bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient-Controlled Analgesia versus Oral Controlled-Release Oxycodone – Are They Interchangeable for Acute Postoperative Pain after Laparoscopic Colorectal Surgeries?
Authors: Ho Hwee Shih
Published: September 2008

Background: Standard therapy for postoperative pain after laparoscopic colorectal surgeries at the Tan Tock Seng Hospital consists of intravenous morphine via patient-controlled analgesia (PCA) for the first 24–48 h, followed by oral analgesics. We compared the efficacy and safety of oral controlled-release (CR) oxycodone hydrochloride (OxyContin® tablets) and PCA after laparoscopic colorectal surgeries. Methods: Between March and August 2006 (phase 1 study), 14 patients underwent laparoscopic colectomy, laparoscopic hemicolectomy or laparoscopic-assisted anterior resections. All patients were on oral CR oxycodone with oral immediate-release oxycodone on an as-needed basis for breakthrough pain. Pain intensity, analgesic use, length of hospital stay and side effects were evaluated. These were compared to data obtained from a second study of a similar design where 9 patients underwent similar operations from October 2006 to July 2007 (phase 2 study) and were on PCA morphine. Results: All patients in the CR oxycodone and PCA morphine groups needed the opioid medication for only 2 days. There was no difference in mean (range) postoperative pain intensity scores between patients on oxycodone and those on PCA morphine for the 1st postoperative day [2.07 (0–5) vs. 2.78 (2–4) on a Visual Analogue Scale (VAS) from 0 to 10; p = 0.10] and the 2nd postoperative day [1.14 (0–2) vs. 1.67 (0–3); p = 0.10]. Generalized estimating equations with linear link function confirmed that there was a significant relief of pain in patients after operation. On average, the VAS score of pain was 1.00 units lower on day 2 when compared with day 1 (p < 0.01). The mean (range) doses of oxycodone used on the 1st and 2nd postoperative day were 13.57 mg (10–30) and 15.36 mg (10–30), and the mean (range) doses of morphine used on the 1st and 2nd postoperative day were 14.9 mg (8–28) and 16.3 mg (4–31), respectively. Incidence of nausea and vomiting was 14.2 and 20% for the CR oxycodone and PCA groups, respectively. Conclusions: Oral CR oxycodone 20 mg per day is a cheaper, convenient and an efficacious alternative analgesic to PCA opioids after laparoscopic colorectal surgery.
Postmarketing Surveillance Study of OxyContin® Tablets for Relieving Moderate to Severe Postherpetic Neuralgia Pain
Authors: Fan Bi Fa
Published: September 2008

Objective: To evaluatethe efficacy and safety of OxyContin®tablets(controlled-release oxycodone hydrochloride: 5, 10, 20, and 40 mg) in relieving moderate to severe postherpetic neuralgia (PHN) pain. Method: A multicenter, open-label, prospective, self-controlled clinical observation. Results: Pain was relieved in 17.3% of patients within 30 min and in 94.1% patients within 1 h after drug administration. OxyContin® tablets showed good clinical efficacy in relieving both moderate and severe PHN pain. Response rate reached 98.4% at the end of the 8th week of treatment. After the 1st week of treatment, stable pain relief was achieved, and pain scores on a Visual Analogue Scale decreased dramatically in most patients. During treatment with controlled-release OxyContin® tablets, the use of concomitant medications was significantly decreased. Some patients developed adverse drug reactions (ADRs) in the 1st week, which decreased significantly during the following weeks of treatment. Nausea (18.1%) was the most commonly reported ADR, followed by constipation (10.1%) and dizziness (10.1%). A number of ADRs disappeared during treatment. Conclusion: Controlled-release OxyContin® tablets demonstrated fast onset of PHN pain control, superior efficacy in relieving both moderate and severe PHN pain, and a good safety profile.
Controlled-Release Oxycodone in the Treatment of Neuropathic Pain of Nonmalignant and Malignant Causes
Authors: Ong Eleanor C.
Published: September 2008

Objective: To assess the efficacy and safety of controlled-release oxycodone in patients with moderate to severe neuropathic pain of nonmalignant and malignant causes. Methods: A retrospective observational study on the use of controlled-release oxycodone for patients with moderate to severe neuropathic pain. Records of patients treated at the Davao Doctor’s Oncology Center Pain Clinic from June 2005 to June 2007 were reviewed. Sixty-seven patients with moderate to severe neuropathic pain despite treatment with adjuvant analgesics (anticonvulsants and antidepressants), who therefore received controlled-release oxycodone, were identified: 35 patients had neuropathic pain not related to a malignancy, and 32 patients had neuropathic pain secondary to a malignancy. Baseline pain intensity and pain intensity on follow-up after 2–4 weeks of treatment were recorded using a Visual Analog Scale. Results: Among patients with nonmalignant neuropathic pain, the baseline Visual Analog Scale score was 8–10/10, with improvement in pain score to 0–2/10 in 96% on follow-up. Average daily dose of oxycodone was 25 mg/day. Patients received concomitant anticonvulsants or antidepressants. Duration of treatment ranged from 2 to 8 months. Among patients with malignant neuropathic pain, the baseline Visual Analog Scale score was 10/10 with improvement to 2–4/10. Average daily dose was 40 mg per day. Patients received concomitant anticonvulsants. Duration of treatment ranged from 1 to 4 months. Oxycodone was well tolerated, with dizziness and nausea occurring only in <5%. No respiratory depression occurred. Discussion/Conclusion: The use of opioids for neuropathic pain is not fully accepted by the majority of physicians at present. This study shows that controlled-release oxycodone is a safe, well-tolerated and effective medication for neuropathic pain.
Neuropathic Pain – The Case for Opioid Therapy
Authors: Allen Stephen C.
Published: September 2008

For many patients, neuropathic pain (NeP) is arguably more difficult to control than nociceptive or ‘normal’ pain. We also now recognise the great burden that NeP has on the lives of patients – it is not only a matter of treating pain in isolation, but managing all of the issues that affect the patient’s quality of life. Until relatively recently we have had little understanding of the pathophysiology causing NeP and have relied on the secondary effects of non-analgesic drugs as the mainstays of treatment. Greater understanding of the pathophysiology of NeP has led to more appropriate therapy and an increased use of multiple drug therapy – ‘rational polypharmacy’. Traditional opinions concerning the treatment of NeP have been challenged and it is because of this that the use of opioids in NeP has been re-evaluated. Opioids will never replace tricyclic antidepressants and anti-epileptic drugs as first-line therapy for NeP. However, they are now fully established as effective and useful second- or third-line drugs. Many patients in the past have been potentially undertreated as a result of our inertia to use opioids. The case for opioid therapy in NeP has been firmly established.
Urodynamic Evaluation of Patients with Lower Urinary Tract Symptoms and Small Prostate Volume
Authors: Gomes Cristiano M. , Nunes Ricardo V. , Araújo Rogerio M. , Sacomani Carlos R. , Trigo-Rocha Flavio E. , Bruschini Homero , Srougi Miguel
Published: September 2008

Introduction: The relevance of prostate size in the pathophysiology of lower urinary tract symptoms (LUTS) is controversial. We evaluated the urodynamic findings in patients with LUTS and small prostate volumes. Materials and Methods: 84 patients aged ≧50 years with LUTS and prostates <40 ml were evaluated. All had an International Prostate Symptom Score (IPSS) ≧8. Average age was 62.0 ± 8.1 years. We evaluated the impact of bladder outlet obstruction (BOO) and detrusor overactivity (DO) on the voiding symptoms and urodynamic findings. Results: Mean prostate volume was 29.2 ± 7.2 ml and mean IPSS was 13.5 ± 4.6. BOO was the main finding, affecting 42 (50.0%) patients, followed by detrusor underactivity (DU) in 41 (48.8%) and DO in 28 (33.3%) patients. Patients without BOO were significantly older than the obstructed (64.0 ± 8.8 and 60.1 ± 6.9 years, respectively; p = 0.026) and had an increased prevalence of DU (76.2 and 21.4%, respectively; p < 0.001). Comparison of patients with and without DO showed reduced bladder capacity and compliance in the DO group (p < 0.001). No other comparisons were significant. Conclusion: Half of the patients with LUTS and small prostates are not obstructed and may have DO or decreased detrusor contractility as the basis for their voiding symptoms. Our results emphasize the value of urodynamics in this population, especially when invasive treatments are being considered.
Eicosapentaenoic Acid Has a Preventive Effect on the Recurrence of Nephrolithiasis
Authors: Yasui Takahiro , Suzuki Sadao , Itoh Yasunori , Tozawa Keiichi , Tokudome Shinkan , Kohri Kenjiro
Published: September 2008

Background: With a westernized diet the oxygenated products of renal prostaglandin synthesis are metabolites of the n–6 series and these are known to play important roles in several pathophysiological processes involved in calcium stone formation. As eicosapentaenoic acid (EPA) administration is effective for the prevention of hyperlipidemia and athelosclerosis, we suggest the use of EPA as a possible method of preventing calcium stone formation. Methods: We administered a highly purified preparation of 1,800 mg/day EPA to 29 patients for 36.4 ± 22.0 months after therapy for nephrolithiasis. We observed the urinary stone recurrence in these patients over the course of 8 years (before, during and after medication) and studied the preventive effect on the recurrence of nephrolithiasis. We analyzed the effect of EPA administration and compared the findings to those before and after administration. Results: The incidence rates of nephrolithiasis (times/year) before, during and after the administration of EPA were 0.2283, 0.0693 and 0.1742, respectively. The incidence rate of nephrolithiasis during the administration of EPA was significantly lower compared the findings to those before and after its administration (p < 0.05). Conclusion: The results suggest that EPA might reduce the risk of calcium stone formation.
Adjustable Continence Therapy for Female Urinary Incontinence: A Minimally Invasive Option for Difficult Cases
Authors: Wachter Johann , Henning Armin , Roehlich Michaela , Marszalek Martin , Rauchenwald Michael , Madersbacher Stephan
Published: September 2008

Aim: To assess the role of Adjustable Continence Therapy® (ACT) as a minimally invasive treatment for women with urinary incontinence (UI) after failed previous incontinence surgery or when conventional surgical treatment was considered problematic. Material and Methods: The ACT device consists of two balloons implanted at the level of the bladder neck using a paraurethral/vaginal approach with the aim of coapting the urethra. Balloon filling can be adjusted postoperatively via a port placed in the labia majora. Results: 41 women with a mean age of 73 (range 42–93) years were evaluated. 15 (38%) women had failed previous UI surgery with 83% having undergone prior pelvic surgery. Mean follow-up was 25 (5–60) months. Adjustment of the ACT balloons was necessary in 28 women (69%). Overall, 44% of women became fully continent, 15% reported a significant improvement of UI, a further 29% had a slight improvement, while 12% indicated no change. ACT-related complications occurred in 16 (39%) patients, including balloon migration, transient urinary obstruction and balloon leakage. Conclusions: ACT is an attractive minimally invasive option for women with UI with previous failed incontinence surgery or when conventional incontinence surgery carries a high risk of failure.
Strategy for Repeat Prostate Biopsy: Predictors of Positive Biopsy and Additional Biopsy Location
Authors: Katto Kazunobu , Takahashi Masayuki , Taue Ryuichi , Nakatsuji Hiroyoshi , Kishimoto Tomoteru , Izaki Hirofumi , Oka Natsuo , Fukumori Tomoharu , Nishitani Masa-Aki , Kanayama Hiro-Omi
Published: September 2008

Purpose: We analyzed patterns of tumor distribution in radical prostatectomy specimens from patients with repeat biopsies to determine additional appropriate biopsy locations for repeat biopsy. Methods: Between January 2000 and June 2005, a total of 382 patients underwent transrectal ultrasound-guided prostate biopsy. Of these, 47 patients underwent repeat biopsy. Radical prostatectomy was performed for 7 of 22 cancer-positive cases. The 7 specimens were superimposed to create an idealized prostate gland at 3 levels: apex, mid-prostate, and base. We compared these tumor maps with those from 35 initial biopsy positive patients. Results: Prostate cancer was detected in 22 of 47 patients who underwent repeat biopsy. Tumor mapping showed that tumors detected on repeat biopsy in comparison with tumor maps of initial biopsy were dense at the periurethral area of the apex in prostate. Conclusions: Additional biopsy cores taken from periurethral area of the apex on repeat biopsy might further enhance the detection of cancers.
Comparison of Prostate Volume Measured by Transrectal Ultrasonography and MRI with the Actual Prostate Volume Measured after Radical Prostatectomy
Authors: Jeong Chang Wook , Park Hyoung Keun , Hong Sung Kyu , Byun Seok-Soo , Lee Hak Jong , Lee Sang Eun
Published: September 2008

Aim: To compare the prostate volume, as measured by transrectal ultrasonography (TRUS) and by MRI, with that of the actual prostate volume measured after a radical prostatectomy (RRP). Materials and Methods: This prospective study included 21 patients who had undergone RRP. TRUS prostate volumes were calculated using the prolate ellipsoid volume formula, with the anteroposterior diameter measured from axial (TRUS-V1) and mid-sagittal images (TRUS-V2). Two prolate ellipsoid volumes (MRI-EV1 and MRI-EV2) were calculated from the MRI using the same method, and planimetric volume (MRI-PV). The actual prostate volume (Actual-V) was measured in a measuring jug within 1 h after RRP. Results: Mean of Actual-V was 40.3ml (21.0–82.0). In paired sample tests, the correlation coefficients (R) for all methods were over 0.8. In a Student’s t test (paired), MRI-PV (p = 0.620), MRI-EV2 (p = 0.703) and TRUS-V1 (p = 0.099) showed no significant differences compared to the Actual-V. The linear regression models of these three methods were y = 1.025x – 0.268, y = 0.946x + 2.979 and y = 1.046x + 0.381, respectively. Conclusions: Between two TRUS volumes, TRUS-V1 was shown to be superior to TRUS-V2. In MRI, MRI-EV2 was more accurate than MRI-EV1. However, MRI-PV was the most accurate method. TRUS-V1 and MRI-EV2 could be used instead of MRI-PV in general clinical settings.
Prostate Cryoablation: Prospective Analysis Comparing High- and Low-Risk Prostate Cancer Outcomes
Authors: El Hayek Omar R. , Alfer, Jr. Wladimir , Reggio Ernesto , Pompeo Antonio Carlos L. , Arap Sami , Marmo Lucon Antonio , Srougi Miguel
Published: September 2008

Aim: To evaluate percutaneous cryotherapy as a primary treatment option for prostate cancer, comparing different risk groups. Patients and Methods: Forty-seven prostate cryoablation procedures were performed on 44 patients. Patients median age was 70.9, and average pretreatment PSA of 13.8 ng/dl. Patients were divided into low-risk (13 patients), high-risk (24 patients) and radiation failure patients (7 patients). The follow-up period ranged from 18 to 60 months (median 41 months). Results: In the low-risk group, we found after 12 and 24 months of follow-up, 92 and 86% of patients free of PSA relapse (PSA <1 ng/ml), respectively. In the high-risk group, the PSA failure was 39 and 52.9%. For the radiation failure group, 86 and 71.4% of patients had PSA below 1 ng/dl. At 48 months of follow-up, 80% of the low-risk patients, 42.8% of the high-risk group and 71.4% of the radiation failure group were free of PSA relapse. The complication rates were low, with 13% of urinary incontinence and no cases of rectal injury. Conclusion: Prostate cryoablation is a viable and promising minimally invasive alternative for localized or locally advanced prostate cancer patients.
[11C]Choline PET/CT for Targeted Salvage Lymph Node Dissection in Patients with Biochemical Recurrence after Primary Curative Therapy for Prostate Cancer
Authors: Rinnab Ludwig , Mottaghy Felix M. , Simon Joerg , Volkmer Bjoern G. , de Petriconi Robert , Hautmann Richard E. , Wittbrodt Markus , Egghart Guenther , Moeller Peter , Blumstein Norbert , Reske Sven , Kuefer Rainer
Published: September 2008

Introduction: In this prospective study we set out to investigate the diagnostic value of [11C]choline-PET/CT in patients with suspected lymph node metastases before salvage lymph node dissection. Patients and Methods: 15 consecutive patients with rising PSA underwent [11C]choline-PET/CT and consecutive open salvage pelvic/retroperitoneal extended lymph node dissection due to uptake of [11C]choline in at least 1 lymph node. Mean age was 62.1 (range 53–73). Results: [11C]choline-PET/CT results were compared with the histopathology reports and clinical follow-up (mean 13.7 months, range 6–24). Mean time to progression was 23.6 months (range 4–81). [11C]choline uptake was observed in nodes along the external and internal and common iliac arteries and in the paraaortic region. A positive histology was reported in 8/15 patients. Only one patient had a PSA nadir of <0.1 ng/ml after salvage surgery. Another patient had stable disease with a PSA of 0.5 ng/ml. Three patients developed bone metastases during follow-up. Conclusions: This interim analysis indicates that [11C]choline-PET/CT may be a useful technique in detection of lymph node metastases when rising PSA occurs after definite prostate cancer therapy. The presented cohort is limited in size, but there is still strong evidence that the patients benefit from [11C]choline-PET/CT and consecutive salvage lymph node dissection is rather small.
Age-Related Changes of Urine Calcium Excretion after Extracorporeal Shock Wave Lithotripsy due to Artificial Renal Calcium Leakage
Authors: Oehlschläger Sven , Hakenberg O.W. , Froehner Michael , Wirth M.P.
Published: September 2008

Introduction: Extracorporeal shock wave lithotripsy (ESWL) is the standard stone treatment. Increased excretion of tubular enzymes and hypercalciuria has been reported after ESWL. We investigated the importance of renally induced hypercalciuria after ESWL. Material and Methods: 30 calcium oxalate stoneformers (23 men, 7 women), mean age 53.3 (range 30–71) years, were evaluated prospectively. Plasma calcium and creatinine concentrations and 8-hour overnight urine were measured before ESWL and on the 1st and 2nd days after ESWL. To estimate the changes of tubular reabsorption, the calcium/creatinine clearance ratios were calculated. Results: Hypercalciuria (>5 mmol/24 h) was seen in 5/30 (16.7%) before, in 12/30 (40.0%) on day 1 and in 13/30 (43.3%) on day 2 after ESWL. The mean plasma levels of calcium were significantly decreased from 2.36 mmol/l before to 2.28 mmol/l on day 2 after ESWL (p< 0.01). The mean calcium/creatinine clearance ratio was significantly increased from 0.012 before to 0.019 after ESWL (p< 0.01). Before and on day 2 after ESWL, the calcium/creatinine clearance ratio was significantly correlated with the age of the patients (r = 0.33, p< 0.04). Conclusion: Our data show an age-related significantly increased urine calcium excretion after ESWL possibly due to decreased tubular calcium reabsorption.
Does Early Orchidopexy Prevent Morphological Changes in Undescended Testes? A Perioperative Assessment Using Ultrasonography
Authors: Michikawa Takehiro , Matsufuji Hiroshi , Araki Yuko , Nakamura Akiko
Published: September 2008

Introduction: The aim of this study was to assess the efficacies of early orchidopexy on later morphological changes in the testis using ultrasonography. Materials and Methods: The medical records of 23 consecutive patients with unilateral undescended testis operated on in our institution between 1992 and 2001 were reviewed in the historical cohort design. The subjects were divided into two groups according to their age at the time of surgery: group A included the patients who underwent surgery before age 2 (n = 13), and group B included those who were operated on at 2 years of age or older (n = 10). The mean undescended testicular volume and the incidence risk of morphological abnormalities detected by ultrasonography were compared between the two groups. Results: At 5 years after orchidopexy, the difference in the mean volume between the two groups was not statistically significant. The incidence risk of structural abnormalities at 5 years after orchidopexy was lower in group A than in group B (25.0 vs. 83.3%, p = 0.05). Conclusions: This study thus provides evidence that orchidopexy at a younger age could prevent morphological changes in the undescended testis.
Dorsal Dartos Flap in Snodgrass Hypospadias Repair: How to Use It?
Authors: Mustafa Mahmoud , Wadie Bassem S. , Abol-Enein Hassan
Published: September 2008

Purpose: To introduce new technique for covering neourethra with dorsal dartos subcutaneous tissue in Snodgrass hypospadias repair. Material and Methods: The study included 26 patients with primary hypospadias, aged 2–22 years (average 7.86), operated from June 2002 to August 2006. Of the patients, 21 had distal, 3 midshaft and 2 penoscrotal hypospadias. The standard technique of tubularized incised plate (TIP) with double-layer covering of the neourethra by subcutaneous tissue was used in all cases of reconstruction. The mean follow-up period was 4.5 months (range 3–12 months). Results: Successful result of a normal-looking penis without fistula was achieved in all patients. One patient had meatal stenosis (3.84%) at the early postoperative period which was corrected by urethral dilatation of the external meatus at an interval of up to 2 months postoperatively. Conclusion: Our technique represents a reasonable option for utilizing dorsal dartos subcutaneous tissue in TIP urethroplasty. The neourethra is covered symmetrically with a double layer of well-vascularized tissue and the penis is kept without rotation. Redundancy of the flap and its excellent vascularization depend on the harvesting technique. Further follow-up and a larger number of patients are needed before a final conclusion can be made
Are TGF-β1 and bFGF Correlated with Bladder Underactivity Induced by Bladder Outlet Obstruction?
Authors: Zhu Yaofeng , Shi Benkang , Xu Zhishun , Liu Yuqiang , Zhang Keqin , Li Yongzhi , Wang Haifeng
Published: September 2008

Background: Transforming growth factor-β1 (TGF-β1) and basic fibroblast growth factor (bFGF) are the two most important growth factors that have been found. Previous studies have indicated that the above two factors play an important role in the physiological growth, response to injury and the following fibrous proliferation of the bladder. Therefore, they may be related to the detrusor underactivity due to bladder outlet obstruction (BOO). The aim of this study is to investigate the relationship between them. Materials and Methods: 29 evaluable Wistar rats were divided into three groups: control group, BOO 2 weeks group and BOO 6 weeks group. After successful models, we measured excised bladder mass, detrusor contraction force (DCF) in vitro stimulated by carbachol of four different concentrations (10–5, 10–4, 10–3 and 10–2 mM). Simultaneously, the expression of TGF-β1 mRNA and bFGF mRNA in detrusor specimens was detected by reverse transcription polymerase chain reaction (RT-PCR) analysis. Additionally, we analyzed the correlation between DCF and the detrusor mRNA expression of the two factors to determine whether they are associated with the detrusor contraction response when BOO occurs. Results: Bladder mass increased steadily and significantly with the progression of the BOO. While at the point of 10–4 and 10–3 mM carbachol concentration, DCF in the BOO 2 weeks group was higher, no significant differences were found at the point of 10–5 and 10–2 mM carbachol concentration when compared to the control group. DCF was found to be significantly lower in the BOO 6 weeks group than in the BOO 2 weeks group and control group at all points of carbachol concentration. TGF-β1 mRNA expression of the detrusor was found to be higher only in BOO 6 weeks. However, there was a steady and significant increase of bFGF mRNA expression with the aggravation of BOO. Correlation analysis demonstrated that there was a significant moderate negative correlation between DCF in vitro and the level of TGF-β1 mRNA. Meanwhile, a significant high negative correlation was acquired between the DCF and bFGF mRNA level. Conclusion: DCF in the severe BOO group is remarkably impaired. There is a sustained rise of bFGF mRNA expression in detrusor with the progression of BOO, but TGF-β1 mRNA expression increase becomes evident only in the decompensation stage. Significant negative correlations are found between DCF in vivo and the expression of TGF-β1 mRNA, bFGF mRNA. Additionally, DCF correlates negatively with the bladder mass statistically after BOO.
Relationship between Glucocorticoid Receptor Signal Pathway and Androgen-Independent Prostate Cancer
Authors: Yan Tian-Zhong , Jin Feng-Shuo , Xie Li-Ping , Li Long-Cheng
Published: September 2008

Objective: To study the role of the glucocorticoid receptor (GR) signal pathway and downstream cytokine interleukin-6 (IL-6) in androgen-independent growth of prostate cancer (PC). Methods: The human androgen-dependent PC (ADPC) cell line LNCaP and androgen-independent PC (AIPC) cell line DU145 were cultured in vitro. Immunocytochemistry was used to examine the expression of the androgen receptor (AR), GR, HSP90 and IL-6. The GR antagonist RU486 was used to treat cultured cells, and the effects of RU486 on the proliferation of both cell lines were analyzed by MTT assay. Expression of HSP90 and IL-6 mRNA and protein was assessed by RT-PCR and Western blots, respectively. Results: LNCaP cells were AR-positive and GR-negative, whereas DU145 cells were GR-positive and AR-negative. The expression of HSP90 and IL-6 in DU145 cells were significantly stronger than that in LNCaP cells (p < 0.01). RU486 had no obvious effects on the growth of LNCaP cells, but exerted a significant time- and dose-dependent growth inhibition on DU145 cells at doses as low as 0.1 µmol/l. RU486 treatment of DU145 cells also resulted in a dose-dependent decrease in the expression of HSP90 and IL-6 mRNA and protein. Conclusions: The GR signal pathway may be the main survival pathway for DU145 cells. Abnormal hyperactivation of the GR signal pathway and its promoting the expression of HSP90 and IL-6 contribute to the progression of ADPC to AIPC after androgen ablation.
Infected Congenital Urethral Diverticulum Manifested as a Scrotal Mass in an Adult Male: Case Report and Review of the Literature
Authors: Cai Tommaso , Gavazzi Andrea , Sarti Enrico , Farina Umberto , Melone Franco , Bartoletti Riccardo
Published: September 2008

Congenital anterior urethral diverticula in adult males are infrequent urological diseases. Clinical manifestation is frequently described with irritative and/or obstructive voiding symptoms or ventral bulging, but manifestation as a scrotal mass is extremely rare. Diagnostic imaging is useful to correctly diagnose the above in the majority of cases. We report the first case of a urethral diverticulum in which neither clinical nor instrumental evaluations were performed to confirm the diagnosis of urethral diverticulum. We stress the importance of a surgical approach in evaluating scrotal mass if diagnostic imaging cannot confirm an exact diagnosis. A complete review of the literature was also carried out.
Manifestation of Congenital Urethral Diverticula in a 57-Year-Old Male
Authors: Gillitzer R. , Hampel C. , Schede J. , Pahernik S. , Melchior S.W. , Thüroff J.W.
Published: September 2008

Congenital urethral diverticula are a rare finding in adult males. Most cases are diagnosed in childhood or adolescence because of voiding symptoms such as urinary dribbling. Diagnostic workup should include radiography and urethroscopy. The standard therapeutic approach is open surgical excision or endoscopic marsupialization. An unusual case of male congenital urethral diverticula that remained asymptomatic until age 57 is presented.
Grade IV Renal Trauma in a Patient with a Solitary Kidney
Authors: Marszalek M. , Madersbacher S. , Rauchenwald M.
Published: September 2008

A 60-year-old woman with a grade IV trauma to a solitary kidney was referred to our hospital. After primary conservative management, a continuous decline of the renal function required surgical exploration with decompression and renal reconstruction on the 4th day after the trauma. Postsurgical anuria prompted insertion of a ureteral stent; thereafter the renal function recovered quickly. A urinoma caused by a urinary fistula emerged 6 months after the trauma and was treated by percutaneous drainage, ureteral stenting, and percutaneous occlusion with fibrin sealant. Twelve months after the trauma, the patient is symptom free with a normal renal function.
Cardiac and Caval Invasion of Left Adrenocortical Carcinoma
Authors: Yavascaoglu Ismet , Yilmaz Mert , Kordan Yakup
Published: September 2008

Adrenocortical carcinoma (ACC) is a rare and highly malignant neoplasm. We present the case of a 51-year-old male patient with a left-sided ACC admitted to hospital with ipsilateral flank pain, weight loss, difficulty in breathing, abdominal discomfort and swelling and bilateral leg edema. Thoracoabdominal computed tomography revealed a huge adrenal mass with obvious tumor thrombus involvement of the inferior vena cava and right atrium. This is the first report describing caval and opposite side renal vein invasion of a left-sided ACC treated with grafting of the vessels. Histopathological examination of the tumors confirmed the diagnosis of ACC. Postoperative recovery was uneventful. The patient received an adrenolytic agent, mitotane, postoperatively and is alive with no evidence of recurrence after 2 years of follow-up.
Single-Stranded DNA Oligoaptamers: Molecular Recognition and LPS Antagonism Are Length- and Secondary Structure-Dependent
Authors: Ding J.L. , Gan S.T. , Ho B.
Published: September 2008

In Gram-negative bacterial infection, lipopolysaccharide (LPS) readily overwhelms the host innate immune system, which could result in inflammation and sepsis in severe cases. Therefore, developing anti-LPS molecules would confer an efficient antibacterial strategy. We used SELEX (Systemic Evolution of Ligands by EXponential enrichment) to isolate single-stranded DNA (ssDNA) aptamers. By immobilizing and exposing different orientations of the LPS molecule on hydrophobic and hydrophilic surfaces, two populations of aptamers were captured from a library of 1014–15 ssDNA oligonucleotides. Progressive SELEX enriched the aptamers towards thymidine residues. The more hydrophobic aptamers with T-rich loops showed strong molecular recognition for the lipid A moiety of LPS, binding at affinity of up to KD of 10–9M, and eliciting 95% neutralization of endotoxicity. The longer ssDNAs exhibited greater avidity for LPS and conferred more efficacious antagonism against LPS. The nucleotide composition imposes subtle influence on the aptamer folding and affinity for LPS.
Toll-Like Receptor-9 Expression Is Inversely Correlated with Estrogen Receptor Status in Breast Cancer
Authors: Jukkola-Vuorinen Arja , Rahko Eeva , Vuopala Katri S. , Desmond Renee , Lehenkari Petri P. , Harris Kevin W. , Selander Katri S.
Published: September 2008

Toll-like receptor 9 (TLR9) recognizes microbial and vertebrate DNA. We previously demonstrated TLR9 expression in human breast cancer cell lines and showed that TLR9 ligands stimulate their in vitro invasion. The aim of this study was to characterize TLR9 expression in clinical breast cancer specimens. Immunohistochemical staining intensity was compared with known baseline prognostic factors and distant metastasis-free survival. TLR9 expression was detected in 98% of the tumors studied (n = 141). The mean TLR9 staining intensity was higher in ER– than in the highly ER+ breast cancers (p = 0.039). High-grade tumors had significantly increased TLR9 expression (p = 0.027) compared with lower-grade tumors. The highest TLR9 expression was detected in the mucinous and the lowest in the tubular breast cancers (p = 0.034). Distant metastasis-free survival was higher in the lower TLR9-expressing half of the cohort than in the higher TLR9-expressing group (p = 0.118). TLR9 expression did not correlate with menopausal, PgR or Her2 status, patient age, tumor proliferative or invasive characteristics.
Proteome Analysis Identifies the Role of Heat Stress in Production of Progeny HCV in Huh7 Cells Harboring Intact HCV
Authors: Zhao Sihai , Xun Meng , Chu Yonglie , Zhu Tong , Wang Yihua , Yan Lipeng , Xun Xin , Xu Kun , Song Juan , Shao Mingming
Published: September 2008

Objective: The intact hepatitis C virus (HCV) cell culture system has provided a powerful tool for studying the interaction between HCV and host cell. We applied proteomic techniques to globally analyze the protein expression profiles of Huh7 in the absence and presence of HCV, with the aim to elucidate the host cell components response to HCV. Methods: Proteomic and molecular biology techniques were used for this aim. Results: The expression of many proteins, including regucalcin, centriolin and several keratins, was up-regulated, after HCV transfection. Among the down-regulated expression proteins, the heat-shock protein family was of prime significance. Subsequently, we studied the role of heat stress in the interaction between HCV and host cell, based on proteomics analysis. We found heat stress did not affect the production of HCV in this in vitro cell culture system. Conclusions: Moreover, this study also provided the global information of proteomic alteration of Huh7 cells in the presence of intact HCV and further improved the understanding of the mechanism of interaction between HCV and host cell. We also draw a conclusion that heat stress had no affect on the production of HCV.
Pathological and Prognostic Value of Urinary Neutrophil Gelatinase-Associated Lipocalin in Macroproteinuric Patients with Worsening Renal Function
Authors: Bolignano Davide , Coppolino Giuseppe , Lacquaniti Antonio , Nicocia Giacomo , Buemi Michele
Published: September 2008

Background/Aims: Persistent proteinuria is a sign of renal damage caused by several factors, but it is itself a cause of tubular injury leading to chronic renal failure. Neutrophil gelatinase-associated lipocalin (NGAL) is a stress protein released by tubular cells which urinary excretion (uNGAL) increases in response to various stimuli. Methods: In the present study we analyzed uNGAL levels in 23 macroproteinuric patients with membranous glomerulonephritis. Results: In these subjects, uNGAL concentrations were significantly higher than in controls, directly correlated with proteinuria and inversely related to residual renal function. Patients were further categorized into two groups, according to a cut-off baseline uNGAL value of 350 ng/ml and evaluated during a 1-year follow-up period. After 12 months, subjects with higher uNGAL levels showed a significant worsening in baseline renal function and a 3.36 risk ratio of developing a severe decrease in GFR (≧50% of baseline values) compared with others. Conclusions: These findings suggest that NGAL may play a key role in tubular adaptations to persistent macroproteinuria. Furthermore, a new, interesting application of NGAL measurement could be proposed in clinical nephrology as a predictor of worsening renal function in patients affected by chronic kidney disease.
The Prognostic Value of the Modified Rankin Scale Score for Long-Term Survival after First-Ever Stroke
Authors: Huybrechts Krista F. , Caro J. Jaime , Xenakis James J. , Vemmos Konstantinos N.
Published: September 2008

Background: The modified Rankin Scale (mRS) is gaining importance as a means to quantity disability following stroke, yet little is known about its usefulness as a determinant of the long-term outcome. Methods: The Athens Stroke Registry, which includes information on 1,816 first-ever stroke patients admitted to the Athens University Hospital from 1992 to 2004, was used to examine the crude and adjusted effect of the 3-month mRS score for long-term survival. The mean age was 70 years, 62% were males, and 84% had an ischemic stroke. Results: The mortality in the first 3 months exceeded 20%, but thereafter the survival declined much more slowly (∼4.5% per year). The patients with worse mRS scores had a significant excess risk of death; the effect persisted when controlling for coexistent cardiovascular problems (transient ischemic attack, claudication, heart failure and atrial fibrillation). Conclusions: These findings underscore the importance of interventions aimed at improving disability following stroke.
Usefulness of a Simplified Management Scheme for Paraclinoid Aneurysms Based on a Modified Classification
Authors: Chen Lukui , Kato Yoko , Karagiozov Kostadin L. , Yoneda Minoru , Imizu Shuei , Hayakawa Motoharu , Sadato Akiyo , Irie Keiko , Negoro Makoto , Sano Hirotoshi
Published: September 2008

Background: Our objective was to set up a management-oriented classification for paraclinoid aneurysms, and then design and apply a simplified management scheme according to each group defined by this classification. Methods: Paraclinoid aneurysms were classified as group I (supraophthalmic artery), group II (ophthalmic artery) and group III (infraophthalmic artery) aneurysms intradurally. Between January 2005 and December 2006, 86 cases with 89 paraclinoid aneurysms were treated. There were 35 (40.2%) aneurysms in group I (20 in group Ia, 15 in group Ib), 32 (36.8%) in group II and 20 (23%) in group III. Results: In group I aneurysms, 20 (57.1%) were treated by clipping or/and wrapping, while 15 (42.9%) were managed by coiling. In group II aneurysms, 20 (62.5%) were treated by clipping and 12 (37.5%) by coiling. The contralateral approach was performed for 4 (6%) aneurysms in groups I and II. All 20 group III aneurysms were treated by coiling. The overall rate of permanent complications was 4.6%. The rate of complete occlusion was 92.5% in surgical cases and 55.6% in endovascular ones. The overall outcomes in the treatment of paraclinoid aneurysms were excellent (GOS = 5, 95.4%). Conclusion: Based on our modified classification of paraclinoid aneurysms, a simplified management scheme was designed and applied. For group I (supraophthalmic artery) and group II (ophthalmic artery) aneurysms, surgical clipping or/and wrapping should be the first choice of treatment, while for group III (infraophthalmic artery) aneurysms, endovascular coiling should be the best modality. Additionally, individualizing the treatment planning might contribute to better results.
Risk Factors for Cerebral Microbleeds in the Elderly
Authors: van Es Adriaan C.G.M. , van der Grond Jeroen , de Craen Anton J.M. , Admiraal-Behloul Faiza , Blauw Gerard J. , van Buchem Mark A.
Published: September 2008

Background: To define the cardiovascular risk factors for cerebral microbleeds and to investigate the relationship between microbleeds on the one hand, and the volume of age-related white matter hyperintensities (WMH) and atrophy on the other in an elderly population. Methods: Four hundred and thirty-nine elderly subjects (age range: 72–85; mean: 77) suffering from vascular disease or at high risk for developing this condition were included in this study. For each subject the number and localization of the microbleeds was recorded. Results: The prevalence of microbleeds in this study was 24%. We found age and a history of hypertension to be risk factors for microbleeds. After regional subdivision systolic blood pressure was found to be a risk factor for microbleeds located in the basal ganglia. A history of hypertension was more prevalent in patients with corticosubcortical and basal ganglia microbleeds. Magnetic resonance imaging risk factors associated with one or more microbleeds were total WMH volume, subcortical WMH volume, and periventricular WMH volume. Total WMH volume and periventricular WMH volume were risk factors for corticosubcortical microbleeds and basal ganglia microbleeds. Conclusion: A high prevalence of microbleeds was found in a population of patients suffering from vascular disease or at high risk for developing this condition. Age, hypertension and WMH were the most important risk factors for microbleeds, especially when located in the corticosubcortial junction or in the basal ganglia.
Sudden Deafness and Right-to-Left Shunts
Authors: Iguchi Yasuyuki , Kimura Kazumi , Kobayashi Kazuto , Tachi Toshihiro , Aihara Teruhito , Harada Tamotsu
Published: September 2008

Purpose: One of the etiologies for idiopathic sudden deafness is considered to be ischemia of the inner ear. Cryptogenic stroke is caused by a right-to-left shunt (RLS). The present study investigated whether RLS is associated with the occurrence of sudden deafness. Methods: Contrast saline transcranial Doppler ultrasonography was performed to detect RLS. Subjects comprised 23 consecutive sudden deafness patients and 46 age- and gender-matched controls. Clinical characteristics, including vascular risk factors, were compared between sudden deafness and control groups. Results: RLS was more frequent in the sudden deafness group than in controls (48 vs. 17%, p = 0.011). No significant differences in other clinical characteristics were seen between groups. Conclusion: RLS may be a potential cause of sudden deafness.
Gamma-Hydroxybutyrate Accelerates Functional Recovery after Focal Cerebral Ischemia
Authors: Gao Bo , Kilic Ertugrul , Baumann Christian R. , Hermann Dirk M. , Bassetti Claudio L.
Published: September 2008

Background and Purpose: γ-Hydroxybutyrate (GHB), a natural metabolite of γ-aminobutyric acid and a drug used in humans to promote slow-wave sleep and treat narcolepsy, has been suggested to protect against ischemic stroke at high doses. This study aimed to assess recovery-promoting effects of GHB at a low dose similar to that used in patients. Methods: Adult mice, subjected to 30 min of intraluminal middle cerebral artery occlusion, were intraperitoneally treated with GHB (100 mg/kg, twice/day, 8 h apart) or saline for 10 days. Motor recovery was evaluated by the grip strength test. The brain lesion was assessed by cresyl violet and NeuN staining 5 weeks after stroke. Expression of neuroplasticity-related genes (GAP43, c-jun, neurocan and ephrin B1) was analyzed by Taqman real-time PCR. Results: GHB-treated mice regained their body weight faster and recovered grip strength (3 weeks after stroke) more quickly than saline-treated mice. This was noteworthy as GHB did not influence ischemia-induced brain injury, as revealed by cresyl violet and neuronal staining. The Taqman PCR assay revealed a decreased expression of c-jun and neurocan in the ischemic striatum of GHB-treated mice in comparison to saline-treated mice. Conclusion: GHB at a low dose accelerates neurological recovery following ischemic stroke. Further studies are necessary to determine the potential relationship between GHB, neuroplasticity, sleep and stroke recovery.
Ischemic Mitral Regurgitation: A Complex Multifaceted Disease
Authors: Magne Julien , Sénéchal Mario , Dumesnil Jean G. , Pibarot Philippe
Published: September 2008

Ischemic mitral regurgitation (MR) is a complex multifactorial disease that involves global and regional left ventricular remodeling as well as dysfunction and distortion of the components of the mitral valve including the chordae, annulus and leaflets. This is a frequent (13–59%) complication of myocardial infarction, which is associated with a poor prognosis. The suboptimal results obtained with the most commonly used surgical strategy, that is, restrictive annuloplasty combined with coronary artery bypass graft, emphasize the need to develop alternative or concomitant surgical techniques that directly target the causal mechanisms of the disease. A comprehensive assessment of mitral valve configuration and left ventricular geometry and function prior to surgery as well as an accurate quantification of MR severity at rest and during exercise may help improve patient risk stratification and better individualize the surgical strategy based on the patient’s specific characteristics. The purpose of this review is to summarize the current state of knowledge with regard to the definition, prevalence, mechanisms, outcome and treatment of ischemic MR.
Treatment of Vascular Dementia: The Route of Prevention
Authors: Sorrentino G. , Migliaccio R. , Bonavita V.
Published: September 2008

Vascular dementia (VaD), rather than being considered as a univocal nosological entity, should be regarded as a heterogeneous clinical entity which differs in clinical-pathological phenotype as well as in pathophysiological mechanisms, but shares cerebrovascular disease (CVD), resulting from vascular or circulatory pathology, as the cause of dementia. The aim of this review is to discuss VaD treatment focusing particularly on more prevalent ischemic forms. Due to the fact that there are presently no treatments capable of obtaining considerable results once VaD is clinically established, specific emphasis will be given to the therapeutic strategies aimed at the prevention of CVD risk factors. The therapeutic strategies aimed at slowing the progression of the disease will also be discussed.
Dementia and Painting in Patients from Different Cultural Backgrounds
Authors: Midorikawa Akira , Fukutake Toshio , Kawamura Mitsuru
Published: September 2008

Background/Aim: Some patients with frontotemporal lobar degeneration (FTLD) have been shown to develop painting abilities after the onset of the disease; however, the reported cases have all been in western countries. The purpose of this report was to investigate whether this phenomenon was unique to western countries. Methods: 2 patients participated in this study. They were nonwestern uneducated patients with FTLD, semantic dementia subtype, who developed drawing skills after the onset of the disease. We compared their drawings with drawings in previous reports. Results: The characteristics of their paintings matched those of paintings from previously reported cases despite the cultural differences. Conclusion: These results support the assumption that the appearance of painting skills during this illness is not a reflection of learning, but instead is an expression of innate functions of the brain.
Risk Factors and Subtype Analysis of Acute Ischemic Stroke
Authors: Lai Shiao-Lin , Weng Hsu-Huei , Lee Meng , Hsiao Ming-Chang , Lin Leng-Jye , Huang Weng-Yi
Published: September 2008

Background and Purpose: Stroke risk factors and subtypes were examined for associations with mortality and recurrence rate in Taiwanese patients with first-ever and recurrent stroke. Methods: This study examined patients with initial and recurrent stroke from 2003 to 2005 for risk factors, demographic data, Bamford subtypes and transient ischemic attack. Results: One thousand and twenty-one patients with 1,085 stroke episodes were recruited. Significant factors associated with recurrent stroke were hyperlipidemia, atrial fibrillation and smoking. A significant incidence of lacunar infarction was noted in the patient population (37.82% in all patients; 41.02% in first stroke vs. 35.67% in recurrent stroke patients). Patients with diabetes mellitus were more likely to have lacunar rather than total anterior circulation infarction (TACI) or partial anterior circulation infarction (PACI). Hyperlipidemia was more often attributable to lacunar stroke than PACI. Atrial fibrillation was significantly associated with nonlacunar infarcts, TACI and PACI but not lacunar stroke. Conclusions: The incidence of lacunar infarction was significantly higher in initial rather than recurrent stroke patients. Diabetes mellitus or hyperlipidemia was highly associated with lacunar infarction. Atrial fibrillation was associated with nonlacunar infarction in Taiwan, similar to the result of White and Black populations in the UK.