bluuebunny/crossref_metadata_2025 huggingface dataset:
Microelectromechanical System-Based Evaporative Thermal Management of High Heat Flux Electronics
Authors: Amon Cristina H. , Yao S.-C. , Wu C.-F. , Hsieh C.-C.
Published: February 2005

This paper describes the development of embedded droplet impingement for integrated cooling of electronics (EDIFICE), which seeks to develop an integrated droplet impingement cooling device for removing chip heat fluxes over 100W/cm2, employing latent heat of vaporization of dielectric fluids. Micromanufacturing and microelectromechanical systems are used as enabling technologies for developing innovative cooling schemes. Microspray nozzles are fabricated to produce 50–100 μm droplets coupled with surface texturing on the backside of the chip to promote droplet spreading and effective evaporation. This paper examines jet impingement cooling of EDIFICE with a dielectric coolant and the influence of fluid properties, microspray characteristics, and surface evaporation. The development of micronozzles and microstructured surface texturing is discussed. Results of a prototype testing of swiss-roll swirl nozzles with dielectric fluid HFE-7200 on a notebook PC are presented. This paper also outlines the challenges to practical implementation and future research needs.
Thermal Transport in Nanostructured Solid-State Cooling Devices
Authors: Li Deyu , Huxtable Scott T. , Abramson Alexis R. , Majumdar Arun
Published: February 2005

Low-dimensional nanostructured materials are promising candidates for high efficiency solid-state cooling devices based on the Peltier effect. Thermal transport in these low-dimensional materials is a key factor for device performance since the thermoelectric figure of merit is inversely proportional to thermal conductivity. Therefore, understanding thermal transport in nanostructured materials is crucial for engineering high performance devices. Thermal transport in semiconductors is dominated by lattice vibrations called phonons, and phonon transport is often markedly different in nanostructures than it is in bulk materials for a number of reasons. First, as the size of a structure decreases, its surface area to volume ratio increases, thereby increasing the importance of boundaries and interfaces. Additionally, at the nanoscale the characteristic length of the structure approaches the phonon wavelength, and other interesting phenomena such as dispersion relation modification and quantum confinement may arise and further alter the thermal transport. In this paper we discuss phonon transport in semiconductor superlattices and nanowires with regards to applications in solid-state cooling devices. Systematic studies on periodic multilayers called superlattices disclose the relative importance of acoustic impedance mismatch, alloy scattering, and crystalline imperfections at the interfaces. Thermal conductivity measurements of mono-crystalline silicon nanowires of different diameters reveal the strong effects of phonon-boundary scattering. Experimental results for Si/SiGe superlattice nanowires indicate that different phonon scattering mechanisms may disrupt phonon transport at different frequencies. These experimental studies provide insight regarding the dominant mechanisms for phonon transport in nanostructures. Finally, we also briefly discuss Peltier coolers made from nanostructured materials that have shown promising cooling performance.
Heat Transfer in Water-Cooled Silicon Carbide Milli-Channel Heat Sinks for High Power Electronic Applications
Authors: Bower C. , Ortega A. , Skandakumaran P. , Vaidyanathan R. , Phillips T.
Published: February 2005

Heat transfer and fluid flow in a novel class of silicon carbide water-cooled milli-channel heat sinks were investigated. The heat sinks were manufactured using an extrusion freeform fabrication (EFF) rapid prototyping technology and a water-soluble polymer material. Rectangular heat exchangers with 3.2 cm×2.2 cm planform area and varying thickness, porosity, number of channels, and channel diameter were fabricated and tested. The perchannel Reynolds number places the friction coefficients in the developing to developed hydrodynamic regime, and showed excellent agreement with laminar theory. The overall heat transfer coefficients compared favorably with the theory for a single channel row but not for multiple rows.
A Multi-Grid Based Multi-Scale Thermal Analysis Approach for Combined Mixed Convection, Conduction, and Radiation Due to Discrete Heating
Authors: Tang Lan , Joshi Yogendra K.
Published: February 2005

A multi-grid embedded multi-scale approach is presented for conjugate heat transfer analysis of systems with a wide range of length scales of interest. The multi-scale analysis involves a sequential two-step “zoom-in” approach to resolve both the large length scales associated with the system enclosure, and the smaller length scales associated with fine spatial structures of discrete heat sources contained within. With this approach, computation time is shortened significantly, compared to conventional single-step computational fluid dynamics/computational heat transfer (CFD/CHT) modeling, with a very fine mesh. Performance of the two-step multi-scale approach is further enhanced by integrating the multi-grid technique in the CFD/CHT solver. Implementation of the enhanced approach is demonstrated for thermal analysis of an array of substrate mounted discrete heat sources cooled by mixed and forced convection, with accompanying experiments performed for validation and for the assessment of the importance of mixed convection. It is found that the multi-grid embedded multi-scale thermal analysis reduces simulation run time by 90% compared to the multi-grid integrated single step solution. The computed temperatures were in good agreement with measurements, with maximum deviation of 8%.
A meta-clustering analysis indicates distinct pattern alteration between two series of gene expression profiles for induced ischemic tolerance in rats
Authors: Kano Makoto , Tsutsumi Shuichi , Kawahara Nobutaka , Wang Yan , Mukasa Akitake , Kirino Takaaki , Aburatani Hiroyuki
Published: February 2005

We have developed a visualization methodology, called a “cluster overlap distribution map” (CODM), for comparing the clustering results of time series gene expression profiles generated under two different conditions. Although various clustering algorithms for gene expression data have been proposed, there are few effective methods to compare clustering results for different conditions. With CODM, the utilization of three-dimensional space and color allows intuitive visualization of changes in cluster set composition, changes in the expression patterns of genes between the two conditions, and relationship with other known gene information, such as transcription factors. We applied CODM to time series gene expression profiles obtained from rat four-vessel occlusion models combined with systemic hypotension and time-matched sham control animals (with sham operation), identifying distinct pattern alteration between the two. Comparisons of dynamic changes of time series gene expression levels under different conditions are important in various fields of gene expression profiling analysis, including toxicogenomics and pharmacogenomics. CODM will be valuable for various types of analyses within these fields, because it integrates and simultaneously visualizes various types of information across clustering results.
Urethrovasocutaneous Fistula in a Case of Anterior Urethral Stricture
Authors: Singh S.K. , Rai R.S. , Sharma S.K.
Published: February 2005

The occurrence of an urethrovasocutaneous fistula is an extremely rare event. We report the first case of such a fistula in a patient with anterior urethral stricture. The patient had epididymo-orchitis preceding the occurrence of the fistula. Increased intravesical and intraurethral pressure during voiding and the patulous ejaculatory ducts were the predisposing factors in this case. The patient was managed successfully by visual internal urethrotomy, bilateral vasectomy and excision of the fistula.
The Unfortunate Influence of the Weather on the Rate of Ageing: Why Human Caloric Restriction or Its Emulation May Only Extend Life Expectancy by 2–3 Years
Authors: de Grey Aubrey D.N.J.
Published: February 2005

Much research interest, and recently even commercial interest, has been predicated on the assumption that reasonably closely-related species – humans and mice, for example – should, in principle, respond to ageing-retarding interventions with an increase in maximum lifespan roughly proportional to their control lifespan (that without the intervention). Here, it is argued that the best-studied life-extending manipulations of mice are examples of a category that is highly unlikely to follow this rule, and more likely to exhibit only a similar absolute increase in maximum lifespan from one species to the next, independent of the species’ control lifespan. That category – reduction in dietary calories or in the organism’s ability to metabolize or sense them – is widely recognized to extend lifespan as an evolutionary adaptation to transient starvation in the wild, a situation which alters the organism’s optimal partitioning of resources between maintenance and reproduction. What has been generally overlooked is that the extent of the evolutionary pressure to maintain adaptability to a given duration of starvation varies with the frequency of that duration, something which is – certainly for terrestrial animals and less directly for others – determined principally by the weather. The pattern of starvation that the weather imposes is suggested here to be of a sort that will tend to cause all terrestrial animals, even those as far apart phylogenetically as nematodes and mice, to possess the ability to live a similar maximum absolute (rather than proportional) amount longer when food is short than when it is plentiful. This generalization is strikingly in line with available data, leading (given the increasing implausibility of further extending human mean but not maximum lifespan in the industrialized world) to the biomedically and commercially sobering conclusion that interventions which manipulate caloric intake or its sensing are unlikely ever to confer more than 2 or 3 years’ increase in human mean or maximum lifespan at the most.
Physical Exercise Retards the Development of Chronic Nephropathy in the Ageing Rat as Efficiently as Food Restriction Does
Authors: Loupal Gerhard , Url Angelika , Skalicky Monika , Viidik Andrus
Published: February 2005

Background: Obesity combined with decreasing physical fitness in the ageing Western populations promotes a number of degenerative diseases, including chronic kidney disease. It has further been shown in rodent models that prevention of obesity by food restriction mitigates development of kidney lesions. Whether lifelong physical activity also has a positive effect is not known. Objective: To compare the effects of physical exercise and food restriction on the development of chronic kidney lesions in ageing rats. Methods: Male Sprague-Dawley rats were divided into groups: voluntarily running in wheels (RW), food restriction to the degree necessary to attain pair weight to RW rats (PW), forced running in treadmills (TM) and sedentary controls housed individually (S1) or 4 in each cage (S4). The interventions began at the age of 5 months and kidneys were sampled and analysed histologically at the ages of 15, 19 and 23 months. Results: Total score for kidney lesions (sum of the scores for glomerular changes, interstitial non-purulent inflammation, proteinaceous casts in tubules and increased amount of connective tissue, the possible maximum being 10.0) increased from 0.5 ± 0.2 at 5 months of age to 1.6 ± 0.3 for RW, 2.3 ± 0.4 for PW, 4.5 ± 0.4 for TM, 3.6 ± 0.5 for S1 and 5.4 ± 0.6 for S4 at the age of 23 months. The increase from 5 months of age was gradual for all groups through 15, 19 and 23 months. The patterns for the various lesions followed the same pattern with the exception of connective tissue, which did not increase. Conclusion: Voluntary running in wheels is as effective in mitigating kidney lesions as is food restriction, while forced running in a treadmill is not effective in this respect.
Improved Physical Performance in Older Adults Undertaking a Short-Term Programme of High-Velocity Resistance Training
Authors: Henwood Tim R. , Taaffe Dennis R.
Published: February 2005

Background: The age-related loss of muscle power in older adults is greater than that of muscle strength and is associated with a decline in physical performance. Objective: To investigate the effects of a short-term high-velocity varied resistance training programme on physical performance in healthy community-dwelling adults aged 60–80 years. Methods: Subjects undertook exercise (EX; n = 15) or maintained customary activity (controls, CON; n = 10) for 8 weeks. The EX group trained 2 days/week using machine weights for three sets of eight repetitions at 35, 55, and 75% of their one-repetition maximum (the maximal weight that an individual can lift once with acceptable form) for seven upper- and lower-body exercises using explosive concentric movements. Results: Fourteen EX and 10 CON subjects completed the study. Dynamic muscle strength significantly increased (p = 0.001) in the EX group for all exercises (from 21.4 ± 9.6 to 82.0 ± 59.2%, mean ± SD) following training, as did knee extension power (p < 0.01). Significant improvement occurred for the EX group in the floor rise to standing (10.4 ± 11.5%, p = 0.004), usual 6-metre walk (6.6 ± 8.2%, p = 0.010), repeated chair rise (10.4 ± 15.6%, p = 0.013), and lift and reach (25.6 ± 12.1%, p = 0.002) performance tasks but not in the CON group. Conclusions: Progressive resistance training that incorporates rapid rate-of-force development movements may be safely undertaken in healthy older adults and results in significant gains in muscle strength, muscle power, and physical performance. Such improvements could prolong functional independence and improve the quality of life.
Factors Predicting Dynamic Balance and Quality of Life in Home-Dwelling Elderly Women
Authors: Karinkanta S. , Heinonen A. , Sievänen H. , Uusi-Rasi K. , Kannus P.
Published: February 2005

Background: Proper balance seems to be a critical factor in terms of fall prevention among the elderly. Objective: The purpose of this cross-sectional study was to examine factors that are associated with dynamic balance and health-related quality of life in home-dwelling elderly women. Methods: One hundred and fifty-three healthy postmenopausal women (mean age: 72 years, height: 159 cm, weight: 72 kg) were examined. General health and physical activity were assessed by a questionnaire. Quality of life was measured using a health-related quality of life questionnaire (Rand 36-Item Health Survey 1.0). Dynamic balance (agility) was tested by a figure-of-eight running test. Static balance (postural sway) was tested on an unstable platform. Maximal isometric strength of the leg extensors was measured with a leg press dynamometer. Dynamic muscle strength of lower limbs was tested by measuring ground reaction forces with a force platform during common daily activities (sit-to-stand and step-on-a-stair tests). Results: Concerning physical activity, 33% of the subjects reported brisk exercise (walking, Nordic walking, cross-country skiing, swimming and aquatic exercises) at least twice a week, and 22% some kind of brisk activity once a week in addition to lighter physical exercise. The remaining 45% did not exercise regularly and were classified as sedentary. The correlations of step-on-a-stair and sit-to-stand ground reaction forces, and leg extensor strength to dynamic balance were from –0.32 to –0.43 (the better the strength, the better the balance). In the regression analysis with backward elimination, step-on-a-stair and sit-to-stand ground reaction forces, and leg extensor strength, age, brisk physical activity, number of diseases and dynamic postural stability explained 42% of the variance in the dynamic balance. Similarly, dynamic balance (figure-of-eight running time), number of diseases and walking more than 3 km per day explained 14% of the variance in the quality of life score. Of these, figure-of-eight running time was the strongest predictor of the quality of life score, explaining 9% of its variance. Conclusion: This study emphasizes the concept that in home-dwelling elderly women good muscle strength in lower limbs is crucial for proper body balance and that dynamic balance is an independent predictor of a standardized quality of life estimate. The results provide important and useful information when planning meaningful contents for studies related to fall prevention and quality of life and interventions in elderly women.
Left Ventricular Function at Peak All-Out Anaerobic Exercise in Older Men
Authors: Sagiv Michael , Ben-Sira David , Sagiv Moran , Goldhammer Ehud
Published: February 2005

Background: All-out anaerobic exercise may be dangerous for the older population, due to hypoxia and inappropriate blood pressure response. Objectives: This study compared and evaluated left ventricular function at peak all-out anaerobic effort in 12 well-trained older (58 ± 1 years) and 12 young men (22 ± 1 years). Methods: Subjects were studied by echocardiography at peak all-out anaerobic exercise, on a cycle ergometer. Results: Seven older subjects experienced ECG abnormalities. Significant (p < 0.05) differences between the older group and the young group, respectively, were noted for: cardiac output (9.8 ± 0.9 and 15.8 ± 0.9 l·min–1), left ventricular end-systolic pressure-volume ratio (4.7 ± 0.8 and 4.4 ± 4.9), left ventricular end-diastolic volume (104.8 ± 6.9 and 125.7 ± 6.2 ml), ejection fraction (67.1 ± 6.0 and 59.8 ± 5.5%), left ventricular end-systolic pressure volume ratio (4.4 ± 0.4 and 4.8 ± 0.3 ratio), and total peripheral resistance (966.0 ± 84.0 and 660 ± 82.8 dyn·s–1·cm–5). Conclusions: Data suggest that during all-out anaerobic exercise, forces opposing ejection were not reduced enough to avoid left ventricular dysfunction and ECG abnormalities in the older subjects. This is attributed to functional changes with age in the myocardium and associated blood vessels, leading to impairment of left ventricular function and blunted inotropic and chronotropic responses to catecholamine. Therefore, an all-out anaerobic-type effort should not be given to an older subject due to the great hazardous potential.
Aging, Longevity, and Diet: Historical Remarks on Calorie Intake Reduction
Authors: Schäfer Daniel
Published: February 2005

Background: The link between longevity and diet is of great interest to biological and gerontological research. The fact that relevant knowledge has generally been available for many centuries is often not remarked upon. Objective: This article examines three aspects of early modern Western medicine which thematize the following links between the elderly, longevity and caloric intake: (1) the question of a diet specifically tailored to old age as background to certain theories of aging; (2) the transfer of these dietetic concepts to younger patients in order to improve health and extend life, and (3) the promotion of dieting in order to avoid the consequences of plethora and to retard the aging process. Methods: A number of Latin texts from premodern medical and health literature will be examined and their contents will be analyzed for material relating to diet for the elderly and longevity in their historic contexts. Results: We will clearly indicate fundamental parallels as well as differences between historic and modern scientific thought. We will thereby show that although a modern understanding of hormones and molecular genetics was obviously lacking, basic knowledge of the influence of nutrition on old age was prevalent. In contrast, the early modern lay concept of longevity through calorie reduction was based on coincidental observation. Conclusion: These premodern, but nonetheless rational ideas must be integrated into the socio-cultural setting and the question must be raised as to the link between contemporary research aims and social reality.
Sensory and Cognitive Factors Influencing Functional Ability in Older Adults
Authors: Wood Kimberly M. , Edwards Jerri D. , Clay Olivio J. , Wadley Virginia G. , Roenker Daniel L. , Ball Karlene K.
Published: February 2005

Background: Age-related sensory and cognitive impairments have been related to functional performance in older adults. With regard to cognitive abilities, processing speed in particular may be strongly related to older adults’ abilities to perform everyday tasks. Identifying and comparing cognitive correlates of functional performance is particularly important in order to design interventions to promote independence and prevent functional disability. Objective: The present study examined the relative importance of cognitive (specifically, speeded and nonspeeded) and sensory factors in relation to older adults’ functional abilities. Functional abilities included measures of mobility and performance of everyday activities. Methods: A cross-sectional study design was employed. Five hundred and thirty adults between the ages of 62 and 94 completed measures of sensory, cognitive (including processing speed, attention, memory, intelligence) and functional abilities. Results: Overall, functional performance was most strongly associated with cognitive speed performance, but nonspeeded cognitive and sensory abilities also accounted for significant amounts of variance in functional performance. Age explained a small but statistically significant amount of additional variance in some functional abilities, but no additional variance in self-reported mobility measures. Conclusion: These findings point to the potential impact of multifaceted training programs, targeting both sensory and cognitive abilities for maintaining functional abilities.
Creutzfeldt-Jakob Disease and Homocysteine Levels in Plasma and Cerebrospinal Fluid
Authors: Bleich Stefan , Otto Markus , Zerr Inga , Kropp Stefan , Kretzschmar Hans A. , Wiltfang Jens
Published: February 2005

Background: There is evidence that homocysteine contributes to various neurodegenerative disorders. Objective: To assess the values of homocysteine in patients with Creutzfeldt-Jakob disease (CJD) in both cerebrospinal fluid (CSF) and plasma. Methods: Study design: Case control study. Total homocysteine was quantified in CSF and plasma samples of CJD patients (n = 13) and healthy controls (n = 13). Results: Mean values in healthy controls: 0.15 µmol/l ± 0.07 (CSF) and 9.10 µmol/l ± 2.99 (plasma); mean values in CJD patients: 0.13 µmol/l ± 0.03 (CSF) and 9.22 µmol/l ± 1.81 (plasma). No significant differences between CJD patients and controls were observed (Mann-Whitney U, p > 0.05). Conclusions: The results indicate that the CSF and plasma of CJD patients showed no higher endogenous levels of homocysteine as compared to normal healthy controls. These findings provide no evidence for an additional role of homocysteine in the pathogenetic mechanisms underlying CJD neurodegeneration.
Usefulness of the (F/T)/PSA Density Ratio to Detect Prostate Cancer
Authors: Veneziano Salvatore , Pavlica Pietro , Compagnone Gaetano , Martorana Giuseppe
Published: February 2005

Introduction: Prostate-specific antigen (PSA) is the most important marker in the detection of prostate cancer, but its reliability is limited by a low specificity. To improve the specificity of PSA, a new parameter, based on the combination of free/total PSA (F/T) with PSA density, is proposed. Materials and Methods: From April 1999 to June 2003, a series of 647 men with high serum PSA levels were submitted to ultrasound-guided multiple prostate biopsies. Total PSA and free PSA were measured by immunoassay (DASIT, Italy). Receiver operating characteristic (ROC) curves of PSA density, F/T and (F/T)/PSA density (F/T divided by PSA/prostate volume) were constructed, and relative specificity and sensitivity were calculated. Results: Prostate cancer was present in 284 cases (137 of them with PSA values between 4 and 10 ng/ml), 31 patientshad intraepithelial neoplasia and the remaining cases showed benign prostatic hyperplasia. Analysis of ROC curves in all examined patients showed that the area under the curve (AUC) for (F/T)/PSA density (0.849) was significantly higher than the AUC for F/T (0.681) (p = 0.012). Similar results were observed in the cases with PSA levels between 4 and 10 ng/ml, where the AUC for (F/T)/PSA density (0.768) was significantly higher than the AUC for F/T (0.610) (p = 0.041). In our study, the prostate cancer risk became very high when (F/T)/PSA density values decreased to <1.5. Conclusion: The use of the (F/T)/PSA density ratio may be useful in the detection of prostate cancer, reducing unnecessary prostate biopsies. A cutoff of 1.5 for the (F/T)/PSA density value is recommended for patients with PSA levels between 4 and 10 ng/ml.
Importance of Transition Zone Prostate Biopsies in Patients with Gray-Zone PSA Levels Undergoing the Ultrasound-Guided Systematic Ten-Biopsy Regimen for the First Time
Authors: Ishizuka O. , Mimura Y. , Oguchi T. , Kawakami M. , Nishizawa O.
Published: February 2005

Introduction: We analyzed the efficacy of routine transition zone biopsies for patients undergoing ultrasound-guided systematic prostate biopsies for the first time because of an elevated serum prostate-specific antigen (PSA) level. Patients and Methods: Using the systematic ten-biopsy regime, four additional transition zone biopsies were performed in 236 consecutive patients, because they showed an elevated PSA level (range 4.0– 9.9 ng/ml). Results: The overall prostate cancer detection rate was 21.2% (50/236). In 24 patients (48.0%), cancers were detected only in the peripheral zone, in 4 (8.0%) only in the transition zone, and in 22 (44.0%) in both zones. No distinguishing characteristics could be determined for the cancers detected in the transition zone only. Conclusions: Although the cancer detection rate for the transition zone was significantly lower than for the peripheral zone, it was higher than that reported in most other studies which may have included biopsy specimens from patients with advanced prostate cancers. The usefulness of transition zone biopsies for the detection of early-stage prostate cancer, especially in patients with a PSA gray zone, can, therefore, not be denied.
Prognostic Significance of the Tumor Volume in Radical Prostatectomy Specimens after Neoadjuvant Hormonal Therapy
Authors: Miyake Hideaki , Sakai Iori , Harada Ken-ichi , Takechi Yoshizumi , Hara Isao , Eto Hiroshi
Published: February 2005

Introduction: The objective of this study was to determine whether the tumor volume in radical prostatectomy specimens of patients with prostate cancer who underwent neoadjuvant hormonal therapy (NHT) could be used as a prognostic predictor. Patients and Methods: In this study, we included 96 patients who underwent NHT followed by radical prostatectomy between January 1995 and July 2003 in our institutions. Several clinicopathological factors of these patients were analyzed, focusing on the association between tumor volume in radical prostatectomy specimens and disease recurrence. Results: The tumor volume in radical prostatectomy specimens after NHT was significantly associated with capsular penetration, seminal vesicle invasion, and lymph node metastases, among the factors examined in this study. The biochemical recurrence-free survival rates in patients with tumor volumes <1.0 cm3 were significantly higher than in those having tumor volumes ≧1.0 cm3. However, multivariate analysis showed that the tumor volume could not be used as an independent predictor for biochemical recurrence. Conclusions: In patients who received NHT prior to radical prostatectomy, the tumor volume was shown to correlate with other prognostic indicators. Furthermore, a higher probability of biochemical recurrence was noted, when there was a residual tumor volume ≧1.0 cm3 after NHT. Thus, careful follow-up and, if necessary, additional treatment should be considered in cases demonstrating tumor volumes ≧1.0 cm3 after NHT.
Lower Incidence of Inguinal Hernia: Minilaparotomy Radical Retropubic Prostatectomy Compared with Conventional Technique
Authors: Nomura Takeo , Mimata Hiromitsu , Kitamura Hirokazu , Fujikura Yoshihisa , Akita Yasuyuki , Yamasaki Mutsushi , Nakano Daisaku , Tasaki Yoshihisa , Nomura Yoshio
Published: February 2005

Introduction: The purpose of the present study was to compare the incidence of inguinal hernias after conventional and minilaparotomy (minilap) radical retropubic prostatectomy (RRP). Patients and Methods: In this retrospective study, we review our experience with 70 consecutive patients with prostate cancer who underwent prostatectomy from April 1995 through March 2001. Of these, 35 patients had conventional RRP, and 35 patients had minilap RRP. Results: Conventional RRP and minilap RRP groups were similar in body mass index (mean 24.4 and 23.5), operative time (mean 260 and 241 min), previous lower abdominal operation record (mean 37.1 and 25.7%), and post-prostatectomy anastomotic strictures (mean 11.4 and 14.3%). The volume of the estimated blood loss was significantly less for minilap RRP (mean 1,220 ml) than for conventional RRP (mean 1,666 ml; p = 0.0194). The incidence of postoperative inguinal hernias was 17.1% (6 of 35), 2.9% (1 of 35), and 3.2% (1 of 31) in conventional RRP, minilap RRP, and unoperated groups, respectively. The incidence of inguinal hernias after minilap RRP was significantly lower than after conventional RRP (p = 0.0464). Seven patients with postoperative inguinal hernias had a high incidence of postoperative strictures (42.9%), while 63 patients without hernia had a low incidence (9.5%). There was a significant difference in developing postoperative strictures between patients with hernia and those without (p = 0.0124). While postoperative stricture and operative technique were different in the hernia and hernia-free groups on univariate analysis, multivariate logistic analysis revealed that the operative technique was an independent factor for the occurrence of inguinal hernias (p = 0.0419). Conclusion: Minilap RRP compares favorably with conventional RRP in view of the postoperative inguinal hernia development.
Clinical Usefulness of Pelvic Floor Reeducation for Men Undergoing Radical Prostatectomy
Authors: Pannek Jürgen , König Jens E.
Published: February 2005

Introduction: Urinary incontinence after radical prostatectomy is a significant clinical problem. We evaluated the clinical usefulness of early-onset pelvic floor reeducation (EPFR) as compared with later-onset pelvic floor reeducation (LPFR) in patients undergoing radical retropubic prostatectomy. Patients and Methods: The continence status of 132 consecutive patients who underwent retropubic radical prostatectomy for clinically localized prostate cancer was assessed 1 year later by a standardized questionnaire. Fifty-eight patients started EPFR 7 days after surgery. Fifty-five patients attended LPFR 4 weeks after surgery. Forty-six patients received no pelvic floor retraining, 28 attended LPFR without EPFR, 27 patients received EPFR and LPFR, and 31 patients attended EPFR without LPFR. Results: Overall, 87 men were continent, 37 patients felt moderately incontinent, and 8 men suffered from severe incontinence. We could not observe a statistically significant influence of any kind of pelvic floor reeducation on continence status, time to continence, frequency or volume of urine loss, or the use of pads. Conclusion: A routine prophylactic use of combined EPFR and LPFR in all patients does not seem to be justified.
Do BPH Patients Have Neurogenic Detrusor Dysfunction? A Uro-Neurological Assessment
Authors: Sakakibara Ryuji , Hamano Satoshi , Uchiyama Tomoyuki , Liu Zhi , Yamanishi Tomonori , Hattori Takamichi
Published: February 2005

Introduction: Most men with benign prostatic hyperplasia (BPH) are middle- aged and elderly. Neurogenic detrusor dysfunction (NDD) may also occur in these populations. We made an uro-neurological assessment in such patients in order to investigate the possibility of a concurrent NDD in patients diagnosed with BPH, and to correlate the presence of NDD with treatment outcome. Materials and Methods: 28 men, mean age 66.4 years, referred by urologists at the outpatient clinic as BPH (initial diagnosis: BPH alone, 24, BPH and NDD, 4) with regards to digital examination and lower urinary tract symptoms, underwent urodynamic study and neurological examination. MRI scans were performed to confirm the diagnosis. Results: Urodynamic study (except for 2, acontractile detrusor (AD)) showed equivocal obstruction (EO), 6; underactive detrusor (UD), 9 (voiding phase); detrusor overactivity (DO), 12; urethral relaxation, 1, and reduced sensation, 5 (filling phase). EO correlated with the presence of UD (p = 0.03). DO did not correlate with the prostate size or urodynamically-defined outlet obstruction. Reduced sensation was common in patients >65 years of age (p = 0.05). Neurological examination/imaging showed exaggerated reflexes, 1; decreased reflexes, 6; multiple cerebral infarction, 8; cervical spondylosis, 1 (in patients with DO); lumbar spondylosis, 5 (in patients with AD/UD), and the final diagnosis was made: definite BPH, 6; probable BPH, 9; BPH and NDD, 13, and NDD were common in the patients aged >65 years (p = 0.015). Transurethral prostatectomy and α-blocker were mostly successful, but the failure rate was reported in definite BPH, none, probable BPH, 29%, and BPH and NDD, 33%. Conclusions: BPH patients, particularly those >65 years of age, commonly have NDD. Multiple cerebral infarction (upper neuron disorder) and lumbar spondylosis (lower neuron disorder) might contribute to DO and UD, respectively. A uro-neurological assessment is important to select typical BPH patients for maximizing therapeutic benefit.
Pre-Surgical Finasteride Therapy in Patients Treated Endoscopically for Benign Prostatic Hyperplasia
Authors: Crea G. , Sanfilippo G. , Anastasi G. , Magno C. , Vizzini C. , Inferrera A.
Published: February 2005

Introduction: Transurethral resection of the prostate is considered the standard technique for patients with moderate or severe lower urinary tract symptoms related to benign prostatic hyperplasia (BPH). Pathologically BPH is characterized by an increased proliferation of stromal and acinar cells, sustained by increased vascularization (neoangiogenesis). Recent studies have also shown that finasteride reduces angiogenesis and prostatic bleeding associated with BPH. Reducing the volume as a final step in reducing neoangiogenesis could thus represent a fundamental advance in limiting intra- and postoperative bleeding in patients undergoing transurethral resection of the prostate (TURP). Materials and Methods: Our study included 60 patients undergoing TURP between January 2001 and January 2002. Of the patients, 30 received pretreatment with finasteride while 30 did not undergo any pretreatment (control group). In all the patients we evaluated the degree of peri-surgical bleeding, intended as a reduction in hemoglobin values in the 24 h following surgery. Results and Conclusions: In the group of patients pretreated with finasteride, blood loss, evaluated as a reduction in hemoglobin values, was minimal, and none of the patients required blood transfusion. The average hemoglobin loss in the 24 h following surgery was 0.9%. In the control group (average age 67 years), 4 patients (12%) required blood transfusion. The loss of hemoglobin was 2.36%. Finasteride, therefore, seems to play a fundamental role in the pretreatment of TURP patients, since by reducing dihydrotestosterone synthesis, it interacts with endothelial growth factors, thus reducing angiogenesis and preventing bleeding.
Subjective Pain Scale and the Need for Analgesia during Shock Wave Lithotripsy
Authors: Oh Seung-June , Ku Ja Hyeon , Lim Dae Jung , Byun Seok-Soo , Kim Hyeon Hoe
Published: February 2005

Objective: To investigate patients’ opinions on the degree of pain during shock wave lithotripsy, and the need for analgesics in patients with urinary stone. Methods: A prospective questionnaire study involving subjective pain assessment during and just after shock wave lithotripsy was performed in consecutive patients with uncomplicated renal or ureteral stones. The patients were given unbiased information on the analgesics prior to the procedure. Ten minutes after beginning shock wave lithotripsy, the degree of pain was rated by the patient using a 10-point visual analog scale. After the procedure, the patients were asked to complete a self-administered questionnaire. Based on the response for the questionnaire, the patients were divided as ‘tolerable’ or ‘non-tolerable’ group. Results: The results from 180 patients (males 113, females 67) with a mean age of 50.0 ± 13.0 were analyzed. The average subjective pain score was 6.6 ± 2.3 during the procedure, and 70 (38.9%) patients responded that they were able to tolerate the pain without analgesics. A total of 116 (64.4%) patients did not agree that analgesic should be recommended to other patients. Subjective pain score during the procedures was not affected by laterality, size of stone, level of education or socioeconomic status, but was affected by patient age (p = 0.042), sex (p = 0.012) and location of stone (p = 0.014). Right and kidney stones were significantly higher in the ‘non-tolerable’ group than in the ‘tolerable’ group (p = 0.003 and p = 0.011, respectively), and the ‘non-tolerable’ patient group had a significant higher pain score than the ‘tolerable’ group (p < 0.001). Conclusions: Our result shows that subjective pain severity during shock wave lithotripsy is high but may be well tolerated in some patients. Our findings raise the question as to whether routine analgesics are required during newer generation shock wave lithotripsy procedures in all patients with a urinary stone.
Tubeless Percutaneous Nephrolithotomy
Authors: Gupta Narmada P. , Kesarwani Pawan , Goel Rajiv , Aron Monish
Published: February 2005

Introduction: To assess the efficacy, safety and morbidity of tubeless percutaneous nephrolithotomy. Materials and Methods: One hundred and fifty-two patients with renal and upper ureteric calculi were included in this study. Sixty-nine patients (71 renal units; group 1) in whom no nephrostomy tube was placed at the conclusion of the procedure was compared with a similar control group of 83 patients (group 2) in whom a nephrostomy tube was placed. Operating time, blood loss, analgesia requirement, puncture site urinary leakage, hospital stay and mean convalescence period were compared in both groups. Results: Both groups were similar with respect to age, sex distribution and stone size. Operating time and blood loss were less in group 1 although they did not reach statistical significance. The mean analgesic requirement, puncture site urinary leakage and hospital stay were significantly less in group 1. Conclusion: Tubeless percutaneous nephrolithotomy is a safe and effective procedure in this selected group of patients.
General Anesthesia versus Epidural and General Anesthesia in Radical Cystectomy
Authors: Ozyuvaci Emine , Altan Aysel , Karadeniz Tahir , Topsakal Medih , Besisik Ahmet , Yucel Mehmet
Published: February 2005

Introduction: The aim of this study is to compare two different anesthetic techniques in radical cystectomy with regard to blood loss, transfusional requirements, intraoperative complications and the quality of analgesia. Materials and Methods: 50 patients scheduled for radical cystectomy were randomized to two groups: group GA – general anesthesia, n = 25 and group CEGA – combined epidural and general anesthesia. The patients were monitored and hemodynamic changes, intraoperative bleeding, transfusional requirements, quality of analgesia and postoperative complications were evaluated. Results: There were no significant differences between the demographic characteristics of the two groups. Intraoperative bleeding which was 874.8 ± 190.7 ml in the CEGA group and 1,248.3 ± 343.4 ml in the GA group was statistically different (p < 0.05). Significantly more intraoperative blood transfusions in terms of units were required in the GA group. Analgesia was better in the CEGA group, with VAS values at 0, 1, 2, 4, 6, 12 and 24 h significantly (p < 0.05) lower than those observed in the GA group. No significant differences in intraoperative hemodynamic parameters or postoperative complications were noted between the two groups. Conclusions: Statistically significant differences in intraoperative bleeding were observed between the two groups: CEGA provides lower intraoperative bleeding and a better postoperative analgesia. Major operations such as radical cystectomy, which also is associated with considerable blood loss, a combination of general and epidural anesthesia may allow for less blood loss, with a better postoperative analgesia and without any increase in complications.
Effects of Benzalkonium Chloride Application on the Rat Bladder
Authors: Kaya Mete , Baba Füsun , Deniz Mustafa , Baykara Serhat , Yücesan Selçuk
Published: February 2005

Aim: To establish a new bladder denervation model for bladder augmentation, using benzalkonium chloride (BCl) treatment, and to characterize the normal and treated rat bladder both urodynamically and immunohistochemically. Methods: Adult Wistar rats were divided into two groups, and the bladders were treated with a local application of 0.3% BCl for 30 min in the denervation group and saline in the control group. Before and at the 8th week after treatment, cystometry was performed in all rats, and results were recorded. The bladders were removed and whole-mount sections were prepared, and also evaluated by immunohistochemistry. Results: BCl-treated rats showed a significant increase in bladder capacity (p < 0.05), but no significant change was observed in other cystometric parameters (p > 0.05) when compared with control rats. Immunohistochemistry revealed none or very few nerve fibers within the BCl-treated bladders. Conclusions: The present study showed that denervation caused by BCl is useful for augmentation of the rat bladder. Bladder capacity was increased by the local application of BCl without impairing bladder functions. This method with a better understanding of the effects of BCl may be useful for augmentation in patients who have neurogenic bladder with low capacity.
Enhanced Expression of Tyrosine Kinase Receptor A in Germ Cells of Rat Testis with Acute Experimental Testicular Torsion
Authors: Moon Changjong , Yasuzumi Fumioki , Okura Nobuhiko , Kim Heechul , Ahn Meejung , Shin Taekyun
Published: February 2005

Objective and Methods: To examine the involvement of neurotrophic factor receptors in the testis with acute experimental testicular torsion, the expression of tyrosine kinase receptors (trk) A and B, and p75 nerve growth factor receptor (NGFR) were studied in the rat testis with ischemia/reperfusion (I/R) injury, using Western blotting and immunohistochemistry. Apoptosis was detected using the terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) method. Results: There was a significant increase in TUNEL-positive reaction in spermatogonia in the seminiferous tubules in rat testes after testicular torsion. Western blot analysis showed that trk A expression reached a significant peak at 12 h after reperfusion (p < 0.01), as compared to sham-operated controls, whereas trk B was not increased in the testis after I/R. Constitutive expression of p75 NGFR was at or below the level detectable by Western blot analysis, and it remained unchanged in the testis after I/R. Immunohistochemistry demonstrated that after I/R trk A expression was increased in spermatocytes and spermatids in the seminiferous tubules, in contrast to the basal location of the TUNEL-positive reaction. Immunoreactivity of trk B was seen mainly in the interstitial cells in the sham-operated testis, and its localization was not changed after I/R. Conclusion: It is postulated that trk A and B, but not p75 NGFR, are involved differently in the survival of testicular cells during acute experimental testicular torsion. In particular, increased trk A seems to be related to germ cell survival following I/R.
Endovascular Treatment of Renal Arteriovenous Malformations
Authors: Chatziioannou A. , Mourikis D. , Kalaboukas K. , Ladopoulos Ch. , Magoufis G. , Primetis E. , Katsenis K. , Vlahos L.
Published: February 2005

We report a case of renal arteriovenous malformation treated with superselective endovascular embolization using a light mixture of n-butyl-2-cyanoacrylate and Lipiodol. Diagnostic imaging modalities and treatment methods are discussed. In conclusion, successful superselective embolization should be the standard of care.
Robotic-Assisted Anatomic Radical Prostatectomy: Technical Difficulties due to a Large Median Lobe
Authors: Sarle Richard , Tewari Ashutosh , Hemal Ashok K. , Menon Mani
Published: February 2005

The case of a robot-assisted laparoscopic radical prostatectomy in a patient with a 143-gram prostate with a large median lobe is reported. The aim of the study was to delineate the difficulties and concern when confronted with such a situation. The technical difficulties, possible preventive methods, correction and management are discussed briefly with the hope of aiding urologists when performing radical prostatectomy in patients with large median lobe prostates.
Radical Prostatectomy for Localized Prostate Cancer in a Liver Transplant Recipient
Authors: Reiter Werner J. , Mock Karl
Published: February 2005

The increasing length of survival of organ transplant recipients necessitates careful attention to the potential neoplastic complications of life-long immunosuppressive therapy. Due to the rarity of prostate cancer after liver transplantation there are no guidelines for its management. In our case, prostate biopsy revealed prostate cancer in a 59-year-old man after an uncomplicated 5-year post-transplant course. After meticulous lymph node dissection, we performed radical retropubic prostatectomy. The postoperative period was uneventful and the prostate-specific antigen value 18 months after surgery was <0.1 ng/ml. We believe that radical retropubic prostatectomy is technically feasible in patients after liver transplantation and should be offered as a treatment option for every patient with good graft function.
Raltitrexed plus Gemcitabine (TOMGEM) in Advanced Pancreatic Cancer
Authors: van Laethem J.-L. , van Maele Ph. , Verslype C. , Polus M. , Demols A. , Houbiers Gh. , Caenepeel P. , Leleux A. , Vermaut R.R. , van Cutsem E. , Peeters M.
Published: February 2005

Objectives: This multicenter phase II study was designed to determine the activity and tolerance of gemcitabine and raltitrexed in advanced pancreatic adenocarcinoma. Patients andMethods: Thirty-three chemonaive patients with measurable disease received the TOMGEM regimen consisting of Raltitrexed 3 mg/m2 in 15 min followed by Gemcitabine 1,000 mg/m2 in 30 min on day 1, Gemcitabine alone 1,000 mg/m2 on day 8 and repeated on day 21. Results: Thirty-three patients (median age: 62; locally advanced/metastatic disease: 5/28) were enrolled; the total number of cycles administered was 173 (median: 4). There were 10 partial response (confirmed), 2 stable disease (SD) ≧24 weeks, 7 SD <24 weeks, and 14 progressive disease for a response rate of 30.3% (95% CI: 14–46%); a clinical benefit was observed in 8/30 patients assessed (30%); median duration of response was 9.1 months. National Cancer Institute Common Toxicity Criteria grade III or IV neutropenia/thrombocytopenia were observed in 42 and 12% of the patients, respectively. Relevant nonhematological toxicities (grade III–IV) were rare although one toxic death was observed. Median time to progression was 2.8 months; one-year survival was 21%; median survival was 4.7 months. Conclusion: Our data suggest that the combination of raltitrexed/gemcitabine is a very convenient regimen with an acceptable toxicity, and is active in advanced pancreatic cancer.