bluuebunny/crossref_metadata_2025_split huggingface dataset:
The value of prostatic specific antigen in the early diagnosis of prostatic cancer: a Greek view
Authors: Deliveliotis Ch. , Alivizatos G. , Karayiannis A. , Kontothanasis D. , Makrychoritis K. , Lysiotis P. , Dimopoulos M.A. 
Published: November 2008

Objective To assess whether it is worthwhile to screen asymptomatic men for prostate Cancer using serum prostate specific antigen (PSA) and to determine how many patients could be cured of prostatic carcinoma if detected by screening.Patients and methods Between June 1992 and January 1994 the serum PSA level of 1400 asymptomatic men over 50‐years‐old was assessed. Those men with PSA levels < 4 ng/mL were not evaluated further. Those men with PSA levels of 4–10 ng/mL underwent digital rectal examination (DRE) and transrectal ultrasonog‐raphy (TRUS) and biopsies were taken when there were significant findings on DRE and/or TRUS. If the PSA levels were > 10 ng/mL patients were submitted for DRE and TRUS and. even if both examinations were negative, random biopsies were taken. Where Cancer was detected the tumour was staged and if it was a clinically confined tumour a radical retropubic prostatectomy was performed. The pathological and clinical stages of the disease were then compared.Results The majority of patients (95%) had PSA levels of < 4 ng/mL. Forty‐nine men had PSA levels of 4–10 ng/mL and of these 28 were biopsied, which detected 12 (24.5%) carcinomas. There were 20 men with PSA levels > 10 ng/mL and among them 11 (55%) were found to have carcinomas. Combining these figures, among the 1400 men there were 69 cases with PSA levels >4 ng/mL and, using DRE and TRUS, 23 patients (33%) were diagnosed as having prostatic adenocarcinomas. Among these, one had metastatic disease, three had lymph node micrometast‐ases during surgical exploration and 19 underwent radical prostatectomies. The pathological and clinical stages agreed in only eight patients.Conclusion Only eight patients can be considered as cured because of the screening protocol and even this result is overoptimistic, as the future biological behaviour of these tumours is unknown. Therefore we cannot recommend screening for prostatic carcinoma among asymptomatic men in Greece.
Antegrade scrotal sclerotherapy for the treatment of varicocele in childhood and adolescence
Authors: MOTTRIE A.M. , MATANI Y. , BAERT J. , VOCES G.E. , HOHENFELLNER R. 
Published: November 2008

Objective To test the efficacy of antegrade scrotal sclerotherapy (ASS) for the treatment of varicocele in teenagers.Patients and methods The study included 38 patients (mean age 14.9 years, range 12–18) with left‐sided varicocele. Three patients had a grade 1 varicocele, 22 were grade 2 and 13 were grade 3. ASS was performed under local anaesthesia on an out‐patient basis.Results ASS was accepted by all patients except one. There were no peri‐operative problems and only one patient developed post‐operative epididymitis. During 9 to 15 months of follow‐up (mean 11 months), only two patients developed persistence of a lower grade of varicocele.Conclusion This study illustrates that ASS is a safe and successful out‐patient procedure for the treatment of varicocele in teenagers.
High educational level associated with reduced semen quality in men with asymptomatic varicocele testis
Authors: LUND L. , SØRENSEN H.T. 
Published: November 2008

Objective To investigate the relationship between education, intelligence, varicocele testis and semen quality.Subjects and methods Of 542 newly‐enlisted soldiers (median age 20 years, range 20–24) 47 men were found who had varicocele testis. Semen quality was assessed in 39 of the men with a varicocele and compared with a similar group with no varicocele. The educational level and intelligence of both groups was also assessed and compared.Results There was a significantly reduced quality of semen in men with varicoceles and in men with > 10 years of school education. There was no significant relationship between intelligence level and semen quality.Conclusions The assumption that there is a relationship between educational level and semen quality in men with asymptomatic varicocele seems well‐founded, and educational level should therefore be considered as an explanatory variable in future investigations; studies are also required to provide a biological explanation of this phenomenon.
Evaluation of patients with diseases of the prostate using prostate‐specific antigen density
Authors: WOLFF J.M. , BOECKMANN W. , EFFERT P.J. , HANDT S. , JAKSE G. 
Published: November 2008

Objective To compare the efficacy of two tests, prostatic‐specific antigen (PSA) and the PSA/prostate volume ratio (PSAD), as diagnostic and staging markers to discriminate patients with benign prostatic hyperplasia (BPH) from patients with cancer of the prostate (CaP).Patients and methods Prostate gland volumes were estimated in 60 patients with BPH and 88 patients with clinically organ‐confined CaP by performing transrectal ultrasonography (TRUS) and using the prolate ellipse formula. Serum PSA concentration was determined using an enzyme immunoassay. In patients with BPH, the prostates were removed either by transurethral resection or retropubic prostatectomy. Patients with CaP underwent laparoscopic pelvic lymph‐adenectomy followed by radical perineal prostatectomy. PSAD was calculated by relating the serum PSA level to the TRUS‐estimated prostate volume.Results The median PSA level was 4.4 ng/mL in patients with BPH, 9.3 ng/mL in patients with CaP‐NO disease and 24 ng/mL in those with CaP‐N + disease. However, imposing a PSA limit of 4 ng/mL for the diagnosis of CaP gave a positive predictive value of only 64.8%, whereas a limit of 10 ng/mL gave a positive predictive value of 71.4%. In contrast, the median PSAD was 0.086 ng/mL/cm3 in patients with BPH, but was 0.295 ng/mL/cm3 in patients with NO‐disease and 0.775 ng/mL/cm3 in those with N+‐disease. With a limit of 0.15 ng/mL/cm3 the positive predictive value of PSAD was 81%. Furthermore, a limit of 0.6 ng/mL/cm3 revealed a positive predictive value of 81% for the diagnosis of metastatic lymph node involvement.Conclusions There was a considerable overlap of PSA concentrations in patients with BPH and CaP, and PSA was not sufficiently accurate to distinguish between them. In contrast, PSAD enhanced the discrimination between BPH and CaP and may provide additional information about the status of the lymph nodes in patients with CaP.
Prostate‐specific antigen density: correlation with histological diagnosis of prostate cancer, benign prostatic hyperplasia and prostatitis
Authors: VAN IERSEL M.P. , WITJES W.P.J. , DE LA ROSETTE J.J.M.C.H. , OOSTERHOF G.O.N. 
Published: November 2008

Objective To assess the additional value of prostate‐specific antigen density in the diagnosis of prostate cancer in patients who undergo prostate biopsies.Patients and methods The study comprised 376 patients with symptoms of prostatism who were undergoing prostate biopsy. Digital rectal examination (DRE) and transrectal ultrasonography (TRUS) were performed and the prostate specific antigen level (PSA) and density (PSAD) were determined for each patient.Results Both PSA and PSAD significantly differentiated (P < 0.001) between benign and malignant histology. Of the 376 patients, 91 (24%) had a PSA level in the intermediate range (4.0–10.0 ng/mL). In these patients PSAD was significantly better than PSA in differentiating between benign and malignant histology (P= 0.027 vs 0.316). With a PSAD limit of 0.15 ng/mL/cm3 in these patients, the sensitivity was 92% and the specificity was 54% for the diagnosis of prostate cancer. No patient with a positive biopsy had a PSAD < 0.11 ng/mL/cm3. No limiting value could be found for PSAD that combined both an acceptable sensitivity and specificity. Of the patients with a malignancy detected by the biopsy, 92% also had a suspect DRE.Conclusion In patients with intermediate PSA levels, PSAD is of limited additional value when compared to DRE in correctly diagnosing prostate cancer. Acute prostatitis is also a possible cause of elevated PSA. Both PSA and PSAD had no additional value in differentiating between benign prostatic hyperplasia (BPH) and histologically proven extensive prostatitis.
Microwave hyperthermia in benign prostatic hypertrophy: a controlled clinical trial
Authors: VENN S.N. , MONTGOMERY B.S.I. , SHEPPARD S.A. , HUGHES S.W. , BEARD R.C. , BULTITIUDE M.I. , LLOYD‐DAVIES R.W. , TIPTAFT R.C. 
Published: November 2008

Objective To compare the effects of microwave hyperthermia in benign prostatic hypertrophy (BPH) to sham treatment.Patients and methods The trial included 96 patients with proven symptomatic bladder outflow obstruction (BOO) caused by BPH. Patients underwent a full subjective and objective assessment (including urodynamics) before inclusion and again 3 and 6 months later. They were randomly assigned to receive 1 h of microwave hyperthermia or a sham treatment. Of the 96 patients, 93 were assessed at 3 months and 62 at 6 months after treatment.Results There was no statistically significant difference in the objective measures of BOO between the treated and control groups of patients. There was an improvement of approximately 40% in all the subjective measures, but there was no significant difference between the treated and control groups.Conclusion Microwave hyperthermia, within the parameters defined in this trial, resulted in no significant difference from sham treatment in subjective or objective outcome.
The STING in the refluxing duplex system
Authors: STEINBRECHER H.A. , EDWARDS B. , MALONE P.S.J. 
Published: November 2008

Objective To assess the efficacy of the subureteric Teflon injection (STING) procedure in the refluxing duplex ureter.Patients and methods The STING procedure was performed in 23 patients (five boys and 18 girls, mean age 6.5 years, [range 1.5–14]) with six refluxing upper and 31 refluxing lower moieties. Teflon was injected separately into each moiety of the duplex. All patients were assessed by a micturating cysto‐urethrogram and ultrasonography at least 3 months after treatment and the results were analysed retrospectively for the success rate of each refluxing unit and the overall cure rate of patients.Results No patient suffered ureteric obstruction. After the first STING the unit cure rate was 57% but only nine of 23 patients were completely cured. This improved to a unit cure rate of 68% and 11 patients cured after a second STING.Conclusion Because the patient cure rate was poor we do not advocate using the STING to treat vesicoureteric reflux in the duplex kidney.
The density and distribution of endothelin 1 and endothelin receptor subtypes in normal and diabetic rat corpus cavernosum
Authors: BELL C.R.W. , SULLIVAN M.E. , DASHWOOD M.R. , MUDDLE J.R. , MORGAN R.J. 
Published: November 2008

Objective To investigate the density and distribution of endothelin l(ET‐l) and endothelin receptor subtypes in rat cavernosal tissue, and to assess any changes brought about by the onset of diabetes mellitus (DM).Materials and methods Hyperglycaemic non‐ketotic diabetes mellitus was induced in five rats using streptozo‐tocin (STZ). Two months later the penises were excised and stored at—70°C. Longitudinal serial sections (6 μm) were cut using a cryostat and thaw‐mounted onto gelatinized microscope slides. Low and high resolution autoradiographs were taken using radioligands for ET‐1 and endothelin A (ETA) and endothelin B (ETB) receptors and the autoradiographs analysed densitometrically. These results were compared with those from five age‐matched control rats.Results ET‐1 and ETA receptor binding was primarily localized to the endothelium lining the cavernosal lacunar spaces; trabecular corporeal smooth muscle was much less intensely stained. No ETB receptor binding could be demonstrated, but increased binding of ET‐1 and ETA receptors was seen in the diabetic cavernosal tissue.Conclusion ET‐1 and ETA receptor binding is increased in diabetic rat cavernosal tissue. A reduction in receptor linked nitric oxide (NO) release has previously been reported in diabetic rats. This finding may provide an explanation for the upregulation of ET‐1 and ETA receptor binding in the diabetic rat.
The limited impact of involved surface area and surgical debridement on survival in Fournier's gangrene
Authors: PALMER L.S. , WINTER H.I. , TOLIA B.M. , REID R.E. , LAOR E. 
Published: November 2008

Objective To evaluate the influence of involved surface area (extent of disease) and the number and timing of surgical debridements on survival in patients with Fournier's gangrene.Patients and methods The medical records of 30 patients with Fournier's gangrene treated over a 15‐year period were reviewed. The extent of disease was quantified and expressed as a percentage of the body surface area by applying a modified diagram used to assess burn injuries. The number of surgical debridements and their timing with respect to initial presentation and to each other were also analysed. Patients were stratified by outcome (survival or death) and the data evaluated by Student's t‐test, Fisher's exact test and regression analysis.Results Of 30 patients treated 13 died (43%) and 17 survived (57%). The mean surface area involved by disease among survivors was 4.3% (range 1–16.5%) and 7.2% (range 5–20.5%) for non‐survivors (P = 0.10). Whilst no direct correlation between death rate and extent of disease existed, patients with <5% surface area involvement were more likely to survive (P = 0.014). Every patient underwent surgical debridement of the involved area (mean 1.72 procedures per patient). Survivors underwent from one to four debridements (mean 1.79) and non‐survivors one to three debridements (mean 1.63); the mean number of debridements did not influence outcome (P = 0.68). The performance of more than one debridement did not affect survival (P= 1.00). The initial debridement was performed within 24 h of presentation in 10 of 13 patients who died and 11 of 17 survivors and had no effect on outcome (P = 0.69). A second debridement was performed after a mean of 6.8 days (range 1–12) among the six survivors and 5.4 days (range 2–16) among the five non‐survivors; this difference was not statistically significant (P = 0.65). Four survivors required a third debridement, one required a fourth and one patient who succumbed underwent a third debridement.Conclusion The mortality rate from Fournier's gangrene continues to be substantial (43% in our series). Although no linear correlation existed, the quantified extent of disease may affect outcome as patients with > 5% of body surface area involved were more likely to succumb to the disease. Finally, the number of surgical debridements, even if first performed within 24 h of presentation, had no impact on outcome in patients with Fournier's gangrene.
The social implications of lower urinary tract reconstruction performed during childhood
Authors: WILLIAMS E.R. , MALONE P.S.J. 
Published: November 2008

Objective To compare the social effects of urinary diversion, undiversion and orthotopic bladder reconstruction performed during childhood.Patients and methods Of 99 patients treated at the Wessex Centre for Paediatric Surgery between 1960 and 1993, 46 (16 with a urinary diversion, eight with an undiversion and 22 with bladder reconstruction) were interviewed using a standardized questionnaire. Information was collected about the types and results of surgery, the medical support received and the social effects of the different treatments.Results By day, continence or only occasional wetting was achieved in 13 patients with diversions, all those with undiversions and 16 of those with reconstructions. At night, 13 patients with diversions, seven with undiversions and 18 with reconstructions were dry or only occasionally wet. Re‐operation rates were higher in those with reconstruction and undiversion.Only five of the diversion group were satisfied with their management compared to all patients in the other two groups.The social effects in terms of employment, schooling, independence, body image and social interactions were also better in those with undiversions and reconstructions.Conclusions The social effects of undiversion and bladder reconstruction were better than those following urinary diversion despite the higher re‐operation rates and the need for a rigid regimen of post‐operative care. However, the need for continuing medical support in this group of patients cannot be over emphasized, and the vital role of the urological nurse specialist is stressed.
Some new insights into bladder function in infancy
Authors: YEUNG C.K , GODLEY M.L. , HO C.K.W. , RANSLEY P.G. , DUFFY P.G. , CHEN C.N. , LI A.K.C. 
Published: November 2008

Objectives To evaluate normal bladder function and micturition patterns in infants.Patients, subjects and methods Twenty‐one infants (16 boys, five girls; mean age 5.9 months) with no lower urinary tract pathology underwent natural filling cystometry. Micturition patterns were also observed simultaneously with polysomnography in 26 healthy neonates (16 boys, 10 girls; mean age 7.4 days).Results In infants, cystometry showed (95% CI) a capacity of 42–53 mL, a maximum rise in detrusor pressure during voiding of 95–120 cmH2O and a voiding efficiency (voided volume/capacity) of 0.86–0.91. On micturition, urinary flow was discoor‐dinated from peak detrusor pressures in 10 infants. Detrusor instability occurred in one of 21 infants. Micturition was observed only during wakefulness or on arousal from sleep. In neonates, 17 of 61 recorded voids (28%) were during full wakefulness and 44 (72%) during arousal from sleep. Notably, none of the recorded voids occurred during quiet sleep.Conclusions The normal infant's bladder was stable and emptied almost completely. Voiding with incomplete co‐ordination between detrusor contraction and urinary sphincter relaxation could be normal. Micturition never occurred during quiet sleep. There was cortical arousal in response to a full bladder even in new‐born infants. This contradicts the traditional concept of a totally uninhibited bladder in infancy. There are potential implications for the management of children with nocturnal enuresis.
Urinary tract candidiasis in neonates and infants
Authors: HITCHCOCK R.J.I. , PALLETT A. , HALL M.A. , MALONE P.S.J. 
Published: November 2008

Objective To examine the range of disease caused by invasive Candida infection in neonates and infants and to discuss the available treatment options, particularly surgery and drug therapy.Patients and methods Five consecutive infants with invasive urinary tract Candida infection presenting over an 18‐month period were reviewed. Treatment protocols included a combination of surgery and treatment with amphotericin, flucytosine and fluconazole.Results The range of disease severity from simple Candida urinary tract infection to overwhelming multi‐organ sepsis was demonstrated. Urinary tract obstruction was identified as a predisposing factor in three of the five cases. In all cases, infection was cleared by the treatment protocol. Two cases with bilateral renal pelvic fungal balls showed resolution with no surgery in three kidneys and showed no advantage of pyelotomy and perfusion.Conclusion The results question the role of surgery, which may be limited to the relief of primary urological obstruction. We advocate the use of oral fluconazole to prevent or treat early systemic infection and, for severe systemic infections, a prolonged course of fluconazole in combination with flucytosine should be considered as an alternative to amphotericin, which is toxic and can only be given intravenously.
Effects of denervation on muscarinic receptors in the at bladder
Authors: GUNASENA K.T. , NIMMO A.J. , MORRISON J.F.B. , WHITAKER E.M. 
Published: November 2008

Objective To demonstrate the specific distribution of muscarinic receptors in the rat urinary bladder and to investigate the effects of afferent and efferent denervation on the density and distribution of muscarinic receptors.Materials and methods Urinary bladders were obtained from female rats which had been injected with vehicle (control), or neonatally with capsaicin (NC, afferent denervation) or which had their pelvic plexus removed (post‐ganglionic denervation, PGD, efferent denervation). Tissue sections were used in radioligand‐binding studies and for autoradiography with the muscarinic receptor ligand l‐quinuclidinyl[phenyl‐4–3H]benzilate (QNB).Results Binding of QNB was saturable and specific to a single population of binding sites, with a mean dissociation constant (Kd) of 1.05 ± 0.14 nmin controls and 0.90 ± 0.13 nmin rats with PGD. Post‐ganglionic denervation caused a 37% increase in maximal binding (Bmax) of QNB from 437.1 ± 39.1 fmol/mg protein (control group) to 599.1 ± 4.5 fmol/mg protein (P< 0.02). Autoradiograms revealed muscarinic binding sites over the smooth muscle, but none over the epithelium. Smooth muscle binding sites were doubled after PGD but were unchanged after NC treatment.Conclusion Muscarinic receptors were localized over the smooth muscle of the rat bladder and were increased after post‐ganglionic denervation. This increase may be responsible for the increased sensitivity to muscarinic agonists reported to occur after bladder denervation.
Characterization and autoradiographic localization of [3H]α,β‐methylene adenosine 5‘‐triphosphate binding sites in human urinary bladder
Authors: BO X. , BURNSTOCK G. 
Published: November 2008

Objectives To characterize [3H]α,β‐methylene adenosine 5′‐triphosphate ([3H]α,β‐MeATP, a radioligand for P2X‐purinoceptors) binding sites in the washed homogenates and membrane preparations of human urinary bladder and, using autoradiography, to localize [3H]α,β‐MeATP binding sites in human bladder.Materials and methods Specimens were obtained from the fundus of the urinary bladder of male patients aged 56–79 years. The washed homogenates or membrane preparations of the bladder specimens were incubated with [3H]α,β‐MeATP and the bound and free radioligand separated by filtration. For autoradiography, cryostat sections were incubated with 10 nM [3H]α,β‐MeATP, washed, dried and exposed for 2 weeks to emulsion‐coated coverslips. In both experiments, 100 μmβ,γ‐methylene ATP was used to determine non‐specific binding.Results Six of 16 specimens in the binding assay and three of seven specimens in the localization study showed specific [3H]α,β‐MeATP binding. The binding process was saturable and the specific binding sites were composed of a high‐and low‐affinity component. The specific binding to membrane preparations was reduced in the presence of Mg2+in the incubation medium. Competitive displacement experiments showed that the order of potency of the unlabelled ligands to displace the [3H]α,β‐MeATP binding was α,β‐methylene ATP < β,γ‐methylene ATP < suramin < 2‐methylthio ATP < ATP > ADP ≫ adenosine, which indicates that the binding sites are, or are linked to, P2X‐purinoceptors. Autoradiography showed that the specific [3H]α,β‐MeATP binding sites were located only over the smooth muscle of the bladder.Conclusions The results suggest that P2X‐purinoceptors exist in human urinary bladder, although at a lower density than reported for rodent urinary bladder.