns C.F.
Published: November 2008

Objective To assess whether the presence of neuroendocrine (NE) cells is of value as an independent indicator of poor prognosis in patients with prostate carcinoma.

Patients and methods A series of 160 consecutive patients with prostate carcinoma was studied retrospectively. In 120 there was sufficient tissue for review and to perform immunoperoxidase stains for neuron specific enolase (NSE) and chromogranin A (CGA). All patients had a potential follow‐up of at least 5 years.

Results Five‐year survival was poorer for patients with a high tumour grade and stage at presentation compared to those with a lower grade and stage. NE cells were more common in higher grade and stage disease, but 5‐year survival did not differ significantly between patients with NE cell positive and negative tumours.

Conclusion NE cells are of no practical value as an independent prognostic indicator in patients with pros‐tatic adenocarcinoma.
Zonal biochemical and morphological characteristics in BPH
Authors: Feneley M.R. , Puddefoot J.R. , Xia S. , Sowter C. , Slaving G. , Kirby R.S. , Vinson G.P.
Published: November 2008

Objective To compare androgen, oestrogen, progesterone and epidermal growth factor receptor concentrations in the transition zone and peripheral zone of the prostate in benign prostatic hyperplasia (BPH), and to relate these findings to epithelial and stromal composition.

Patients and methods Tissue from both the transition and peripheral zone of the prostate was obtained from 26 patients undergoing transurethral prostatectomy for benign prostatic obstruction and used for both receptor binding studies and morphometric analysis. Androgen receptor (AR), oestrogen receptor (ER), progesterone receptor (PR) and epidermal growth factor receptor (EGFR) concentrations were assayed by saturation binding with a competitive inhibitor. The epithelial, stromal and luminal composition of the tissue was determined using a Zeiss AxioHOME microscope workstation.

Results The epithelial content was significantly greater in the transition zone than in the peripheral zone. No overall zonal difference in AR concentration was detected; however, when values were expressed relative to the epithelial component, the AR content was significantly higher in the peripheral zone. Conversely, overall EGFR concentrations were significantly greater in the transition zone, although not when expressed per unit epithelium. Higher concentrations of oestrogen receptor were measured in the transition zone per unit stroma. No zonal difference in PR was detected. However, there was a significant correlation between AR and PR in the peripheral zone and between EGFR and AR in the transition zone.

Conclusion These data demonstrate that receptor concentrations should be related to tissue composition. Concentrations of AR were higher in the peripheral zone epithelium than in transition zone epithelium, suggesting greater androgen dependence. This may be important in determining its greater propensity for malignancy. Although EGFR concentrations were greater in the transition zone, there was no zonal difference after correction for the amount of epithelium. Finally, higher concentrations of ER were detected in the transition zone stroma which may reflect important zonal differences in regulating growth and provides further evidence of a role for oestrogens in BPH.
Periurethral collagen injections for genuine stress incontinence: a 2‐year follow‐up
Authors: MONGA A.K. , ROBINSON D. , STANTON S.L.
Published: November 2008

Objective To assess the short‐and medium‐term efficacy of periurethral collagen injection in women with urethral sphincter incompetence and to determine if urodynamic variables can elucidate the mechanism of action.

Patients and methods Sixty women (mean age 64 years, range 20–90) with genuine stress incontinence received periurethral collagen injections under local anaesthesia; 55 had undergone previous continence surgery. A total of three injection sessions were allowed. Subjective and urodynamic assessments were obtained at 1, 3, 6, 12 and 24 months after injection to evaluate success and long‐term effects of collagen.

Results Subjective success rates were 86% at 3 months, 77% at 12 months and 68% at 24 months. Objective cure rates were 61% at 3 months, 54% at 12 months and 48% at 24 months. Low urethral pressures and decreased bladder neck mobility did not affect the outcome. Collagen injections significantly increased stress maximum urethral closure pressures and functional urethral length; increase in the latter and clinical assessment of bulking at the time of injection appeared to predict medium‐term success. There were some minor early complications and none in the medium‐term.

Conclusions Periurethral collagen injections continued to be effective at the 2‐year follow‐up, although there was a time‐dependent decline. In comparison with more complicated procedures used in patients with previous failed continence surgery, periurethral collagen injection is a simple, acceptable, day case procedure which improves the quality of life in physically fit or frail patients, with few complications.
Diabetes mellitus increases nitric oxide synthase in penises but not in major pelvic ganglia of rats
Authors: ELABBADY A.A. , GAGNON C. , HASSOUNA M.M. , BEGIN L.R. , ELHILALI M.M.
Published: November 2008

Objective To determine the effect of diabetes mellitus (DM) on erectile function and evaluate the levels of nitric oxide synthetase (NOS) activity in streptozotocin‐induced diabetic rats.

Materials and methods Rats were studied at 9 weeks and 14 weeks after the induction of DM by streptozoto‐cin and compared with untreated control rats. Erectile potency was assessed physiologically by testing and recording mating behaviour. NOS activity was assayed in penile tissues and major pelvic ganglia (MPG) by conversion of [3H] L‐arginine to [3H] citrulline. Histological, ultrastructural and immunohisto‐chemical studies of penile tissues were performed in similar groups of rats.

Results Diabetes mellitus adversely and significantly degraded all parameters of mating behaviour, thus

indicating defective erectile potency. However, NOS activities in penile tissues from both groups of diabetic rats were significantly higher than those in controls (P<0.01). In MPG, NOS activities were not significantly different between diabetic and control rats (P>0.05). Histological, ultrastructural and immu‐nohistochemical studies of penile tissues revealed no significant differences between control and diabetic rats, indicating an intact effector organ (smooth muscles) in rats with up. to 14 weeks of DM.

Conclusion The impotence frequently observed in diabetic subjects would suggest that despite the increase in NOS activity in the penis, the pharmacological action of nitric oxide is impaired.
Interferon‐alpha and survival in renal cell cancer
Authors: FOSSA S. , JONES M. , JOHNSON P. , JOFFE J. , HOLDENER E. , ELSON P. , RITCHIE A. , SELBY P.
Published: November 2008

Objective To establish whether the use of interferonalpha might result in improved survival, using two large series of patients with advanced renal cell cancer treated during studies of chemotherapy and biological therapy, respectively.

Patients and methods Patients treated either in the Eastern Cooperative Oncology Group (ECOG) chemotherapy protocols (327 patients) or in protocols employing interferon as part of a European randomized study or phase II studies at the Norwegian Radium Hospital (231 patients) were retrospectively analysed. Groups for comparison were matched by exclusion of those with an ECOG performance status >2, no prior nephrectomy, brain metastases or prior chemotherapy. Univariate analysis of prognostic factors for survival was performed by the log rank method and multivariate analysis by Cox regression.

Results Univariate analysis of the whole population showed that performance status, time from diagnosis to treatment, sites of metastases and the use of interferon carried the greatest prognostic significance. In multivariate analysis, the use of interferon remained a significant predictor of survival (P < 0.001). Subgroup analysis suggested that the impact of interferon treatment was greatest in those patients with two of the following characteristics; good performance status, an interval of < 2 years from diagnosis to treatment and no more than one site of metastasis.

Conclusion Although a prospective randomized trial is needed to establish definite benefit from the use of interferon in advanced renal cell cancer, this analysis supports the rationale for performing such a trial, particularly in patients with relatively good prognostic features. Patients should be entered into the Medical Research Council study comparing interferon with medroxyprogesterone acetate.
In situ piezoelectric extracorporeal shock wave lithotripsy of ureteric stones
Authors: ROBERT M. , DELBOS O. , GUITER J. , GRASSET D.
Published: November 2008

Objective To evaluate the efficacy of the EDAP LT 02 lithotripter for the in situ treatment of ureteric calculi.

Patients and methods One hundred consecutive patients presenting with ureteric calculi were treated with in situ piezoelectric extracorporeal shock wave lithotripsy (ESWL) using the EDAP LT 02 lithotripter. There were 49 patients with upper, nine with mid and 42 with lower ureteric stones. The largest diameter of the stones varied from 7 to 21 mm (mean 9.6 mm). Mild or severe hydronephrosis was present in 53 cases. Mid and lower ureteric stones were treated with the patients in the prone position, with no anaesthesia or pre‐medication, and upper ureteric stones in the supine position, with intravenous sedation in 44 cases.

Results Localization of the stones was easy in 81 cases and more difficult in 19, but an intravenous pyelogram was only necessary in three cases. The number of sessions per patient varied from 1 to 3 (mean 1.17). Complete success rate was achieved in 75% of patients and partial success (residual stones ≤ 3 mm) in 6%. The stone‐free rate was statistically affected by stone size but was independent of stone localization or the degree of obstruction. The rate of infective and obstructive complications was 14% and auxiliary treatments were necessary in 5% of patients.

Conclusion In situ piezoelectric ESWL with the EDAP LT 02 device is a convenient and efficient method for the treatment of ureteric stones.
Renal function up to 16 years after conduit (refluxing or anti‐reflux anastomosis) or continent urinary diversion. 1. Glomerular filtration rate and patency of uretero‐intestinal anastomosis
Authors: KRISTJÁNSSON A. , WALLIN L. , MÅNSSON W.
Published: November 2008

Objective To evaluate the glomerular filtration rate (GFR) and incidence of anastomotic stenosis in patients with urinary diversion by ileal or colonic conduit (refluxing or anti‐reflux uretero‐intestinal anastomosis) or with a continent caecal reservoir.

Patients and methods All conduit urinary diversions performed from 1977 to 1984 were randomized by type (ileal or colonic) and by the method of ureteric implantation (with or without anti‐reflux technique). In continent caecal reservoirs anti‐reflux implantation was used for both ureters. Total and separate GFR were measured pre‐operatively and after a mean follow‐up of 123 months (range 36–198) with 51Cr‐EDTA and scintillation renography.

Results Of the 56 evaluable patients, 18 had an ileal and 20 a colonic conduit, and 18 had a continent reservoir. The total mean GFR fell from 88 to 71 mL/min in the ileal group, from 84 to 65 mL/min in the colonic group and from 100 to 85 mL/min in the reservoir group. Separate GFR did not differ significantly between kidneys with and without reflux protection in the patients with a conduit diversion. Strictures occurred in 15 uretero‐intestinal anastomoses and were unrelated to the mode of ureteric implantation (in the conduit groups). Renal function improved after ureteric reimplantation in six of seven kidneys, but after balloon dilatation in only one of five.

Conclusion GFR fell moderately in all three groups, with no significant intergroup difference, and the continent caecal reservoir compared favourably with conduit diversion. The fall in separate GFR did not differ significantly between kidneys with and without reflux protection. Surgical exploration of uretero‐intestinal stenosis is recommended if renal function is threatened.
Renal function up to 16 years after conduit (refluxing or anti‐reflux anastomosis) or continent urinary diversion. 2. Renal scarring and location of bacteriuria
Authors: KRISTJÁNSSON A. , BATC M. , WALLIN L. , WILLNER J. , MÅNSSON W.
Published: November 2008

Objective To evaluate the importance of refluxing versus anti‐reflux ureteric implantation for the development of renal scarring in patients with a conduit or continent urinary diversion and for the incidence of bacteriuria in the upper urinary tract of patients with a conduit.

Patients and methods Renal scintigraphy using 99mTcdimercaptosuccinic acid was performed on 32 of 37 evaluable patients from a prospective, randomized study at a mean of 150 months (range 102–198) after urinary diversion. In five patients with a conduit diversion and unilateral renal scarring, urine was sampled for culture from the proximal end of the conduit and from both renal pelvices by direct percutaneous aspiration.

Results Of 35 renal units (18 patients), studied after conduit diversion, scarring was found in 11 (two grade I, six grade H and three grade III) of 17 with refluxing anastomosis and in six (one grade I, four grade II and one grade III) of 18 with anti‐reflux anastomosis (P= 0.06). Of 25 renal units (14 patients) after continent diversion, 16 showed scarring (seven grade I and nine grade II). Bacteriuria was found in four of five upper urinary tracts with a refluxing anastomosis, but in only one of five with an antireflux anastomosis. In these five patients scarring was present in all kidneys with refluxing anastomosis.

Conclusion Anti‐reflux ureteric anastomosis seems to be important for preventing scarring and bacteriuria in the upper urinary tract of patients with a conduit urinary diversion. Despite the anti‐reflux technique of ureteric implantation, most patients with a continent reservoir had renal scarring, though it was generally less severe than in patients with a conduit urinary diversion.
Flow‐cytometric DNA analysis of paraffin‐embedded renal cell carcinoma tissue from patients treated by parenchymal‐sparing surgery
Authors: CIANCIO G. , FERRELL S. , BLOCK N.L.
Published: November 2008

Objective To determine the utility of deoxyribonucleic acid (DNA) ploidy pattern, detected by flow cytometry, in predicting the outcome of renal cell carcinoma (RCC).

Patients and methods DNA content was retrospectively assessed by flow cytometry in 28 primary paraffin‐embedded RCCs from 24 patients (16 men and eight women, mean age 61.9 years, range 40–89) who had undergone renal parenchymal‐sparing surgery.

Results Tumour recurred locally in three patients, two with diploid tumours and one with aneuploid tumour. Two patients with diploid tumours had metastatic disease 11–58 months after surgery. Only one patient with aneuploid tumour developed metastatic disease. There was no difference in local recurrence or metastases with the type of renal parenchymal‐sparing surgery used (enucleation or partial nephrectomy) nor any significant difference in overall survival (P= 0.11).

Conclusion While DNA content might be of considerable predictive value for patients with RCC, these results showed that there was no difference in mortality rate, recurrence rate, or type of renal parenchymal‐sparing surgery used between aneuploid and diploid tumours.
The use of Doppler ultrasound in the clinical management of acute testicular pain
Authors: ALMUFTI R.A. , OGEDEGBE A.K. , LAFFERTY K.
Published: November 2008

Objective To evaluate the reliability and the clinical application of the use of a hand‐held Doppler ultrasound flowmeter probe as an aid to differential diagnosis in the assessment of cases with acute testicular pain presenting to a district general hospital.

Patients and methods Over a period of 1 year, testicular Doppler ultrasonic assessment was performed on 56 patients admitted with acute scrotal pain. A handheld Doppler ultrasound probe was used, with a transducer operating at 8 MHz. All the patients were assessed pre‐operatively by a single operator in the Accident and Emergency department before transfer to theatre. The decision to explore the testis was made purely on clinical grounds by which ever emergency surgical team was on duty. The operating surgeons were not informed of the result of Doppler examinations before surgical exploration.

Results Twenty‐two patients were subsequently shown to have torsion of the testis at surgical exploration, all of whom had no Doppler signal over the affected side. Of the remaining 34 patients, who were subsequently shown not to have torsion at operation, normal testicular blood flow and cord‐compression tests were demonstrated confidently in 33 patients when examined pre‐operatively. Thus the sensitivity was 100% (22/22) and the specificity 97% (33/34).

Conclusion Testicular Doppler examination using an 8 MHz probe in conjunction with the cord‐compression test is a useful, simple and highly accurate clinical tool which can differentiate between testicular torsion and other conditions presenting with acute testicular pain. It is also inexpensive and readily available in the district general hospital situation.
The value of radionuclide scrotal imaging in the diagnosis of acute testicular torsion
Authors: MELLOUL M. , PAZ A. , LASK D. , MANES A. , MUKAMEL E.
Published: November 2008

Objective To assess the accuracy of radionuclide scrotal imaging (RSI) in the diagnosis of testicular torsion and torsion of testicular appendages.

Patients and methods Eighty‐seven patients (mean age 30.1 years, range 8–65) who presented with acute scrotal pain were evaluated by RSI and the results correlated with the clinical and surgical findings.

Results Of the 87 patients, 44 underwent scrotal exploration and 42 patients were treated conservatively. One patient with a ‘missed torsion’ pattern on RSI refused operation and was lost to follow‐up. Of the 44 patients who underwent surgery, testicular torsion was found in 30 and torsion of testicular appendages in 14 patients. The specificity of the RSI in diagnosing testicular torsion was 100% and the sensitivity was 98%. An area of increased tracer activity in the presence of a normal radionuclide angiogram was suggestive of torsion of testicular appendages with a specificity of 93%. Of the 42 patients who were treated conservatively, 19 had epididymitis, according to clinical and RSI findings, 10 had torsion of testicular appendages, two had orchiepididymitis, two had hydrocele, two had haematocele and seven patients had normal testes. At a follow‐up examination, normal testicles were found in all 42 patients.

Conclusion The RSI may assist in the evaluation of nontraumatic acute scrotum, and can clearly distinguish among testicular torsion, torsion of testicular appendages and epididymitis.
EMLA cream anaesthesia for frenuloplasty
Authors: BROUGH R.J. , BETTS CD. , PAYNE S.R.
Published: November 2008

Objective To evaluate the use of a eutectic mixture of local anaesthetics (EMLA) cream as the sole anaesthetic for frenuloplasty.

Patients and methods Fifteen patients (mean age 25.6 years, range 19–41) were given topical EMLA cream 30 min before frenuloplasty: a Tegaderm® dressing was applied to keep the anaesthetic in place. The level of anaesthesia was assessed on arrival in theatre using pin‐prick testing and the patients were asked to grade their level of pain during the procedure using a visual analogue scale. If the level of anaesthesia was inadequate for the operation to be performed, then supplementary infiltrative anaesthesia was administered.

Results Fourteen patients had pain scores of zero and were fully anaesthetized during the procedure. One patient's Tegaderm® dressing was displaced soon after application and he was inadequately anaesthetized on testing, had a pain score of 4 and required infiltrative lignocaine before proceeding with frenuloplasty.

Conclusions EMLA cream is a well‐tolerated and reliable anaesthetic for frenuloplasty. Using a condom to keep the cream in place would reduce the small failure rate associated with the displacement of the Tegaderm® dressing.
Clinical outcomes associated with the implementation of a cost‐efficient programme for radical retropubic prostatectomy
Authors: KOCH M.O. , JR J.A. SMITH
Published: November 2008

Objective To develop and analyse a cost‐containment programme for radical retropubic prostatectomy.

Patients and methods An in‐depth analysis of the hospital charges associated with radical retropubic prostatectomy was conducted and a standard programme developed to control patient costs using a collaborative pathway method. The development of this programme and the outcomes of the first 50 patients who underwent radical retropubic prostatectomy while on the collaborative care pathway system are summarized.

Results The programme reduced both overall hospital charges per patient and the duration of hospital stay by 44%. In addition, there was a significant reduction in the duration of surgery, intra‐operative blood loss and the need for transfusion. Implementation of this programme had no apparent adverse effects on the rates of major or minor complications or hospital re‐admissions, and was accepted well by the patients.

Conclusion The collaborative care pathway developed for radical prostatectomy provides a system to deliver high quality, cost‐efficient care in an environment which is highly acceptable to patients and which allows continued refinements in the care delivered.
Prostate‐specific antigen density: correlation with histological diagnosis of prostate cancer, benign prostatic hyperplasia and prostatitis
Authors: IERSEL M.P. VAN , WITJES W.P.J. , ROSETTE J.J.M.C.H. DELA , OOSTERHOF G.O.N.
Published: November 2008

Objective To assess the additional value of prostate‐specific antigen density in the diagnosis of prostate cancer in patients who undergo prostate biopsies.

Patients and methods The study comprised 376 patients with symptoms of prostatism who were undergoing prostate biopsy. Digital rectal examination (DRE) and transrectal ultrasonography (TRUS) were performed and the prostate specific antigen level (PSA) and density (PSAD) were determined for each patient.

Results Both PSA and PSAD significantly differentiated (P < 0.001) between benign and malignant histology. Of the 376 patients, 91 (24%) had a PSA level in the intermediate range (4.0–10.0 ng/mL). In these patients PSAD was significantly better than PSA in differentiating between benign and malignant histology (P= 0.027 vs 0.316). With a PSAD limit of 0.15 ng/mL/cm3 in these patients, the sensitivity was 92% and the specificity was 54% for the diagnosis of prostate cancer. No patient with a positive biopsy had a PSAD < 0.11 ng/mL/cm3. No limiting value could be found for PSAD that combined both an acceptable sensitivity and specificity. Of the patients with a malignancy detected by the biopsy, 92% also had a suspect DRE.

Conclusion In patients with intermediate PSA levels, PSAD is of limited additional value when compared to DRE in correctly diagnosing prostate cancer. Acute prostatitis is also a possible cause of elevated PSA. Both PSA and PSAD had no additional value in differentiating between benign prostatic hyperplasia (BPH) and histologically proven extensive prostatitis.
Ex vivo activated memory T‐Iymphocytes as adoptive cellular therapy of human renal cell tumour targets with potentiation by cis‐diamminedichloroplatinum(II)
Authors: GOLD J.E. , MASTERS T.R. , BABBIT B. , FINE E.M. , WEBER H.N. , UNGER P.D. , LEVENTHAL I. , ZIPPE C.D. , OSBAND M.E.
Published: November 2008

Objective To determine if cis‐diamminedichloroplat‐inum(II) (CDDP) enhances, by immune‐modulation, ex vivo anti‐tumour cytotoxicity of autolymphocyte therapy (ALT) against a chemotherapy‐resistant tumour, and if lysis is mediated through T‐cells, NK‐cells, or both.

Materials and methods Human renal cell carcinoma (RCC) target cells were derived from surgical specimens and incubated in complete medium (CM) with CDDP, or in CM alone (control group). ALT‐cells were prepared from autologous whole peripheral blood mononuclear cells (PBMC) or NK‐cell (CD56)‐depleted PBMC obtained before surgery. Tumour cells from each group were labelled with chromium‐51(51Cr) and used as targets for ALT‐cells and PBMC in a standard (4h) and delayed (18 h) 51Cr‐release assay at varying effector/target ratios (E:T).

Results Tumour cells incubated in CDDP showed enhanced lysis, as measured by the 51Cr‐release assay, at all E:T tested. This lysis was significantly greater during the 18 h assay and when ALT‐cells were used as the effector cells rather than PBMC. Depletion of CD45RO+ (memory) T‐cells from the ALT cell population precluded both the 4 and 18 h tumour cell lysis. Depletion of NK‐cells (CD56+) diminished the ex vivo lysis of autologous targets during the 4 but not the 18 h assay. ALT‐cells derived from two patients demonstrated ex vivo tumour‐specificity against autologous and allogeneic RCC.

Conclusions These data suggest that: (i) ex vivo activated memory T‐cells are the principal component demonstrating significant tumour‐specific cytotoxicity of ALT‐cells against RCC tumour targets; (ii) CDDP may alter the physical properties of tumour cells rendering them susceptible to immune‐mediated attack; (iii) the combination of ALT and CDDP may lead to increased therapeutic efficacy in patients with metastatic RCC.
Mapping Highly Detailed Colour Information on Extremely Dense 3D Models: The Case of David's Restoration
Authors: Dellepiane M. , Callieri M. , Ponchio F. , Scopigno R.
Published: November 2008

The support of advanced information technology (IT) to preservation, restoration and documentation of Cultural Heritage (CH) is becoming a very important goal for the research community. Michelangelo's David was one of the first applications of 3D scanning technology on a highly popular work of art. The subsequent restoration campaign, started in 2002 and concluded in 2004, was also a milestone for the adoption of modern scientific analysis procedures and IT tools in the framework of a restoration process. One of the focuses in this restoration was also methodological, i.e. to plan and adopt innovative ways to document the restoration process. In this paper, we present the results of an integration of different restoration data (2D and 3D datasets) which has been concluded recently. The recent evolution of HW and SW graphics technologies gave us the possibility to interactively visualize an extremely dense 3D model which incorporates the colour information provided by two professional photographic campaigns, made before and after the restoration. Moreover, we present the results concerning the mapping, in this case on the 2D media, of the reliefs produced by restorers to assess and document the status of the marble surface before the restoration took place. This result could lead to new and fascinating applications of computer graphics for preservation, restoration and documentation of CH.
STOCK MARKET INTEGRATION FOR THE TRANSITION ECONOMIES: TIME‐VARYING CONDITIONAL CORRELATION APPROACH
Authors: WANG PING , MOORE TOMOE
Published: November 2008

In this paper, we investigate the extent to which the three emerging Central Eastern European stock markets have become integrated with the aggregate eurozone market over the sample period from 1994 to 2006 by utilizing the dynamic conditional correlation. We find a higher level of the stock market correlation during the period after the Asian and Russian crises and also during the post‐entry period to the European Union. It is found that financial market integration seems to be a largely self‐fuelling process, depending on existing levels of financial sector development for the Czech Republic and Hungary.