bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of an enzyme‐linked immunosorbant assay (ELISA) for the serodiagnosis of canine dermatophytosis caused byMicrosporum canis
Authors: PEANO ANDREA , RAMBOZZI LUISA , GALLO MARIA G.
Published: April 2005

Abstract In dogs, dermatophytosis should be considered in any case of alopecic, papular or pustular lesion. The aim of this study was to develop an enzyme‐linked immunosorbant assay (ELISA) as an aid in the diagnosis of canine dermatophytosis. The antigen used was a whole fungal extract obtained from an isolate ofMicrosporum caniscultured on a liquid medium from the parasitized hair of a cat with patches of alopecia. To assess the ELISA performances, sera from 18 dogs with dermatophytosis caused byM. canis(group A,n = 18), 20 dogs with skin diseases other than dermatophytosis and 22 healthy dogs (group B,n = 42) were tested. Four further animals were tested: three with dermatophytosis caused byM. gypseumand one byT. mentagrophytes. A significant difference (P < 0.01, Wilcoxon's test, w = 364) was found between IgG‐specific levels of sera of recentlyM. canis‐infected dogs (infection < 15 days) and controls (although three dogs had negative titres at this stage). A highly significant difference (P < 0.001, w = 462) was noted between controls and dogs with infection of longer duration (> 30 days). All dogs had positive titres at this stage. A highly significant correlation (P < 0.001, Spearman's test, rho = 0.86) between duration of infection and IgG concentration was noted. The test has good sensitivity (83.3%) and high specificity (95.2%) but some dogs retained positive titres after elimination of infection. The sensitivity is higher than that of direct microscopic hair examination and similar to that of fungal culture with DTM (dermatophyte test medium).
Mechanisms behind postspinal headache and brain stem compression following lumbar dural puncture – a physiological approach
Authors: Grände P.‐O.
Published: April 2005

Background:  The cause of postspinal headache and its specific characteristics are unknown, and whether lumbar dural puncture (LP) triggers brain‐stem compression in patients with brain oedema is still controversial.

Methods:  Hydrostatic effects of distal opening of the dural sac towards the atmosphere are described and applied to the normal brain and the brain with disrupted BBB. Analogue analyses from previous results using an isolated skeletal muscle enclosed in a rigid shell were applied to the brain in an attempt to simulate and verify the haemodynamic effects of distal opening of the spinal canal.

Results:  The theoretical considerations and the experimental results are compatible with the hypothesis that hydrostatic effects of distal opening of the fluid‐filled spinal canal may obliterate the normal subdural venous collapse after a change from the horizontal to vertical position, which may be compatible with postural postspinal headache as occurring close to pain‐sensitive meningeal regions. The hydrostatic forces may also initiate transcapillary filtration and aggravate oedema when permeability is increased, which may cause a narrower situation in the brain stem region, perhaps aggravated by venous stasis and a Cushing reflex‐induced increase in blood pressure. An magnetic resonance imaging (MRI) picture illustrates how this scenario may separate the subdural space into an upper high‐ and a lower low‐pressure cavity, pressing the brain downwards with sagging of the brain. A life‐threatening positive feedback situation for brain‐stem compression may develop.

Conclusion:  The present study strongly suggests that postspinal headache and brain‐stem compression and other LP‐related effects are predictable following LP, without involving CSF leakage, and can be explained by hydrostatic effects triggered by distal opening of the normally closed dural space to the atmosphere.
Score system for elective tracheotomy in major head and neck tumour surgery
Authors: Kruse‐Lösler B. , Langer E. , Reich A. , Joos U. , Kleinheinz J.
Published: April 2005

Background:  This study was designed to evaluate prognostic parameters for respiratory failure after major oropharyngeal resections in head and neck cancer surgery, focusing on a score system to identify patients requiring an elective tracheotomy and to avoid tracheotomy under emergency conditions.

Methods:  One hundred and fifty‐two out of 928 patients with oropharyngeal cancers, treated between January 1993 and June 2000 at our hospital, fulfilled the inclusion criteria for a retrospective analysis. This collective underwent tumour resection in different regions of the oropharynx combined with bony resection of the mandible and neck dissection without primary tracheotomy. The reconstruction was accomplished using radial forearm flaps (n1 = 59) or local flaps (n2 = 93). These two groups were subdivided into patients treated post‐operatively by tracheotomy due to respiratory failure (n1 = 26; n2 = 12) and those without such treatment (n1 = 33; n2 = 81). The database comprising tumour localization and size, staging, general medical condition, smoking and alcohol consumption was evaluated by logistic regression.

Results:  We developed a score system which predicts the likelihood of post‐operative respiratory failure. For indication of tracheotomy, tumour size and localization, multimorbidity, alcohol consumption and pathologic chest X‐ray findings were identified as significant parameters with different weightings. The predictive value for tracheotomy (yes/no) using the score system was 96.7% for the total collective.

Conclusion:  The decision on whether or not an elective tracheotomy in major head and neck tumour surgery is necessary can be facilitated using this score system which is based on objective facts. It may reduce post‐operative complications and contribute to safer treatment.
Posterior labat vs. lateral popliteal sciatic block: posterior sciatic block has quicker onset and shorter duration of anaesthesia
Authors: Fournier R. , Weber A. , Gamulin Z.
Published: April 2005

Background:  During foot and ankle surgery, a combination of a sciatic and femoral nerve block is a well‐recognized technique for providing anaesthesia and post‐operative analgesia. Our hypothesis is that the posterior gluteal sciatic block (PSB) is more efficient than the lateral popliteal sciatic block (LPSB), and this study compared the anaesthetic characteristics between these two techniques performed for elective ankle and foot surgery.

Methods:  This retrospective database analysis reviewed the onset, duration of action, success rate and complications among 287 patients who were operated upon using sciatic block. PSB was performed in 149 patients and LPSB in 138 patients, all with the use of 30 ml of 5 mg/ml ropivacaine (150 mg).

Results:  In the PSB group, the time to perform the block was shorter than in the LPSB group (2.5 ± 1 vs. 4.5 ± 4 min, P < 0.001), as was the time to complete sensory block (13 ± 13 vs. 23 ± 26 min, respectively; P < 0.001). However, the duration of sensory block was longer in the LPSB group (1130 ± 470 vs. 960 ± 310 min, respectively; P < 0.006).

Conclusion:  PSB is easier to perform, and has a quicker onset of sensory blockade whereas LPSB has a longer duration of analgesia.
A‐line autoregression index monitoring to titrate inhalational anaesthesia: effects on sevoflurane consumption, emergence time and memory
Authors: Rinaldi S. , Consales G. , Gallerani E. , Ortolani O. , De Gaudio A. R.
Published: April 2005

Background:  A‐line autoregression index (AAI) is a parameter derived from auditory evoked potentials proposed as depth of anaesthesia monitor. We evaluated the effects of AAI guidance on sevoflurane consumption, emergence time, explicit and implicit memory.

Methods:  One hundred patients submitted to major abdominal surgery were randomized into two groups. In group A (n = 50), sevoflurane was titrated according to AAI (target = 20 ± 5), in group B (n = 50) according to clinical signs. Anaesthesia was induced with fentanyl, propofol, atracurium and maintained with sevoflurane. The mean value of sevoflurane consumption (g/min) and emergence time has been assessed in both groups. After emergence, A test of explicit memory was administered. We assessed implicit memory using a category generation test.

Results:  In group A, mean sevoflurane consumption was significantly (P = 0.0001) reduced by 20.4% and mean emergence time was significantly (P = 0.00012) shorter by 2 min with respect to group B. No patients experienced explicit memory while the difference between the two groups in implicit memory results was not significant (P = 0107).

Conclusions:  AAI titration of anaesthesia allows a significant reduction in sevoflurane consumption and emergence time without significant effects on the incidence of explicit and implicit memory. Nevertheless the relationship between AAI and memory requires studies in larger groups of patients.
Plasma concentrations of meperidine and normeperidine following continuous intrathecal meperidine in patients with neuropathic cancer pain
Authors: Vranken J. H. , Van Der Vegt M. H. , Van Kan H. J. M. , Kruis M. R.
Published: April 2005

Background:  Intrathecal administration of meperidine, an opioid with local anesthetic activity, can induce analgesia in patients with intractable cancer pain. However, continuous intrathecal administration may result in the accumulation of normeperidine, responsible for central nervous system toxicity.

Methods:  Ten patients with neuropathic cancer pain, not responding to conventional opioid therapy, were treated with continuous intrathecal administration of meperidine. In all patients, plasma concentrations of meperidine and normeperidine were measured the first days after the start of treatment. Visual analog scale scores were recorded to evaluate pain relief. Quality of life was assessed before and 3 weeks following the start of intrathecal treatment.

Results:  In three patients the plasma concentrations of meperidine and normeperidine increased rapidly. In one patient the plasma normeperidine concentration was higher than the meperidine concentration. One patient demonstrated transient symptoms suggestive for central nervous system excitation. Three weeks following the start of treatment, seven patients were available for evaluation of their quality of life. Pain relief and overall quality of life improved during the intrathecal treatment.

Conclusion:  We conclude that continuous intrathecal administration of meperidine alone, or in combination with clonidine, can provide significant pain relief in patients with poor pain control despite pharmacological treatment. However, accumulation of meperidine and normeperidine resulting in central nervous system toxicity may occur during this treatment.
Effects of hydroxyethyl starch on hepatic production of cytokines and activation of transcription factors in lipopolysaccharide‐administered rats
Authors: Lv R. , Zhou W. , Zhang L. D. , Xu J. G.
Published: April 2005

Background:  Hydroxyethyl starch (HES) is one of the most frequently used plasma substitutes. Some studies have indicated that HES may have anti‐inflammatory effects. The present in vivo study was performed to investigate the effects of HES on hepatic production of cytokines and activation of transcription factors in sepsis.

Methods:  Adult male Sprague‐Dawley rats were randomly divided into four groups: rats challenged with lipopolysaccharide (LPS) (5 mg kg−1) and treated with saline (64 ml kg−1); challenged with LPS (5 mg kg−1) and treated with HES (16 ml kg−1); injected with saline and treated with HES (16 ml kg−1); and saline control. Each hepatic tissue was collected in groups of rats 2 h after induction of endotoxemia for determination of tumour necrosis factor (TNF)‐α levels, TNF‐α mRNA expressions, and nuclear factor (NF)‐κB, activator protein (AP)‐1 activities or 3 h after LPS challenge for IL‐1β, IL‐6, IL‐8, IL‐10 levels and the mRNA expressions.

Results:  Endotoxemia was associated with significant increases in hepatic proinflammatory cytokine productions and transcription factor activities. HES significantly reduced the increased hepatic levels of TNF‐α, IL‐1β, IL‐6, IL‐8 and the mRNAs in the endotoxemic rats. Similarly, HES could inhibit hepatic NF‐κB and AP‐1 activations.

Conclusion:  The results suggest that in sepsis HES may down‐regulate hepatic inflammatory mediators production and these anti‐inflammatory effects may act through inhibition of NF‐κB and AP‐1 activations.
Observations and warning signs prior to cardiac arrest. Should a medical emergency team intervene earlier?
Authors: Nurmi J. , Harjola V. P. , Nolan J. , Castrén M.
Published: April 2005

Background:  The Medical Emergency Team (MET) has evolved in some hospitals as a means of delivering effective treatment early enough to prevent cardiac arrests. Our aim was to analyze the effectiveness of observation practice to detect abnormalities in vital signs prior to cardiac arrest and to determine the need for a MET system in Finnish hospitals.

Methods:  The charts of patients who suffered cardiac arrest during 18 months in four hospitals were reviewed. The vital signs, symptoms and interventions during 8 h prior to arrest were recorded and analyzed against trigger criteria of the MET.

Results:  During the study period, 110 patients suffered cardiac arrest in hospitals, and 56 (51%) of the arrests occurred on the wards. Of those patients, 30 (54%) had an abnormal vital sign fulfilling the MET criteria, documented on average 3.8 h prior to the arrest. During this period, 13 patients did not receive any intervention (e.g. supplemental oxygen or medication), eight received intervention within 1 h and nine received intervention after more than 1 h. Response to the first intervention was not attained in any patient; nevertheless re‐interventions took place in one patient only.

Conclusion:  Significant physiological deterioration seems to be common in the hours before a cardiac arrest on the wards of Finnish hospitals, suggesting that implementation of a MET‐system may be worthwhile. However, the practice of vital sign observation by the nursing staff should be improved before maximal benefit of a MET can be achieved.
Oxygen extraction in pigs subjected to low‐dose infusion of endotoxin after major abdominal surgery
Authors: Porta F. , Takala J. , Kolarova A. , Ma Y. , Redaelli C. A. , Brander L. , Bracht H. , Jakob S. M.
Published: April 2005

Background:  Sepsis may impair O2 extraction due to blood flow redistribution or decreased utilization of the available oxygen.

Methods:  We assessed the effect of endotoxemia on systemic and regional O2 extraction and lactate handling in pigs, randomized to receive either endotoxin (0.4 µg kg−1 h−1; n = 10) or saline infusion (controls; n = 9) for 12 h.

Results:  High baseline regional and systemic O2 extraction in the endotoxin group (median 56%, range 45–77%) and in the controls (67%, 49–72%) was maintained until the end of the experiment (endotoxin group: 60%, 50–71%; controls: 60%, 50–74%) despite hypotension and a decrease in stroke volume in endotoxic animals. Hepatic lactate exchange decreased during endotoxemia from 14 µmol kg−1 min−1 (range 10–28 µmol kg−1 min−1) to 10 (range 3–15) µmol kg−1 min−1; P < 0.01), but remained stable in the controls, with 13 µmol min−1 (4–18 µmol min−1) at baseline and 7 µmol min−1 (3–17 µmol min−1) after 12 h of saline infusion.

Conclusions:  The high and sustained oxygen consumption and oxygen extraction in this endotoxemic model speak against any major impairment of hepatosplanchnic or systemic oxygen extraction and oxidative metabolism. The reduced hepatic lactate exchange despite an unchanged hepatic lactate influx suggests altered metabolic activities independent of oxygen consumption.
Thoracic epidural analgesia via the lumbar approach using nerve stimulation in a pediatric patient with Down syndrome
Authors: Tsui B. C. H. , Entwistle L.
Published: April 2005

This case illustrates the threading of an epidural catheter with electrical stimulation guidance from the lumbar epidural space to the thoracic space in a pediatric patient. A 17‐year‐old boy with Down syndrome, weighing 48 kg, was scheduled to undergo a laparotomy for duodenal obstruction and gastrostomy tube insertion. Combined general and continuous epidural anesthesia was selected for his anesthetic. Following the induction of general anesthesia and tracheal intubation, a 17G Tuohy needle (Arrow International, Inc., Reading, PA) was inserted into the lumbar space (L3–4) using loss of resistance with air. A 20G styletted epidural catheter was then inserted and threaded cranially. As the catheter was advanced, a low electrical current (1–10mA) was applied to the catheter. Motor response was observed from the lower limb muscles to the upper abdominal muscles as the catheter advanced cranially. After 22 cm of the epidural catheter had been inserted, intercostal muscle movement (T9 – 10) was observed at 3.0 mA. Radiographical imaging later confirmed the catheter tip at T10. The patient awoke without distress and was discharged to the ward with subsequent good pain control from a continuous epidural infusion of bupivacaine 0.1% with 1 µg ml−1 fentanyl at 4–6 ml−1.
Intentional lateral epidural catheter placement for anterior cruciate ligament reconstruction
Authors: Dauri M. , Sidiropoulou T. , Fabbi E. , Mariani P. P. , Sabato A. F.
Published: April 2005

Background:  Unilateral epidural block might constitute a clinical option in lower limb orthopedic surgery.

Methods:  Seventy‐five patients undergoing anterior cruciate ligament reconstruction (ACLR) were randomized to either a laterally directed epidural catheter (IUEC, n = 40) or a classic midline catheter (CMEC, n = 35). Paresthesia encountered during catheter insertion was registered. The start dose of the anesthetic mixture clonidine 60 µg (0.4 ml), sufentanil 15 µg (0.3 ml) and ropivacaine 10 mg ml−1(10.3 ml) in 11 ml of total volume) was set at 5 ml and was increased by 2 ml if anesthesia was inadequate after assessment for sensory blockade to cold and pin‐prick. Data were registered intra‐ and postoperatively regarding pain scores as well as motor block, hemodynamic parameters, adverse effects and need for supplemental analgesia other than a continuous postoperative epidural infusion.

Results:  In the IUEC group 80% of patients reported a light paresthesia of the affected side during catheter insertion, whereas 71% of patients in the CMEC group reported no paresthesia at all. The amount of anesthetic used to establish surgical anesthesia was lower in the IUEC group (6.2 ± 0.8 vs. 8 ± 1.9 ml, P < 0.001). Motor block (Bromage score) of the unaffected side was significantly lower in the IUEC group (P < 0.001). Pain intensity scores, hemodynamic parameters, and supplemental analgesia given were similar between the two groups except for VAS scores at 12 h postoperatively, which were higher in the CMEC group (P < 0.01). Urinary retention was significantly more frequent in the CMEC group (19/35 vs. 5/40, P < 0.001).

Conclusion:  These results suggest that the IUEC technique is a feasible and efficient method for providing anesthesia and analgesia for ACLR and is associated with a lower consume of anesthetics, less motor block and a reduced incidence of urinary retention.
Efficacy of vertical infraclavicular plexus block vs. modified axillary plexus block: a prospective, randomized, observer‐blinded study
Authors: Heid F. M. , Jage J. , Guth M. , Bauwe N. , Brambrink A. M.
Published: April 2005

Background:  Despite containing severe risks, infraclavicular approaches to the brachial plexus gained increasing popularity. Likewise, the vertical infraclavicular plexus block improved anesthesia compared to the standard axillary approach but contains the risk of pneumothorax. Therefore we modified the standard axillary technique by inserting a proximal directed catheter, referred to as a high axillary plexus block. We prospectively compared quality and onset of neural blockade after vertical infraclavicular plexus block (VIP) and high axillary plexus block (HAP) in two randomized groups (30 patients in each).

Methods:  In group VIP the insulated needle was inserted midway between the ventral process of the acromion and the jugular notch. In group HAP, first an axillary needle was placed. Through this a stimulating catheter was inserted in a proximal direction (10–15 cm); correct placement was confirmed by nerve stimulation. All patients received 40 ml ropivacaine 0.75% (300 mg). Discriminating between analgesia and anesthesia, a blinded observer assessed progression of neural blockade every 5 min for 60 min by pin prick. Incomplete blocks were supplemented 60 min after initial injection.

Results:  All patients in both groups demonstrated sufficient surgical anesthesia. No patient needed systemic supplementation or general anesthesia. However, vertical infraclavicular plexus block indicated superior anesthesia compared to high axillary plexus block, regarding musculocutaneous, axillary and radial nerve, which were completely blocked with a higher success rate and in a shorter time interval (P < 0.05).

Conclusions:  While both techniques provide sufficient surgical anesthesia, vertical infraclavicular plexus block demonstrated a partially higher success rate and a faster onset than high axillary plexus block.
Altered expression of aquaporin‐2 in human explants with chronic renal allograft dysfunction
Authors: Ho Kossen M.T. , Li Amy Z.L. , Yiu Ming K. , Lee Kam C. , Lui Vincent C.H. , Fung Peter C.W. , Yiu Tim F. , Tam Paul K.H.
Published: April 2005

OBJECTIVE

To investigate the distribution of aquaporins, a recently discovered family of transmembrane water channels, in human renal explants, with specific reference to chronic renal allograft dysfunction (CRAD).

MATERIALS AND METHODS

Immunohistochemistry for aquaporin‐1 and ‐2 was used in 11 explants, of which five had clinically and histologically confirmed CRAD. Controls were taken from the six explants unaffected by CRAD and from histologically normal areas of six kidneys excised for renal tumours.

RESULTS

In the renal tumour control group, aquaporin‐1 immunoreactivity was detected in the glomerular endothelium, Bowman's capsule, the proximal convoluted tubules and the thin limb of the loop of Henle, whereas immunoreactivity for aquaporin‐2 was detected in the collecting ducts only. Of the explants without CRAD, where architecture was preserved, immunoreactivity for aquaporin‐1 and ‐2 was the same as in the renal tumour controls. In the two explants with no CRAD and loss of collecting ducts, there was no aquaporin‐2 immunoreactivity. In five explants with CRAD, immunoreactivity for aquaporin‐2 was decreased or absent from the medulla to the cortex. The apparent decreased immunoreactivity of aquaporin‐1 in this group was secondary to a decrease in the number of viable proximal tubules.

CONCLUSION

There was less aquaporin‐2 immunoreactivity in human renal explants diagnosed with CRAD, starting from the medullary region. In explants with no CRAD and viable collecting ducts, or in normal controls, aquaporin‐2 immunoreactivity remained unchanged. Aquaporins might be useful as markers for CRAD.
The role of bisphosphonates in the treatment of prostate cancer
Authors: Parker Christopher C.
Published: April 2005

In this section there are mini‐reviews on four different important subjects, which should be of general interest. First, there is a critical review of the role of bisphosphonates in the treatment of prostate cancer, followed by a review of the literature on the Bosniak classification of renal cystic masses, a controversial topic which relates to a common problem. These are followed by two mini‐reviews on less common, but also very important topics: renal haemangiopericytoma, and the mechanics of renal ischaemic injury and the impact they have on clinical practice.
Decline in the overall incidence of regional‐distant prostate cancer in Olmsted County, MN, 1980–2000
Authors: Mullan Rebecca J. , Jacobsen Steven J. , Bergstralh Erik J. , Slezak Jeffrey M. , Tindall Donald J. , Lieber Michael M. , Roberts Rosebud O.
Published: April 2005

There are many papers in this section covering a wide range of topics relating to prostate, kidney and bladder cancer. Authors from the Mayo Clinic evaluate trends in the incidence of regional‐distant prostate cancer before and after the introduction of PSA screening in 1987 in their residents in Olmsted County. They found a decrease in the overall incidence of this type of disease, regardless of stage at initial diagnosis.

Authors from the Royal Marsden describe their policy of active surveillance and contrast it with watchful waiting, differentiating clearly between the policies. These are early results, but they make interesting reading. The authors mention ongoing studies which seek to optimise the active surveillance protocol.

OBJECTIVE

To describe trends in the incidence of regional‐distant prostate cancer over the entire course of the disease, before and after the introduction of prostate‐specific antigen screening in 1987.

PATIENTS AND METHODS

All residents of Olmsted County, MN, USA, with a diagnosis of prostate cancer from 1964 to 2000 were identified using the resources of the Rochester Epidemiology Project. Their community medical records were examined to identify men with documented evidence of locally advanced (T3/4 or N+ disease) or metastatic prostate cancer between 1980 and 2000.

RESULTS

In all, 407 men had regional‐distant prostate cancer, based on clinical or pathological staging at the time of initial diagnosis of prostate cancer and/or on radiological information over the entire course of their illness. The age‐adjusted incidence per 100 000 men increased from 47.4 in 1980–86 to 65.8 in 1987–93, and declined to 33.3 in 1994–2000 (P < 0.001). Based on clinical and radiological information over the entire course of illness (268 men) the age‐adjusted incidence of regional‐distant disease was 42.3 in 1980–86, 41.2 in 1987–93, and declined to 18.1 in 1994–2000 (P < 0.001). These latter rates were 27%, 32% and 47% higher for the three periods, respectively, than rates based on clinical staging at initial diagnosis of prostate cancer.

CONCLUSIONS

The overall incidence of regional‐distant stages of prostate cancer has declined in recent years, regardless of the stage at initial diagnosis. This may be a result in part of early detection and curative treatments. These findings also indicate that assessing the incidence of regional‐distant prostate cancer only at the initial diagnosis underestimates the full impact of the benefits of early detection and treatment.
Early outcomes of active surveillance for localized prostate cancer
Authors: Hardie Claire , Parker Chris , Norman Andrew , Eeles Ros , Horwich Alan , Huddart Robert , Dearnaley David
Published: April 2005

OBJECTIVE

To describe the preliminary clinical outcomes of active surveillance (AS), a new strategy aiming to individualize the management of early prostate cancer by selecting only those men with significant cancers for curative therapy, and illustrate the contrast with a policy of watchful waiting (WW).

PATIENTS AND METHODS

Eighty men with early prostate cancer began AS at the authors’ institution between 1993 and 2002. Eligibility included histologically confirmed prostatic adenocarcinoma, fitness for radical treatment, clinical stage T1/T2, N0/X, M0/X, a prostate specific antigen (PSA) level of ≤ 20 ng/mL, and a Gleason score of ≤ 7. PSA was measured and a digital rectal examination conducted at 3–6 month intervals. The decision between continued monitoring or radical treatment was informed by the rate of rise of PSA, and was made according to the judgement of each patient and clinician. During the same period, 32 men with localized prostate cancer (any T stage, N0/X, M0/X, any PSA, Gleason score ≤ 7) were managed by WW; hormonal treatment was indicated for symptomatic prostate cancer progression. The PSA doubling time (DT) was calculated using linear regression of ln(PSA) against time, using all pretreatment PSA values.

RESULTS

At a median follow‐up of 42 months, 64 (80%) of the 80 patients on AS remained under observation, 11 (14%) received radical treatment and five (6%) died from other causes. No patient developed evidence of metastatic disease, none started palliative hormone therapy, and there were no deaths from prostate cancer. Of the 11 patients who received radical treatment all remained biochemically controlled with no clinical evidence of recurrent disease. The median PSA DT while on AS was 12 years. Twenty (62%) of the 32 patients on WW remained on observation, eight (25%) received palliative hormonal therapy and four (12%) died, including one from prostate cancer.

CONCLUSIONS

AS is feasible in selected men with early prostate cancer. The natural history of this disease often appears extremely indolent, and most men on AS will avoid radical treatment. There is a marked contrast between AS (with radical treatment for biochemical progression) and WW (with palliative treatment for symptomatic progression). Ongoing studies are seeking to optimize the AS protocol, and to compare the long‐term outcomes with those of immediate radical treatment.
C‐reactive protein is significantly associated with prostate‐specific antigen and metastatic disease in prostate cancer
Authors: Lehrer Steven , Diamond Edward J. , Mamkine Boris , Droller Michael J. , Stone Nelson N. , Stock Richard G.
Published: April 2005

OBJECTIVE

To further analyse the relationship of c‐reactive protein (CRP) levels to prostate cancer, by measuring CRP in men with prostate cancer and benign prostatic hypertrophy (BPH), as chronic inflammation has long been linked to cancers with an infectious cause and CRP is a nonspecific marker for inflammation, associated with prostate cancer incidence and progression.

PATIENTS AND METHODS

Data from 114 men, most of whom had had radioactive seeds implanted, were evaluated from November 1990 to April 2002. In addition, 27 men were included who had biopsy‐confirmed BPH. CRP was assessed with an automated chemiluminometric high‐sensitivity assay kit.

RESULTS

There was no significant difference in CRP levels in men with localized prostate cancer or BPH but levels were significantly higher in men with bone metastases. There was also a significant correlation of CRP level with prostate‐specific antigen (PSA) in those with cancer. Because PSA is correlated with disease stage, multiple linear regression was used with CRP as the dependent variable, and PSA and disease stage as independent variables. The regression was significant overall (P < 0.001) and the effect of disease stage on CRP (P < 0.001) was independent of the effect of PSA level (P = 0.001).

CONCLUSION

The strong association of CRP with PSA, independent of tumour stage, suggests that inflammation might be fundamental in prostate cancer, and that chronic inflammation may be a legitimate target for prostate cancer chemoprevention and treatment.
A phase I/II dose‐escalation study of exisulind and docetaxel in patients with hormone‐refractory prostate cancer
Authors: Ryan Christopher W. , Stadler Walter M. , Vogelzang Nicholas J.
Published: April 2005

OBJECTIVE

To determine the safety and efficacy, in a dose‐escalation study, of exisulind (an oral sulphone metabolite of sulindac thought to induce apoptosis in malignant cells by inhibiting cGMP‐phosphodiesterase) combined with docetaxel in men with hormone‐refractory prostate cancer (HRPC), as pre‐clinical studies suggested activity against prostate cancer and synergy with cytotoxic agents.

PATIENTS AND METHODS

Thirty‐four patients with HRPC were treated with oral exisulind twice daily for 21‐day cycles and intravenous docetaxel given for 1 h on the first day of each cycle. Three dose levels were assessed, combining exisulind 150 and 250 mg twice daily with docetaxel at 60 or 75 mg/m2. Toxicity was then evaluated using standard criteria.

RESULTS

The recommended phase II dose was determined to be exisulind 250 mg and docetaxel 60 mg/m2, with escalation to 75 mg/m2 after cycle 1, as tolerated. The most common grade 3–4 toxicities among all patients were neutropenia (56%), infection (24%) and hyperglycaemia (18%). Twelve of 32 evaluable patients (38%, 95% confidence interval, CI, 23–55%) had a decline in PSA by at least half. Only four of 17 evaluable patients (95% CI, 1–47%) treated at the phase II dose level had such a decline in PSA. The median (95% CI) overall survival of all patients was 16 (12.9–19.7) months and median progression‐free survival 4.7 (2.7–5.2) months.

CONCLUSION

The combination of exisulind and docetaxel was tolerable in patients with HRPC. The PSA response rates do not suggest an improvement over historical data with single‐agent docetaxel in this population.
Is a digital rectal examination necessary in the diagnosis and clinical staging of early prostate cancer?
Authors: Philip Joe , Dutta Roy Subhajit , Ballal Mohammed , Foster Christopher S. , Javlé Pradip
Published: April 2005

OBJECTIVE

To assess the role of a digital rectal examination (DRE) in the clinical diagnosis of prostate cancer and in predicting the pathological stage, as the diagnosis of early prostate cancer usually comprises prostate‐specific antigen (PSA) testing, a DRE and transrectal ultrasonography (TRUS)‐guided biopsies.

PATIENTS AND METHODS

Over the 4 years between 2000 and 2004, 408 consecutive patients (mean age 63.8 years) referred with age‐specific PSA levels of 2.5–10.0 ng/mL and who had a TRUS‐guided 12‐core prostate biopsy were included in the study. They had a DRE by either of two experienced consultant urologists. The results of the DRE and core biopsy histology were compared with the histology and the radical prostatectomy specimen in a subset (82 men) of the study population.

RESULTS

Cancer was detected on biopsy in 152 patients; of the 196 with an abnormal DRE, 47% had cancer on biopsy. In the patients with a normal DRE, 59 cancers were detected. Men with cancer were older and had a higher median PSA level. There was no correlation between the DRE and biopsy findings, and none between an abnormal DRE and histological diagnosis of cancer. Of the patients who had a radical prostatectomy, 38% had a normal DRE.

CONCLUSION

There was no correlation between the DRE, biopsy findings and pathological staging. The DRE did not contribute to managing patients with prostate cancer, but this does not mean that there is no longer a place for the DRE in assessing the urological patient. If patients are appropriately counselled before PSA testing, a DRE may not be essential for patients with a PSA level of 2.5–10 ng/mL.
Influence of nitrate levels in drinking water on urological malignancies: a community‐based cohort study
Authors: Volkmer Bjoern G. , Ernst Birgitta , Simon Joerg , Kuefer Rainer , Bartsch Georg , Bach Dietmar , Gschwend Juergen E.
Published: April 2005

OBJECTIVE

To evaluate the effect of nitrate levels in the drinking water on the incidence of urological malignancies in a German community.

PATIENTS AND METHODS

For 28 years (1957–86) the community of Bocholt, Germany (70 000 inhabitants) had a drinking water supply with different nitrate levels, i.e. 60 mg/L in group A (57 253 inhabitants) and 10 mg/L in group B (10 037 inhabitants). All newly diagnosed cases of urological malignancies were registered from 1986 to 1997. The incidence was calculated using an age standardization based on the German population.

RESULTS

In all, there were 527 urological malignancies recorded (urothelial cancer 39.8%, renal cell carcinoma 10.8%, testicular tumours 8.0%, penile carcinoma 1.7%, prostate cancer 39.7%). The incidence per 100 000 inhabitants/year of urinary tract tumours was 33.8 in group A and only 17.1 in group B (relative risk, RR 1.98, 95% confidence interval, CI, 1.10–3.54). The RR was 0.87 (0.34–2.22) for renal tumours, 0.66 (0.14–2.88) for penile cancer and 1.06 (0.76–1.48) for prostate cancer. For testicular tumours there was an inverse association with nitrate level, with a RR of 0.43 (0.21–0.90).

CONCLUSION

This study showed an association of nitrate load in drinking water and the incidence of urothelial cancer in both genders, with an inverse correlation to testicular tumours and no correlation with renal, penile and prostatic tumours.
The utility of screening renal ultrasonography: identifying renal cell carcinoma in an elderly asymptomatic population
Authors: Malaeb Bahaa S. , Martin David J. , Littooy Fred N. , Lotan Yair , Waters William B. , Flanigan Robert C. , Koeneman Kenneth S.
Published: April 2005

OBJECTIVE

To evaluate the efficacy and utility of screening renal ultrasonography (RUS) in older patients with a high prevalence of risk factors for renal cell carcinoma (RCC), as with the widespread use of advanced imaging techniques the identification of incidental RCC has increased, and although previous studies in low‐risk groups reported little use for screening RUS, its utility in high‐risk groups is unknown.

PATIENTS AND METHODS

From 1993 to 1997, screening RUS was completed for 6678 consecutive patients in conjunction with the Aneurysm Detection and Management study. Patient demographics, medical and social history were recorded for each patient. Screening RUS was completed by one ultrasonographer using a 3.5‐MHz sector scanner. A urologist verified any abnormalities identified by RUS during consultation. Additional imaging tests were obtained selectively and intervention was recommended based on the results of the genitourinary evaluation.

RESULTS

From the screened population of 6678 patients, 817 (12.3%) renal anomalies were found, including a solid renal mass in 22 (0.32%), simple renal cysts in 627 (9.4%), hydronephrosis in 21 (0.31%), renal calculi in 121 (1.8%), or other abnormalities in 24 (0.36%). Treatment was completed for 15 renal cancers; 13 were organ‐confined on pathological review. At a mean follow‐up of >55 months, 12 of the 15 patients with RCC survived.

CONCLUSIONS

In this older cohort, retroperitoneal RUS was an effective tool for case‐finding by detecting significant findings in an asymptomatic population. The prevalence of solid renal masses (0.32%) was higher than reported with other screening protocols. Although probably not the best method for generalized primary screening, the use of RUS may still be beneficial for ‘secondary’ screening in a more selected patient population.
Analysis of HER2 expression in primary urinary bladder carcinoma and corresponding metastases
Authors: Gårdmark Truls , Wester Kenneth , De La Torre Manuel , Carlsson Jörgen , Malmström Per‐Uno
Published: April 2005

OBJECTIVE

To evaluate the expression of HER2 receptors (previously reported to be over‐expressed in malignant urothelium) in both primary tumours and metastases of transitional cell cancer, using two different staining methods and two different scoring techniques, considering the potential use of these receptors as targets for planned systemic anti‐HER2 nuclide‐based treatment.

MATERIALS AND METHODS

HER2 expression was evaluated with two different immunohistochemical methods in 90 patients with primary urinary bladder cancer tumours and corresponding metastases. Sections were first stained with the commercially available breast cancer test kit (HercepTest®, Dako, Glostrup, Denmark). Parallel sections were then stained with a modified HercepTest procedure. Two different evaluation criteria were compared; the HercepTest score that requires ≥ 10% stained tumour cells (as for breast cancer) and a proposed ‘Target score’ that requires >67% stained tumour cells. The latter score is assumed to be preferable for HER2‐targeted radionuclide therapy.

RESULTS

Using the HercepTest kit, the Target score gave lower fractions of positive primary tumours and metastases than the HercepTest score. The modified HercepTest staining procedure and Target score gave high HER2 values in 80% of primary tumours and 62% of metastases, which is considerably more than that obtained with the HercepTest staining and score. There was a significant decrease in HER2 positivity with increasing distance from the primary tumour. In nine sentinel‐node metastases assessed, all but one were HER2‐positive. Considering all regional metastases, 74% were positive, and of distant metastases, 47%; 72% of the patients with positive primary tumours also expressed HER2 in their metastases.

CONCLUSIONS

When combining the modified HercepTest with customised evaluation criteria, more HER2‐positive tumours were diagnosed. The degree of HER2 down‐regulation was significantly higher in distant than in regional metastases. HER2‐targeted therapy may be an alternative or complementary to other methods in the future treatment of metastatic urinary bladder carcinoma.
Prognostic significance of insulin‐like growth factor (IGF) binding protein‐2 to IGF‐binding protein‐3 ratio in patients undergoing radical cystectomy for invasive transitional cell carcinoma of the bladder
Authors: Miyake Hideaki , Hara Isao , Yamanaka Kazuki , Muramaki Mototsugu , Eto Hiroshi
Published: April 2005

OBJECTIVES

To analyse the prognostic significance of insulin‐like growth factor binding protein‐2 (IGFBP‐2) and IGFBP‐3 in patients having a radical cystectomy for invasive bladder cancer.

PATIENTS AND METHODS

Tissue samples of invasive bladder cancer were obtained from 97 patients who had radical cystectomy. The expression of IGFBP‐2 and IGFBP‐3 mRNAs in these samples was measured by real‐time reverse transcription‐polymerase chain reaction (RT‐PCR), and the findings analysed in relation to clinicopathological factors.

RESULTS

During the observation period, 31 patients (group A) developed disease recurrence, while the remaining 66 (group B) had no evidence of recurrence. The expression level of IGFBP‐2 mRNA was significantly higher in group A than in B, while IGFBP‐3 mRNA expression was significantly lower in group A than in B, and there was a significant difference in the relative expression ratio of IGFBP‐2 to IGFBP‐3 (BP‐2/BP‐3 ratio) between the groups. Recurrence‐free survival in patients with an elevated BP‐2/BP‐3 ratio was significantly lower than in those with a normal ratio. Multivariate analysis indicated that an elevated BP‐2/BP‐3 ratio, but not IGFBP‐2 and IGFBP‐3 mRNA levels, was an independent predictor of disease recurrence.

CONCLUSIONS

These findings suggest that the BP‐2/BP‐3 ratio measured by real‐time RT‐PCR could be useful for predicting disease recurrence in patients who have had a radical cystectomy for invasive bladder cancer.
The results of plaque incision and venous grafting (Lue procedure) to correct the penile deformity of Peyronie's disease
Authors: Kalsi Jas , Minhas Suks , Christopher Nim , Ralph David
Published: April 2005

Associate Editor

Michael G. Wyllie

Editorial Board

Ian Eardley, UK

Jean Fourcroy, USA

Sidney Glina, Brazil

Julia Heiman, USA

Chris McMahon, Australia

Bob Millar, UK

Alvaro Morales, Canada

Michael Perelman, USA

Marcel Waldinger, Netherlands

OBJECTIVE

To assess plaque incision and venous grafting (the Lue procedure) to correct the deformity associated with Peyronie's disease and to maintain penile length, evaluating the results over an 8‐year period.

PATIENTS AND METHODS

The penile deformity of 113 patients (mean age 45 years, range 17–71) with Peyronie's disease was corrected by plaque incision and saphenous vein grafting. All patients had stable Peyronie's disease and had a mean (range) penile deformity of 64.5 (20–180)°; the mean follow‐up was 12 months.

RESULTS

The result was excellent or satisfactory in 105 patients (93%), and the penis completely straightened in 97 (86%). Erectile dysfunction after surgery developed in 10 of 68 potent patients (15%) although they had arterial risk factors of diabetes, hypertension or cardiac disease that may also have contributed. There was penile shortening of >1 cm in 29 men (25%) but this only prevented intercourse in two. Of the 51 patients with ≥ 5 years of follow‐up, the penis remained completely straight in 80% but the incidence of erectile dysfunction increased to 22.5% and penile shortening of >1 cm to 35%.

CONCLUSION

The Lue procedure is an effective long‐term option in the surgical management of Peyronie's disease, but penile shortening after surgery remains a risk, and patients with vascular risk factors must be warned of the possibility of later erectile dysfunction.
A cost comparison of nephron‐sparing surgical techniques for renal tumour
Authors: Lotan Yair , Cadeddu Jeffrey A.
Published: April 2005

The cost of nephron‐sparing renal tumour surgical techniques was compared by authors from Dallas, assessing open partial nephrectomy, laparoscopic partial nephrectomy and percutaneous radiofrequency ablation. They found that radiofrequency ablation was significantly less costly, with the other two techniques being cost‐equivalent.

Authors from Philadelphia devised a study to determine the optimum size of flexible ureteroscope to minimize the need for ureteric dilatation. They found that the ability to pass the ureteroscope was directly related to their outer diameter, with the ideal being 7.4 F.

OBJECTIVE

To compare costs associated with open partial nephrectomy (OPN), laparoscopic PN (LPN) and percutaneous radiofrequency ablation (PRF) in consecutive patients undergoing nephron‐sparing surgery.

PATIENTS AND METHODS

The charts and costs were reviewed for all 46 patients undergoing nephron‐sparing PN at our institution from March 2003 to March 2004. Clinical characteristics, operative techniques, radiographic and pathological information were recorded. Detailed cost information for room and board, laboratory, pharmacy, radiology, operating room, surgical supplies, anaesthesia, recovery room, electrocardiography and respiratory services were obtained from our institution.

RESULTS

The hospital stay was significantly shorter for PRF (0.5 days) than either LPN (1.86) and OPN (4.94). PRF was statistically less costly than LPN and OPN, with mean (sd) costs of (US$) 4454 (938), 7013 (934) and 7767 (1605). There was no significant difference in cost between LPN and OPN. Surgical supply costs were significantly higher for LPN and PRF than OPN. LPN had less than a third of the room and board costs of OPN (P < 0.001). Decreases in room and board were also associated with lower pharmacy and laboratory costs.

CONCLUSIONS

PRF is significantly less costly than LPN and OPN; LPN is cost‐equivalent to OPN as the shorter stay compensates for significantly higher surgical supply costs. In those patients with tumours of appropriate size and location, minimally invasive approaches can decrease the morbidity, with cost benefits.
Ureteric access with flexible ureteroscopes: effect of the size of the ureteroscope
Authors: Hudson R. Guy , Conlin Michael J. , Bagley Demetrius H.
Published: April 2005

OBJECTIVE

To determine the optimum size of a flexible ureteroscope (FU) to minimize the need for ureteric dilatation.

MATERIALS AND METHODS

FUs from several different manufacturers and with different shaft diameters were used for ureteroscopy in adults. An initial attempt was made to pass one of the larger diameter FUs; if this was unsuccessful, the smaller 7.5 F FU was used. The results were reviewed retrospectively.

RESULTS

Flexible ureteroscopy was used in 115 consecutive patients at two different institutions. The ability to pass the FUs with no formal dilatation was directly related to the FU diameter. The rate of failing to pass with no formal dilatation was 37% for the 9.0 F, 8.5% for the 8.6 F, 5% for the 8.4 F and 0.9% for the 7.4 F ureteroscope.

CONCLUSION

Although other factors influence the overall effectiveness of the FU, the ability to pass FUs is directly related to their outer diameter. When only the ease of introduction is considered, the ideal ureteroscope outer diameter is 7.4 F.