bluuebunny/crossref_metadata_2025 huggingface dataset:
Expression of transitional cell‐specific genes, uroplakin Ia and II, in bladder cancer: Detection of circulating cancer cells in the peripheral blood of metastatic patients
Authors: Yuasa Takeshi , Yoshiki Tatsuhiro , Isono Takahiro , Tanaka Tsutomu , Hayashida Hideshi , Okada Yusaku
Published: March 2003

Background: Uroplakins (UP), urothelium‐specific transmembrane proteins, are present only in urothelia and may be good candidates as tumor markers specific for transitional cell carcinomas (TCC). We investigated the expression of UP‐Ia and UP‐II genes in the tissues and peripheral blood of patients with TCC.

Methods: We investigated UP‐Ia and UP‐II gene expression in tissues from 12 patients with TCC by reverse transcription–polymerase chain reaction (RT‐PCR). HT1197, a TCC cell line, was used as an indicated cell line to assess a detection system for the UP‐II gene‐expressing cancer cells by nested RT‐PCR. We also investigated UP‐II gene expression in the peripheral blood of 12 other patients with TCC by nested RT‐PCR.

Results: Prior to the investigation of UP‐Ia and UP‐II gene expression, a partial nucleotide sequence of human UP‐II gene cDNA was determined to prepare the primers for RT‐PCR. Uroplakin genes were expressed in both cancerous and non‐cancerous urothelia taken from all patients examined by RT‐PCR. The detection sensitivity of our assay showed that one cancer cell could be detected in 5 mL peripheral blood. UP‐II gene‐expression was detected in the peripheral blood from all three patients with metastatic TCC but not from the nine patients with non‐metastatic TCC nor the three healthy volunteers.

Conclusions: Uroplakins may be employed as tumor markers for transitional cell cancer, because they are highly conserved and well expressed, not only in non‐cancerous cells but also in cancer cells. Furthermore, detection of UP‐II gene expression in blood by nested RT‐PCR may provide helpful information in the diagnosis and management of TCC.
Recurrence of sigmoid colon carcinoma in the residual urethra after cystectomy
Authors: Yoshimura Koji , Isogawa Yoshiaki , Yoshida Hiroshi , Kawase Norio , Taki Yoji
Published: March 2003

Introduction
: We report a case of recurrence of sigmoid colon cancer in the residual urethra after cysto‐prostato‐sigmoidectomy.

Methods/Results
: The patient successfully underwent urethrectomy and is currently tumor‐free. To our knowledge, this is the first case of recurrence of a non‐urothelial malignant tumor in the residual urethra.
Diagnosis of pheochromocytoma using [123I]‐ compared with [131I]‐metaiodobenzylguanidine scintigraphy
Authors: FURUTA NOZOMU , KIYOTA HIROSHI , YOSHIGOE FUKUO , HASEGAWA NORIO , OHISHI YUKIHIKO
Published: March 2003

Background: Patient with pheochromocytoma (PCT) cannot be cured without operation, therefore, preoperative determination of the localization of PCT should be performed accurately. [131I]‐Metaiodobenzylguanidine (MIBG) scintigraphy is a gold standard for the diagnosis of PCT. However, [123I]‐MIBG is also found to accumulate in PCT. In order to clarify the usefulness of [123I]‐MIBG scintigraphy for the local detection of PCT, we compared the distribution of [123I]‐ and [131I]‐MIBG in patients with or without PCT.

Methods: [131I]‐ and [123I]‐MIBG scintigraphy was performed in 29 and 16 patients, respectively. In the former group, 14 patients had PCT, 12 had hypertension without any adrenal disorder and three had other diseases. In the latter group, eight patients had PCT, two had hypertension without any adrenal disorder and six had other diseases. The sensitivity, specificity and accuracy of [123I]‐compared with [131I]‐MIBG scintigraphy were compared.

Results: The sensitivity of [131I]‐ and [123I]‐MIBG scintigraphy was 85.7 and 90%, respectively. The specificity of each test was 100%. The accuracy of [131I]‐ and [123I]‐MIBG scintigraphy was 93.1 and 95%, respectively. The quality of images obtained using [123I]‐MIBG was better than with [131I]‐MIBG, because [123I]‐MIBG generated a higher dose of γ‐rays with a higher specificity than [131I]‐MIBG. In addition, normal adrenal grands were visualized in 50% of patients tested with [123I]‐MIBG scintigraphy.

Conclusions: These results indicate that [123I]‐MIBG scintigraphy is a valuable tool for the local detection of PCT, as is [131I]‐MIBG scintigraphy. Furthermore, it is possible that [123I]‐MIBG can be used as an alternative to [131I]‐MIBG for the detection of PCT. Our study was not a prospective study and the background of the patients was not matched. Further prospective studies are needed in order to determine the efficacy of [123I]‐MIBG scintigraphy for the diagnosis of PCT.
Prolonged nocturnal penile tumescence caused by epinastine
Authors: YAMANAKA MASAKI , KITAMURA MASAYA , IWASA ATSUSHI , KOGA MINORU , MATSUMIYA KIYOMI , OKUYAMA AKIHIKO
Published: March 2003

Purpose: We report a case of prolonged nocturnal penile tumescence (NPT) caused by the antiallergic agent epinastine.

Methods/Results: We measured NPT using Rigiscan‐PlusTM (DacoMed, Minneapolis, MN, USA) with or without the patient having taken epinastine.

Conclusions: Considering its pharmacological effects on cyclic nucleotides, epinastine may have an effect on erectile function.
Extragonadal germ cell tumor of the prostate associated with Klinefelter’s syndrome
Authors: NAMIKI KAZUNORI , TSUCHIYA AKIRA , NODA KENJIRO , OYAMA HIRONORI , ISHIBASHI KEIICHIRO , KUSAMA HIROSHI , FURUSATO MASAKUNI
Published: March 2003

Purpose: We report on a case of extragonadal germ cell tumor of the prostate associated with Klinefelter’s syndrome.

Methods/Results: The patient was a 33‐year‐old man. A transrectal prostate biopsy suggested combined germ cell tumor (yolk sac tumor + teratoma). Because there was no tumor except from the prostate, we considered this case to be a primary extragonadal germ cell tumor of the prostate. The prostate tumor responded to systemic chemotherapy with cisplatin, vinblastine and bleomycin and elevated lactate dehydrogenase and α‐fetoprotein levels normalized. In addition to chemotherapy, the patient also underwent radiation therapy.

Conclusion: The patient has survived for approximately 4 years since the diagnosis.
Effect of prostatic biopsy on free‐to‐total prostate‐specific antigen ratio in patients with prostate cancer
Authors: Furuya Yuzo , Akakura Koichiro , Ichikawa Tomohiko , Masai Motoyuki , Igarashi Tatsuo , Ito Haruo
Published: March 2003

Background
: We determined the effect of prostatic biopsy on the changes in total and free prostate‐specific antigen (PSA) and free‐to‐total PSA ratio (F/T ratio) and examined if there are differences in these parameters between patients with benign and malignant histologic findings.

Methods
: The concentration of total and free PSA and the F/T ratio were determined in 35 men before and 1 h after prostatic biopsy. The level of PSA was measured with a chemiluminescent enzyme assay. Of 35 patients, nine were diagnosed as having prostate cancer.

Results
: In patients whose biopsy revealed cancer, the F/T ratio was lower than those without cancer, although there were no differences in total and free PSA value before prostatic biopsy. One hour after prostatic biopsy, there was an increase in the level of total and free PSA and the F/T ratio in all men. The increase in the F/T ratio was greater in patients whose biopsies revealed no prostate cancer. In patients with stage B cancer, these parameters increased more than those with stage C/D cancer.

Conclusion
: Prostatic biopsy causes a dramatic increase in total and free PSA. The F/T ratio also increased after biopsy. The PSA response to prostatic biopsy might be different in patients with and without prostatic malignancy. The response might also be different according to stage of prostate cancer.
Interferon therapy for renal cell carcinoma in hemodialysis patients: Report of two patients
Authors: Hanazawa Kisaburo , Tanaka Michio , Watanabe Ryota , Fujime Makoto
Published: March 2003

The method of interferon therapy has not been clarified in hemodialysis patients with renal cell carcinoma. Two hemodialysis patients with renal cell carcinoma were treated with natural interferon‐α. The serum levels of interferon‐α in both patients were measured after 24, 48, 72 and 96 h of injection. In case 1, the serum concentration of interferon‐α after 24 h of injection at a dose of 3 × 106 reached a maximum and decreased gradually. In case 2, the serum concentration of interferon‐α reached a maximum 24 h after injection at a dose of 3 × 106 and decreasing gradually after this. After an injection of interferon‐α at a concentration of 6 × 106 7 days later, the serum concentration of interferon‐α reached a maximum 48 h after the injection and decreased gradually thereafter. The serum interferon‐α concentrations of these cases were higher than normal renal function patients in other literature. It is necessary to modify the interval between injections for hemodialysis patients with renal cell carcinoma.
Clinical experience with BCG alone versus BCG plus epirubicin
Authors: Bilen Cenk YÜcel , Özen Haluk , AKI. FAZI.l Tuncay , AygÜn Cem , Ekici Sinan , Kendi Sezer
Published: March 2003

Background
: Bacillus Calmette–Guérin (BCG) and epirubicin have both been shown to be effective in the treatment of superficial bladder cancer. We studied whether the alternating combination of these agents could improve the efficacy with tolerable side‐effects in the treatment of high‐risk superficial bladder tumors.

Methods
: Forty‐one patients with high‐risk superficial bladder transitional carcinoma were included in this study. Twenty‐one patients were randomized into the BCG group and 20 patients were treated with sequential BCG and epirubicin. The patients were followed for 9–24 months (mean 18 months). Recurrence rates, median time to the first recurrence, progression rate and complications were compared.

Results
: Fifteen percent of the patients in the BCG and epirubicin group and 19% of the patients in the BCG alone group developed tumor recurrence. Tumor progression was observed in 4.7% and 10% in the BCG/epirubicin group and the BCG alone group, respectively. Median time to first recurrence was 11 months for the BCG/epirubicin group and 16 months for the BCG group (P > 0.05). Three patients in the BCG/epirubicin treatment group developed serious side‐effects, which necessitated antituberculosis treatment.

Conclusion
: Because the efficacy of combination was no better than the standard treatment and the alternating combination seemed to be related to a higher incidence of side‐effects, this study albeit small, does not recommend combination therapy of BCG and epirubicin in high risk patients with superficial bladder cancer.
Significance of simultaneous determination of serum human chorionic gonadotropin (hCG) and hCG‐β in testicular tumor patients
Authors: Hoshi Senji , Suzuki Ken‐Ichi , Ishidoya Shigeto , Ohyama Chikara , Sato Makoto , Namima Takashige , Saito Seiichi , Orikasa Seiichi
Published: March 2003

Background
: Simultaneous determinations of human chorionic gonadotropin hormone (hCG) and hCG‐β frequently produce discrepancies, that is when hCG or hCG‐β is normal, the other is elevated. Accordingly, we examined the significance of simultaneous determination of serum hCG and hCG‐β in testicular tumors.

Methods
: Simultaneous determination of hCG and hCG‐β was performed in 54 patients with testicular seminoma and 74 with non‐seminomatous testicular tumors.

Results
: For detection of seminoma patients, hCG‐β was more effective than hCG because hCG‐β was positive in 83% (45/54) of the patients and hCG was positive in 50% (27/54). In non‐seminomatous testicular tumor cases, hCG‐β was positive in 74% (55/74) and hCG was positive in 82% (61/74). The cases of hCG <1.0 mIU/mL and HCG‐β > 0.1 ng/mL were significantly more frequently seen in patients with seminoma than in those with non‐seminomatous testicular tumor (P < 0.001). Fourteen patients had recurrent tumor. At recurrence, only hCG was elevated in nine cases, only hCG‐β was elevated in two cases and both in one case. For diagnosis of falsely positive hCG, testosterone administration was effective because after testosterone administration, serum hCG levels became undetectable (< 1.0 mIU/mL) within one week in three examined cases.

Conclusion
: Human chorionic gonadotropin‐β was a better marker of seminoma than hCG. For earlier detection of recurrence, both markers should be examined. For diagnosis of falsely positive hCG, testosterone administration was effective.
Diagnostic value of prostate‐specific antigen‐related parameters in discriminating prostate cancer
Authors: Matsuyama Hideyasu , Baba Yoshikazu , Yamakawa Gen‐Ichiro , Yamamoto Norio , Naito Katsusuke
Published: March 2003

Abstract Background Using the percentage (of total) of free prostate‐specific antigen (PSA) in discriminating prostate cancer (CaP) from benign prostate hyperplasia (BPH) has not been fully delineated in Japanese men. To clarify the clinical significance of percent free PSA, various parameters, including total prostate volume, percent free PSA, PSA density (PSAD) and PSA density of transition zone volume (PSAT), were compared.

Methods Ninety‐seven patients who had visited one of three community‐based hospitals, and whose total PSA value ranged from 4 to 20 ng/mL were prospectively enrolled in this study. Fresh sera were applied to measure the percent free PSA.

Results Of the 97 patients, CaP and BPH were diagnosed in 24 (25%) and 73 patients, respectively. In discriminating CaP patients, the cutoff values of 17% for percent free PSA, 0.3 ng/mL per cm3 for PSAT, and 0.19 ng/mL per cm3 for PSAD yielded specificity levels of 56, 40 and 58% at sensitivity levels of 92, 92 and 79%, respectively. As for the 65 patients with intermediate PSA, range 4–10 ng/mL, and normal digital rectal examination, the percent free PSA and total prostate volume statistically discriminated CaP patients from BPH patients. A multiple logistic regression model proved percent free PSA to be the only significant discriminating factor (P = 0.045; odds ratio, 9.06).

Conclusions This prospective study revealed percent free PSA to be a significant useful predictor in discriminating CaP from BPH in Japanese men.
Role of leukocyte adhesion molecules in monocyte/macrophage infiltration in weanling rats with unilateral ureteral obstruction
Authors: Takeda Atsushi , Fukuzaki Atsushi , Kaneto Hiroyuki , Ishidoya Shigeto , Ogata Yukihiko , Sasaki Toru , Konda Ryuichiro , Sakai Kiyohide , Orikasa Seiichi
Published: March 2003

Abstract Background Unilateral ureteral obstruction (UUO) of rats is a well‐established model for studying obstructive nephropathy. Meanwhile, pathophysiology of pediatric obstructive nephropathy is not well understood. In this report, we studied monocyte/macrophage infiltration and expression of intercellular adhesion molecule 1 (ICAM‐1) and macrophage antigen 1 (Mac‐1) in weanling rats with UUO.

Methods Three‐week‐old male Sprague–Dawley rats underwent left unilateral ureteral ligation. Both obstructed kidneys (OBK) and contralateral kidneys (CLK) were harvested at 3, 6, 12, 24, 72 and 120 h after surgery. Monocyte/macrophage infiltration and expression of ICAM‐1 and Mac‐1 were evaluated immunohistochemically, and results were compared with those of sham‐operated control rats (SOK).

Results Monocyte/macrophage infiltration was observed in the interstitium and perivascular region in the cortex of OBK within 6 h. The CLK and SOK showed slight monocyte/macrophage infiltration. Expression of ICAM‐1 was markedly observed in the periarterial and peritubular interstitium and in renal cortical peritubular capillaries 12 h after obstruction. In CLK and SOK, ICAM‐1 was slightly expressed in the endothelium of microvessels and parietal linings of Bowman's capsule. Expression of Mac‐1 was detected mainly in cells infiltrating the perivascular interstitium in OBK. In CLK and SOK, few Mac‐1‐positive cells were observed.

Conclusions Adhesion molecules, ICAM‐1 and Mac‐1, are expected to recruit monocyte/macrophage infiltration into OBK of weanling rats with UUO.
Aberrant expression of Pax‐2 mRNA in renal cell carcinoma tissue and parenchyma of the affected kidney
Authors: Igarashi Tatsuo , Ueda Takeshi , Suzuki Hiroyoshi , Tobe Toyofusa , Komiya Akira , Ichikawa Tomohiko , Ito Haruo
Published: March 2003

Abstract
Background:
Pax proteins are transcription factors that demonstrate oncogenic properties and appear to play a crucial role in ontogenesis. Pax‐2 is expressed in early kidney organogenesis, Wilms' tumor and renal cell carcinoma. In order to determine whether the expression of Pax‐2 mRNA is a frequent and specific event in renal cell carcinoma, its expression in nephrectomized specimens and cell lines was investigated.

Methods:
The expression of Pax‐2 mRNA was examined by reverse transcription polymerase chain reaction in 55 nephrectomized specimens, nine renal parenchyma specimens from patients without renal cell carcinoma and 16 cell lines from various malignant diseases.

Results:
All tumor tissue specimens expressed Pax‐2 mRNA. In addition, 38 of 55 specimens from the renal parenchyma of the affected kidney expressed Pax‐2 mRNA. In contrast, only two of the nine kidney specimens from patients without renal cell carcinoma expressed Pax‐2 mRNA, indicating that expression of this protein is significantly higher in renal cell carcinoma (P < 0.01). All three cell lines from renal cell carcinoma expressed Pax‐2. In contrast, Pax‐2 was only expressed in two of three cell lines from transitional cell carcinoma and in none of the other lines.

Conclusion:
The results indicate that Pax‐2 expression is a frequent and highly specific event in renal cell carcinoma.
Gene and immune therapy for renal cell carcinoma
Authors: Pantuck Allan J , Zisman Amnon , Belldegrun Arie
Published: March 2003

Abstract Conventional therapy for metastatic renal cell carcinoma is associated with a poor response rate and few patients are long‐term survivors. The occurrence of spontaneous regression and the prolonged latency period between primary tumor removal and the appearance of metastases in some patients suggest the existence of important host immune responses to autologous tumor cells. With the advent of molecular gene transfer techniques and increased knowledge of the basic pathways of immune activation, the field of cancer immunotherapy has finally begun to develop novel and effective approaches for harnessing the immune system as a therapeutic agent. Current immunotherapy and gene therapy strategies, including methods of cytokine delivery and tumor‐cell‐based vaccines, are presented.
Development of low‐turnover bone diseases after parathyroidectomy and autotransplantation
Authors: Yajima Aiji , Ogawa Yoshihide , Ikehara Akashi , Tominaga Takashi , Inou Tsunamasa , Otsubo Osamu
Published: March 2003

Abstract Parathyroidectomy and immediate autotransplantation (PTX‐AT) has been shown to decrease bone pain and increase bone mineral density. However, adynamic bone disease (ABD) has been predicted to develop if the serum intact parathyroid hormone (i‐PTH) level remains lower than normal for a long period of time. Therefore, we investigated the bone histology of patients whose serum i‐PTH levels did not increase over 70 pg/mL for 1 year after PTX‐AT. Four chronic hemodialysis patients were investigated. The serum intact osteocalcin (i‐OC) level was measured and histomorphometry for cancellous bone was performed 1 year after the operation. Tetracycline hydrochloride was administered in the 12 weeks after PTX‐AT. The serum i‐PTH levels were 20.5 ± 15.0 pg/mL and i‐OC levels were 19.5 ± 0.9 ng/mL. Histomorphometric analyses showed the osteoclast surface to be 0.1% in two cases and 0% in the other two cases, the eroded surface was 7.7 ± 6.1%, and the fibrosis volume and osteoblast surface were 0% in all four cases. Osteoid volume, osteoid surface and osteoid thickness were lower in cases 1–3, but higher in case 4. All tetracycline labelings were in contact with the mineralization front in cases 1 and 3, but some were not in cases 2 and 4. Serum i‐PTH and i‐OC levels indicated that ABD developed in these four cases. Histomorphometric analyses revealed that ABD developed in case 1, while either ABD or low‐turnover osteomalacia developed in cases 2 and 4, and low‐turnover osteomalacia was observed in case 3 after PTX‐AT. In conclusion, i‐PTH should not be maintained at lower levels to avoid low‐turnover bone diseases.
Seminal plasma cytokine levels in the diagnosis of chronic pelvic pain syndrome
Authors: Orhan Irfan , Onur Rahmi , Ilhan Necip , Ardiçoglu Arslan
Published: March 2003

Abstract Background: Chronic non‐bacterial prostatitis/chronic pelvic pain syndrome (CPPS) are frequently encountered clinical entities characterized by painful and irritative voiding symptoms often referable to the prostate. Diagnosis usually depends on the symptoms and treatment mainly consists of reassurance, anti‐inflammatory medications and antibiotics in the absence of a documented infection. To have objective diagnostic criteria, we determined the possible roles and diagnostic efficacies of soluble cytokines interleukin‐1β (IL‐1β), tumor necrosis factor‐α (TNF‐α), IL‐2R, IL‐6 and IL‐8 in the seminal plasma of patients with different forms of CPPS.

Methods: Seminal plasma was obtained from a total of 30 subjects who were evaluated in three groups. Each group comprised 10 patients having inflammatory CPPS, non‐inflammatory CPPS and control subjects, respectively. The levels of IL‐1β, IL‐2R, TNF‐α, IL‐6 and IL‐8 were measured in seminal plasma using chemiluminescence.

Results: The level of IL‐2R in all three groups was below measurable values. Interleukin‐1β, TNF‐α, IL‐6 and IL‐8 levels were elevated significantly in the two groups with CPPS compared with the control group (P < 0.05). Soluble cytokines showed a slight difference between patients with inflammatory CPPS and non‐inflammatory CPPS, but this was not statistically significant (P > 0.05).

Conclusion: Although there are individual variables between the discrimination of inflammatory and non‐inflammatory CPPS, cytokines are frequently present and elevated in the expressed prostatic secretions from men with CPPS. Our results indicate that several soluble cytokines can be used to identify this chronic and long‐term disease.
Recurrence of renal cell carcinoma more than 5 years after nephrectomy
Authors: UCHIDA KOHSUKE , MIYAO NORIOMI , MASUMORI NAOYA , TAKAHASHI ATSUSHI , ODA TOSHIRO , YANASE MASAHIRO , KITAMURA HIROSHI , ITOH NAOKI , SATO MASAAKI , TSUKAMOTO TAIJI
Published: March 2003

Abstract Objectives: We evaluated clinical features and predictive factors for the recurrence of renal cell carcinoma (RCC) developing more than 5 years after nephrectomy.

Methods: We retrospectively reviewed 239 patients with RCC who underwent surgery for the primary lesion. To identify factors that affected recurrence more than 5 years after nephrectomy (delayed recurrence) and its clinical outcomes, we performed a multivariate analysis using Cox’s proportional hazards model and a survival study.

Results: Recurrence developing within 5 years after nephrectomy (early recurrence) was found in 57 patients and delayed recurrence in 11 patients. The multivariate analysis revealed no clinical and pathologic features influencing delayed recurrence in 114 patients who survived more than 5 years after nephrectomy without having early recurrence. The patients with delayed recurrence showed better clinical outcomes than those with early recurrence when the rate was determined from the time of recurrence.

Conclusions: Although delayed recurrence is not a rare event for patients with RCC, no clinical and pathologic factors at the time of the initial treatment can predict the recurrence. Patients who are free of recurrence for more than 5 years after surgery for a primary lesion should be carefully followed up for delayed recurrence.
Neo‐adjuvant treatment of infiltrating transitional‐cell carcinoma of the bladder with paclitaxel and cisplatin: A phase II trial
Authors: SOUSA‐ESCANDÓN ALEJANDRO , VAZQUEZ SERGIO , QUINTERO‐ALDANA GUILLERMO , PICALLO JOSE A , NEIRA JAVIER , GARCIA‐NOVIO FRANCISCO , MATEO A , RICO MANUEL , MEL JOSE R
Published: March 2003

Background
: A phase II multicentric trial of paclitaxel and cisplatin was conducted in previously untreated patients, with locally advanced transitional‐cell carcinoma (TCC) of the bladder, to assess its toxicity and efficiency in preserving the bladder.

Methods
:

Forty‐four patients with locally advanced TCC of the bladder (seven with T3a, 27 with T3b, and eight with T4a) were treated with paclitaxel 175 mg/m2 over 3 h, and cisplatin 75 mg/m2 over 30 min, on the first day of each 21‐day treatment cycle. Therapy was continued for three cycles. Patients were re‐evaluated and scheduled for radiotheraphy or radical surgery depending on tumoral response. Tumoral response was measured by citology, computed tomographical scans, and deep randomized biopsies of the bladder.

Results
:

Thirty‐two out of 42 patients (76%; 95% confidence interval 45–93%) showed a major response (22 complete, and 10 partial). Response times ranged from 18 to 54 months. Three patients with T4 bladder primary tumors experienced a pathological CR. At a median follow‐up of three years, 20 patients remain free of disease (47.6%), six patients are alive with disease (14.3%), 12 patients died of disease (28.5%), and four others died of unrelated causes (9.5%). Hematological toxicity included anemia, thrombocytopenia, and neutropenia. No grade four febrile neutropenia was observed. Non‐hematological toxicity included alopecia (93.2%), diarrhea (11.4%), vomiting (18.5%) mucosytis (4.6%), and neuropathy (4.6%). Drug omissions or dose delay for adverse events were only necessary in one patient (2.2%), and three patients (6.8%), respectively.

Conclusions
:

Paclitaxel and cisplatin is an active and well‐tolerated neo‐adjuvant regimen for previously untreated patients with pure TCC of the bladder, achieving a vesical preservation rate of 52%.
Snodgrass procedure for primary hypospadias repair
Authors: Zhou Yun , Lu Jinxing , Takahashi Go
Published: March 2003

Background: In this study, the authors’ experience in adaptation of the Snodgrass technique for primary hypospadias repair, with an alternative way to create a barrier layer of dartos flap for neourethral covering, is presented.

Methods: Between March 2000 and January 2001, Snodgrass urethroplasty was consecutively done on 24 boys aged between 14 months and 9 years (median: 3 years). The position of the meatus was coronal in one boy, at the distal shaft in two, at mid‐shaft in eight, at the proximal shaft in five, penoscrotal in four, scrotal in three and perineal in one. Dorsal plication was carried out in nine patients (37.5%) to correct residual ventral curvature after penile degloving. Postoperatively the neourethra was stented for 10–12 days and suprapubic diversion was used for 12–14 days.

Results: Postoperative follow up ranged from 4 to 14 months (median: 8 months). All patients undergoing Snodgrass repair obtained a neourethra with a slit‐like meatus at the tip of the glans. A small urethrocutaneous fistula occurred in one patient with mid‐shaft and two with proximal‐shaft hypospadias (an overall fistula rate of 12.5%). Urethral stricture had not been encountered at the time of this report. One patient developed mild meatal stenosis and was successfully managed by simple dilatation.

Conclusions: The results indicate that Snodgrass urethroplasty provides satisfactory cosmetic and functional results and is versatile in repairing almost all types of hypospadias.
Perivesical abscess caused by migration of a fish bone from the intestinal tract
Authors: Imamoto Takashi , Tobe Toyofusa , Mizoguchi Kenichi , Ueda Takeshi , Igarashi Tatsuo , Ito Haruo
Published: March 2003

A 55‐year‐old woman was admitted to the Department of Urology at Chiba University Hospital. The patient's chief complaint was frequent urination and micturition pain. Computed tomography of the abdomen demonstrated a mass lesion in contact with the anterior wall of the bladder. Mass extirpation was performed transperitoneally. On dissection of the mass, a thin foreign body shaped like a skewer was detected. A specimen of the mass revealed non‐specific inflammation. Elemental analysis with an electron probe microanalyser (EPMA) revealed that the composition of the foreign body was consistent with bone. The perivesical mass was diagnosed as an abscess caused by a fish bone that migrated from the intestinal tract.
Significance and diagnostic accuracy of renal calculi found by ultrasonography in patients with asymptomatic microscopic hematuria
Authors: Marumo Ken , Horiguchi Yutaka , Nakagawa Ken , Oya Mototsugu , Ohigashi Takashi , Asakura Hirotaka , Nakashima Jun , Murai Masaru
Published: March 2003

Background : The purpose of the present study was to evaluate the clinical significance and the accuracy of the diagnosis of renal calculi incidentally found by ultrasonography (US).

Methods : A total of 906 subjects (639 men and 267 women) aged 18–78 years were referred for asymptomatic microscopic hematuria. Of these, 743 patients who underwent US were studied.

Results : Hyperechogenic spots in the central echo complex suggesting renal calculi were noted in 195 patients (21.5%). The occurrence of hyperechogenic spots was higher in patients with 20 or more urinary red blood cells per high‐power field (χ2 = 4.896, P = 0.0269) and in men than in women (χ2 = 7.101, P = 0.0077), but it was lowest in patients who were 29 years old or younger. Of these 195 patients, who were followed up for 1–161 months (average: 33.5 months), 24 patients (12.3%) needed urological management. Extracorporeal shockwave lithotripsy was carried out in eight patients, transureteral lithotripsy was carried out in three patients, spontaneous passage occurred in 11 patients and medication for hyperuricemia was initiated in two patients (1%). Among the patients in whom hyperechogenic spots were found in the kidney by US but calculi were not visible on abdominal plain radiographs, 39 patients underwent computed tomography. Of them, 31 patients were confirmed to have renal calculi.

Conclusion : The obtained results suggest that US is an effective and reliable means of detecting renal calculi in patients with asymptomatic microscopic hematuria, and in facilitating prompt urological intervention or predicting the natural course of renal calculi.
Malignant mesothelioma of testicular tunica vaginalis
Authors: ABE KAZUHIRO , KATO NOBUKI , MIKI KENTA , NIMURA SATOSHI , SUZUKI MASAFUMI , KIYOTA HIROSHI , ONODERA SHYOICHI , OISHI YUKIHIKO
Published: March 2003

We report here a case with malignant mesothelioma of testicular tunica vaginalis. An 81‐year‐old Japanese man with left hydrocele was referred for operation. When hydrocelectomy was performed, a thick wall of tunica vaginalis without malignancy was observed. Seven months after hydrocelectomy, a hard irregular mass was noticed in the left scrotum, therefore inguinal orchiectomy was performed. Pathologically, the mass showed severe atypia and mitosis. The diagnosis of malignant mesothelioma was made. He refused any adjuvant treatment and died 1 year later from multiple metastases to the paraaortic lymph nodes and lumbar supine.
Renal metastasis of thyroid carcinoma
Authors: Abe Kazuhiro , Hasegawa Taro , Onodera Shoichi , Oishi Yukihiko , Suzuki Masafumi
Published: March 2003

We report here the sixth known case of metastatic renal tumor of thyroid carcinoma. In 1999, a 37‐year‐old man was referred to us with a left renal mass found incidentally by ultrasound during an annual check‐up. Computed tomography (CT) revealed a well‐defined, hyperdense mass 3 cm in diameter in the middle of the left kidney. Left radical nephrectomy was performed under the preoperative diagnosis of renal cell carcinoma. Histologically, the tumor was metastatic of typical papillary thyroid carcinoma.
Primary bilateral spermatocele
Authors: BASAR HALIL , BAYDAR SENOL , BOYUNAGA HAKAN , BATISLAM ERTAN , BASAR M MURAT , YILMAZ ERDAL
Published: March 2003

We report the case of a bilateral, relatively huge, multilocular spermatocele diagnosed at sonography with surgical and pathological correlation. A 45‐year‐old man presented with bilateral, large inguinoscrotal masses. He had had the masses since his adolescence and their size gradually increased in the past 5 years. Scrotal ultrasonographic examination showed cystic fluid masses that were 65 × 45 × 50 mm in size on the right and 55 × 45 × 40 mm in size on the left side in multilocular spaces. The cystic masses were excised via bilateral inguinoscrotal incision staying near the body of the epididymis. The patient had fathered three children with no fertility problem.
Adverse drug events as a cause of hospital admission in the elderly
Authors: Chan M. , Nicklason F. , Vial J. H.
Published: March 2003

Background: Previous studies of adverse drug events (ADE) as a cause of hospital admission in the elderly have often been limited in their ability to assess fully the impact and potential for prevention because they either did not include all categories of ADE and/or did not assess severity and preventability.

Aims: To assess the frequency, severity and preventability of ADE causing emergency medical admissions in the elderly.

Methods: Cross‐sectional survey of 219 patients aged 75 years and over who were consecutive unplanned admissions to acute medical units of the Royal Hobart Hospital in an 8‐week period during August and September 1998.

Results: Seventy‐three of 240 (30.4%) admissions may have been a result of ADE. Patients admitted because of ADE were taking more drugs than those admitted for other reasons. Most ADE were adverse drug reactions to a single (46%) or multiple drugs (25%). Non‐compliance, omission or cessation of indicated treatment accounted collectively for 26% of admissions. Of all ADE admissions 53.4% were considered definitely preventable. The commonest causative drugs were cardiovascular drugs (48.4%), and the commonest manifestations were falls and postural hypotension (24.1%), heart failure (16.9%) and delirium (14.5%). ADE categories in which a high proportion of admissions was both severe and definitely preventable were non‐compliance and omission of indicated treatment.

Conclusions: Adverse drug events are a common preventable cause of unplanned medical admissions in the elderly. Non‐compliance and omission of indicated treatment are causes of ADE‐related admissions that are both preventable and frequently associated with severe ADE. (Intern Med J 2001; 31: 199–205)
Pregnancy‐associated osteoporosis with hypercalcaemia
Authors: Tran H. A. , Petrovsky N.
Published: March 2003

Abstract

Pregnancy‐associated osteoporosis is an uncommon condition. It predominantly affects thinly built, primi­gravid, lactating women. These patients can sustain vertebral fractures with minimal or no trauma, resulting in significant morbidity. The association with hypercalcaemia is rare and typically occurs during the first few months postpartum, while lactating. This condition is, however, relatively benign and patients can expect to return to normal bone mineral density 6−12 months after breast‐feeding has stopped. (Intern Med J 2002; 32: 481−485)
Responses of annual bluegrass (Poa annua L.) and creeping bentgrass (Agrostis palustris Huds.) seedlings to nitrogen, phosphorus and potassium†
Authors: NAM‐IL PARK , OGASAWARA MASARU , YONEYAMA KOICHI , TAKEUCHI YASUTOMO
Published: March 2003

The growth response to fertilizer under different soil texture (light clayey soil and composite soil consisting of the light clayey soil and sand), and the timing of N fertilization (early summer and fall fertilization) were determined for annual bluegrass (Poa annua L.) and creeping bentgrass (Agrostis palustris
Huds., var. Penncross) in glasshouse experiments. At the three‐leaf stage, both plant
species were treated with 30, 100, 300, 1,000, 3000 or 10 000 p.p.m. (w/v) of N,
P2O5 and K2O equivalent to ammonium sulfate (N), calcium superphosphate (P) and potassium chloride (K). Three weeks after fertilization, the dry weight of shoots or roots was measured. Both plant species were more sensitive to N than to P or K; however, creeping bentgrass required a higher rate of N (1000 p.p.m.) for maximum shoot and root growth than did the weed (300 p.p.m., N). Shoot growth of both plant species was strongly affected by the timing of N fertilization and soil texture; their shoot responses to N increased in the order: composite soil > light clayey soil, and early summer N fertilization > fall N fertilization, and this tendency was especially marked for creeping bentgrass. These results suggest that the response of annual bluegrass to fertilizer is similar to that of creeping bentgrass; however, the two plants are different in regard to the N requirement or their relationship between response to N and application timing and/or soil texture.
Acute airway obstruction in a child with acute lymphoblastic leukaemia during central venous catheterization
Authors: Mark Sanderson Peter , Hartsilver Emma
Published: March 2003

We report the case of a seven‐year‐old girl with recently diagnosed acute lymphoblastic leukaemia (ALL) who suffered acute airway obstruction during insertion of a central venous catheter under general anaesthesia. The central airway obstruction was due to a mixture of leukaemic cells, blood clot and fibrin. There is discussion about airway obstruction both as a complication of central line insertion and secondary to ALL. The pulmonary complications of ALL, with particular reference to pulmonary haemorrhage, are detailed. The management of blood clot obstructing the central airway is discussed.
Tracheal intubation without neuromuscular blockade in children: a comparison of propofol combined either with alfentanil or remifentanil
Authors: Robinson  , O’Brien  , Kumar R , Morton
Published: March 2003

Forty healthy children, aged between two and 12 years of age undergoing elective surgery where the anaesthetic technique involved tracheal intubation followed by spontaneous ventilation were studied. Induction of anaesthesia was with either alfentanil 15 μg·kg−1 or remifentanil 1 μg·kg−1 followed by propofol 4 mg·kg−1 to which lignocaine 0.2 mg·kg−1 had been added. Intubating conditions were graded on a four point scale for ease of laryngoscopy, vocal cord position, degree of coughing, jaw relaxation and limb movement. All children were successfully intubated at the first attempt. There were no significant differences in the assessments of intubating conditions between the two groups. Arterial blood pressure and heart changes were similar in the two groups with both alfentanil and remifentanil attenuating the haemodynamic response to tracheal intubation. The time taken to resumption of spontaneous ventilation was similar in both groups.
A comparison of intubation success for paediatric transport team paramedics using lighted vs regular tracheal tube stylets
Authors: MACNAB ANDREW J. , MACPHAIL IAIN , MACNAB MAGNUS K. , NOBLE ROBERT , O’FLAHERTY DEBRA
Published: March 2003

We conducted a prospective randomized study of success rate and time to intubation using Trachlight and Surch‐Lite lighted stylets versus a regular tracheal tube stylet, in a training setting. Participants, 18 paediatric transport paramedics, performed two intubations with each of the three devices, using an airway management trainer. There was no significant difference in mean time for intubation between the three devices. The times for external confirmation of correct tube placement were comparable using the two lighted stylets. External confirmation of the tube placement using the lighted stylets was quicker than laryngoscopic visualization. In darkness, with a nonfunctioning laryngoscope, intubations were successfully performed 100% of the time with the lighted stylet, but only 11% of the time with the regular stylet. All paramedics felt that a lighted stylet would be a useful airway management adjunct for the transport environment for complicated intubations or for use in very high or low levels of ambient light.
Laryngeal mask for difficult intubation in children
Authors: Osses H. , Poblete M. , Asenjo F.
Published: March 2003

We present a new intubation technique using an oral preformed tracheal tube passed through a laryngeal mask. Six patients (neonate to six months old) with craniofacial malformations of head and neck and scheduled for reconstructive plastic surgery are the basis of this report.

An inhalation induction with increasing doses of halothane in oxygen while maintaining spontaneous ventilation was performed. Once an adequate anaesthetic depth was achieved, a direct laryngoscopy was performed. The epiglottis could not be seen in any of the patients. Anaesthesia was deepened in order to insert the laryngeal mask, size 1 or 2, with an oral preformed 3.5 or 4.0 tracheal tube inside it. Correct position of the mask was confirmed by capnography. The preformed tracheal tube was then advanced 1–2 cm. and its position in the trachea verified. The 15 mm connector was then removed, and an adult intubating stylet was attached to the end of the tracheal tube. The laryngeal mask was removed, holding the stylet and tube in place. Once the mask was removed, the stylet was disconnected, and the 15 mm connector reattached. Our experience was that this takes about 20 to 30 s. We recommended this technique in paediatric patients in which a difficult intubation is foreseen.
Difficult airway management in the neonate: a simple method of intubating through a laryngeal mask airway
Authors: Ellis Diane S. , Potluri Prabhu K. , O’Flaherty Jennifer E. , Baum Victor C.
Published: March 2003

Tracheal intubation through a laryngeal mask airway is one option for securing an airway in the patient with a difficult airway. A variety of techniques and equipment have been used to stabilize the position of the tracheal tube while removing the laryngeal mask airway. We have shown that if a fibreoptic bronchoscope is used to place an tracheal tube through a laryngeal mask in neonates, additional equipment is not needed to remove the laryngeal mask airway without endangering tracheal tube placement. This is possible even in small neonates.
Axillary brachial plexus block for perioperative analgesia in 250 children
Authors: Fisher W. J. , Bingham R. M. , Hall R.
Published: March 2003

A cannula technique for axillary brachial plexus block in combination with general anaesthesia has been in use since 1994 for children undergoing surgical correction of congenital hand anomalies. During a 4‐year period data were collected on 250 procedures in 185 patients of median age 3 years detailing the block technique and the intraoperative and postoperative analgesic requirements. Fifteen patients (6%) required supplemental intravenous opioid intraoperatively and this is taken as a marker of failure of the block. Ninety‐five patients (38%) required postoperative codeine phosphate with a mean time to receiving codeine phosphate of 9 h. Postoperative pain was controlled in this series with oral analgesia in all but six patients who received parenteral codeine. It is proposed that a cannula technique is an effective and safe method of producing axillary brachial plexus block in children.
Alfentanil for intubation under halothane anaesthesia in children
Authors: Ng K.P. , Wang C.Y.
Published: March 2003

Intubating conditions under halothane anaesthesia aided with alfentanil 20 μg·kg−1 were compared with suxamethonium 2 mg·kg−1 in 40 children presenting for day dental procedures. The condition of vocal cords, jaw relaxation and presence of movement and coughing were scored to give the overall intubating conditions. Successful intubation was achieved in 100% of the suxamethonium group and 94.7% of the alfentanil group. The cardiovascular response to intubation was attenuated in the alfentanil group. Some 43.7% of those receiving suxamethonium developed myalgia the day after surgery compared with 0% in the alfentanil group (P < 0.01).
Failed epidural anaesthesia in a patient with Hurler's disease
Authors: Vas Lakshmi , Naregal Falguni
Published: March 2003

Failure of epidural anaesthesia in a patient with Hurler's disease is presented. The possibility that epidural anaesthesia may fail due to deposition of mucopolysaccharide in the meninges, or in the epidural space is discussed. A granuloma in the upper trachea and severe choanal stenosis complicated the already difficult airway management.
Continuous monitoring of oesophageal pH during general anaesthesia with laryngeal mask airway in children
Authors: Cebrián J. , Avellanal M. , Morales J.L.
Published: March 2003

We studied the incidence of gastro‐oesophageal reflux (GOR) during general anaesthesia with the laryngeal mask airway (LMA) in a paediatric population with two ventilatory regimes: spontaneous breathing and controlled mechanical ventilation (CMV). Thirty children between 6 months and 15 years, ASA I‐II, for routine surgery, were randomly assigned in two groups: spontaneous ventilation (n=14), and CMV (n=16). A pH probe was situated in the central third of the oesophagus. Some 66% of the patients breathing spontaneously had GOR episodes vs. 92% of the patients with CMV (P < 0,01). Reflux took place mainly after LMA removal (21% vs. 68%; P < 0,01) and in the Postanaesthetic Care Unit (PACU) (29% vs. 43%; P < 0,05). There was a high incidence of GOR during general anaesthesia and in the PACU in paediatric patients anaesthetized with the LMA. GOR episodes were significantly more evident in the CMV group, mainly after LMA removal, but without clinical significance.
Protein concentration in pulmonary oedema fluid for negative pressure pulmonary oedema in children
Authors: Devys J.M. , Cadi P. , Nivoche Y.
Published: March 2003

We report a case of acute pulmonary oedema following upper airway obstruction in a 1‐year‐old patient. We discuss the pathophysiology of this infrequent complication of upper airway obstruction and the interest of alveolar protein/blood protein ratio measurement to determine the mechanism of pulmonary oedema.
Dislodgement of bronchial foreign body during retrieval in children
Authors: Pawar Dilip K.
Published: March 2003

Foreign body aspiration is a leading cause of death in children aged less than 1 year. The removal of a foreign body poses a great challenge to the skill of the anaesthetist. Four cases are presented, analysing the part played by modes of respiration in the dislodgement of a bronchial foreign body during its retrieval.
Postbypass pulmonary artery pressure influences respiratory system compliance after ventricular septal defect closure
Authors: Takeuchi Muneyuki , Kinouchi Keiko , Fukumitsu Kazuo , Kishimoto Hidefumi , Kitamura Seiji
Published: March 2003

It is reported that surgical correction of left‐to‐right shunt improves respiratory function in paediatric cardiac patients. However, such correction sometimes does not result in an improvement of respiratory compliance. The purpose of this study was to look for factors determining changes in respiratory system compliance (Crs) in patients who underwent closure of ventricular septal defect (VSD closure). In a prospective study, 17 children (< 10 kg) who underwent VSD closure were enrolled. They were divided into two groups, according to postbypass mean pulmonary artery pressure (mPAP). The patients were allocated to Group C if mPAP was ≤ 18 mmHg (n=12) and to Group PH if > 18 mmHg (n=5). We compared the ratio of postoperative Crs to preoperative Crs (Cpost/Cpre) between the groups. A multiple occlusion technique was used to measure Crs. The Cpost/Cpre in group C was larger than that in group PH (1.11 ± 0.17 vs. 0.81 ± 0.12, P < 0.01). There was a correlation between postbypass mPAP and Cpost/Cpre (rs=0.49, P < 0.05), but no correlation was noted between preoperative mPAP, Qp/Qs or Rp/Rs and Cpost/Cpre. We concluded that high postbypass mPAP was associated with a perioperative decrease in Crs after VSD closure.