bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of end‐stage renal disease and renal transplantation on serum prostate‐specific antigen
Authors: Morton J.J. , Howe S.F. , Lowell J.A. , Stratta R.J. , Taylor R.J. 
Published: November 2008

Objective To evaluate the effect of dialysis and kidney transplantation on serum prostate‐specific antigen (PSA) levels, and to compare these results with those from normal age‐matched controls. In addition, to evaluate the efficacy of PSA and digital rectal examination (DRE) for detection of prostate cancer in patients on dialysis and following kidney transplantation. Patients and methods Between January 1990 and July 1993 all men in the transplant programme over the age of 40 years who were undergoing pre‐transplant evaluation or post‐transplant follow‐up underwent a yearly DRE and PSA evaluation. Twelve patients were evaluated pre‐transplant and 70 patients were evaluated post‐transplant. A total of 136 PSA levels were obtained (1.7 per patient). Patients with suspicious findings underwent further evaluation with transrectal ultrasound and biopsies if indicated. Controls were patients without known prostate cancer who had been evaluated in a Prostate cancer Awareness Clinic. Results The average PSA values in the study groups were unaffected by either dialysis or transplantation when compared with age‐matched controls. In addition, 12 patients who had been on dialysis at the time of their initial evaluation and who subsequently underwent transplantation did not show any difference in their average PSA values pre‐ or post‐transplant. Three patients (4%) were found to have prostate Cancer and two underwent radical retropubic prostatectomy. They are free of disease 24 and 36 months post‐operatively and neither has experienced any decline in renal function. Immunosuppression was not modified. Conclusion Transplantation and dialytic therapy do not appear to affect clinical serum PSA levels. PSA and DRE appear to be equally valid for detection of prostate cancer in patients on dialysis and post‐transplant when compared with the general population. Finally, radical prostatectomy appears to be a safe and feasible treatment option in this group of patients.
Increase of serum prostatic specific antigen and clinical progression in pN + M0 prostate cancer
Authors: Josefsen D. , Waehre H. , Paus E. , Fosså S.D. 
Published: November 2008

Objective To analyse the increase of serum prostatic specific antigen (PSA) as a means of early detection of progression in hormonally untreated or androgen‐deprived patients with T1‐T4, pN+ and M0 prostate cancer. Patients and methods From 1986 to 1992 40 patients with T1‐T4 pN+ M0 prostate cancer were either deprived of androgen at diagnosis (Group 1, 19 patients) or had no immediate hormone manipulation (Group 2, 21 patients) and were followed at 3–6‐monthly intervals when determinations of PSA and routine clinical/radiological examinations were performed. A significant increase in PSA was defined as a ≥ 50% increase of the baseline PSA value which was the either the lowest PSA value within 6 months from the start of androgen deprivation (Group 1) or the initial PSA value (Group 2). Results By June 1993 22 of the 40 patients had clinically progressed. In 12 patients the progression was pre‐ceded by a significant increase in PSA (Group 1, three of four progressing patients; Group 2, nine of 18 progressing patients). A PSA increase of ≥ 50% was observed simultaneously with clinical progression in six patients, whereas clinical progression occurred in four patients with no previous or simultaneous significant increase in PSA. In four of nine hormonally untreated patients ≥1 year elapsed between antecedent PSA increase and clinical progression. Conclusion In routine clinical practice PSA does not significantly increase (≥50% of baseline value and > 10 μg/L) before disease progression in about one third of patients with pN + M0 prostate cancer managed with or with no hormone manipulation. Future studies should be carried out to determine whether a lower rate of increase in PSA during follow‐up has any clinical significance.
Prostate‐specific antigen and prognosis in patients with metastatic prostate cancer — a multivariable analysis of prostate cancer mortality
Authors: Reynard J.M. , Peters T.J. , Gillatt D. 
Published: November 2008

ObjectiveTo analyse the prognostic significance of pre‐and post‐treatment serum prostate‐specific antigen (PSA) levels, together with a variety of other factors, in a multivariable analysis of survival in men with stage D2 prostate cancer.Patients and methodsCox's proportional hazards model was used to compare survival in 134 men with stage D2 metastatic prostateCancerfollowed prospectively over a 4 year period, using both univariable and multivariable models. The influence of the following factors on survival was analysed: pre‐ and post‐treatment PSA (both absolute and percentage values), age, treatment, testosterone, pre‐ and post‐treatment alkaline phosphatase (absolute and percentage values), acid phosphatase, haemoglobin, symptom score and performance status and extent of disease on bone scan.ResultsPre‐treatment PSA levels did not significantly influence survival. Similarly, a low absolute post‐treatment PSA level at 3 months after the start of treatment conferred no survival advantage relative to patients with a high PSA level at this time. A post‐treatment percentage PSA of <10% at 2, 3 and 6 months after commencement of treatment was associated with prolonged survival. Low pre‐treatment alkaline phosphatase (less than the upper limit of normal) and high pre‐treatment testosterone levels (≥10 nmol/L) were similarly associated with prolonged survival.ConclusionsThe strong influence of post‐treatment percentage PSA on survival in patients with stage D2 prostateCancersuggests that the percentage change in bulk of metastatic deposits is more important in determining survival than the absolute volume of tumour. Pre‐treatment alkaline phosphatase seems to be a better indicator of tumour activity than pre‐treatment PSA. These findings have important implications for the design and analysis of clinical trials of new therapies in men with stage D2 prostateCancerand for the future selection of alternative treatments for patients with this stage of the disease.
Renal cell carcinoma extending into the vena cava: surgical approach, technique and results
Authors: Reissigl A. , Janetschek G. , Eberle J. , Colleselli K. , Weimann S. , Schwanninger J. , Bartsch G. 
Published: November 2008

Objective To describe the technique and results of a thoraco‐abdominal approach to removing the caval thombi in patients with renal cell carcinoma extending into the vena cava. Patients and methods Between 1970 and 1990 35 patients presenting with renal cell carcinoma extending into the vena cava were treated at the Department of Urology, Innsbruck. Twenty‐three of these patients underwent radical tumour nephrectomy including cavotomy and thrombectomy or caval resection. A transabdominal approach had been used in this department for radical tumour nephrectomy including cavotomy and thrombectomy or caval resection until 1987. Since 1988, a thoraco‐abdominal approach has been employed. In group I patients the approach was via the seventh intercostal space, whereas in group II and III patients the thoraco‐abdominal incision was made through the fifth intercostal space. In the present study the anatomy of the thoraco‐abdominal approach is described. Results Tumour staging and grading yielded stage T3b in 15 patients (grade I, 1; grade n, 6; grade III, 8); another eight patients with stage T3b were found to have metastatic disease (N1, 6; N2, 2; M1, 3). On the basis of the extension of the caval thrombus the patients were classified as follows: group 1,16; group II, 3; group IE, 4. In T3b NO MO patients the 5‐year‐survival rate was 62.5%, while in patients with positive lymph nodes the mean survival rate was 15.5 months. Conclusion Our Results suggest that the thoraco‐abdominal approach is the method of choice for the safe removal of renal cell carcinomas associated with caval thombi. If resection of the caval tumour is complete, prognosis is dependent on known factors, such as tumour invasion, nodal involvement and distant metastases rather than the extension of the tumour thrombus. An aggressive approach is not warranted in patients with nodal involvement and/or distant metastases, as it does not improve survival.
Health‐related quality of life after cystectomy: bladder substitution compared with ileal conduit diversion. A questionnaire survey
Authors: Bjerre B.D. , Johansen C. , Steven K. 
Published: November 2008

Objective To compare the health‐related quality of life after bladder substitution with that following ileal conduit diversion. Patients and methods Sixty‐seven male patients with bladder cancer completed the questionnaire; 38 had undergone bladder substitution and 29 ileal conduit diversion; the median follow‐up was 1.0 year (range 0.5–3.0) and 4.8 years (range 1.1–15.2), respectively. Semi‐structured qualitative interviews were conducted and analysed, and the questionnaire was developed based upon these results. Results Both day‐ and night‐time urinary leakage occurred more frequently following bladder substitution (18% against 10%, and 21% against 3%). Nevertheless, urinary leakage affected conduit patients more severely and they scored higher on a leakage distress scale. Furthermore, 58% of the ileal conduit but only 21% of the bladder substitution patients gave urinary leakage as their main concern (P=0.04). Ileal conduit patients did not retain their body image as well as those with bladder substitution. The frequency of both sexual and non‐sexual physical contacts decreased in the majority of the conduit patients but only in a minority of the bladder substitute patients. Global satisfaction was high and similar in both groups. Conclusion These results show that the health‐related quality of life is retained to a higher degree after bladder substitution and supports the use of this procedure as the standard method of diversion after cystectomy for bladder cancer.
Paternity after cryptorchidism: lack of correlation with age at orchidopexy
Authors: Lee P.A. , O'Leary L.A. , Songer N.J. , Bellinger M.F. , Laporte R.E. 
Published: November 2008

Objective To determine whether paternity is decreased among men who were formerly unilaterally or bilaterally cryptorchid and to ascertain whether paternity is related to their age at orchidopexy. Subjects and methods Men who underwent orchidopexy between 1955 and 1969 at the Children's Hospital of Pittsburgh (363) and a group of age‐matched control men (336) were surveyed by questionnaire and their medical records reviewed. Results Of the married men, significantly more of the unilateral cryptorchid (75%) and control (76%) groups had fathered children than had the bilateral cryptorchid group (P < 0.005). Furthermore, when the groups were compared during the period of regular intercourse with no contraception until conception of their first child, the bilateral group had relatively fewer conceptions during the first year and more after the first year. When the unilateral and bilateral groups were analysed separately, there was no relationship between either age at orchidopexy and paternity or between the age at orchidopexy and the duration of regular unprotected intercourse before conception. Conclusions Compared with a control group, paternity was compromised after bilateral, but not unilateral, cryptorchidism. Age at orchidopexy was not correlated with paternity.
Urological day case surgery in elderly and medically unfit patients using sedoanalgesia: what are the limits?
Authors: Briggs T.P. , Anson K.M. , Jones A. , Coker B.J. , Miller R.A. 
Published: November 2008

Objective To assess how elderly and medically unfit patients cope with day case surgery in a urological unit using sedoanalgesia. Patients and methods One hundred patients (mean age 78 years, range 59‐97) either over the age of 75 years, or with an American Society of Anesthesiologists (ASA) status of 3 or 4 (58 patients) were studied before and after surgery to assess their medical condition, home circumstances and how they coped with their first day after the operation. Results Ninety patients found the procedure good or acceptable and 86 thought having their operation and going home on the same day was a good idea. Conclusion Elderly and medically unfit patients can be treated safely with no serious complications using sedoanalgesia in a well organized Day Unit equipped with full monitoring facilities.
Increased number of substance P positive nerve fibres in interstitial cystitis
Authors: Pang X. , Marchand J. , Sant G.R. , Kream R.M. , Theoharides T.C. , J.  
Published: November 2008

Objective To explore the presence of the neuropeptide substance P (SP) in the bladders of rats and humans and to investigate its relationship to mast cells (MCs) in interstitial cystitis (IC), a bladder disorder which occurs mostly in women and is characterized by frequency of voiding, nocturia and debilitating supra‐pubic pain. Patients, materials and methods Bladder biopsies from eight women with untreated IC (mean age 36 years, range 29‐58) and five control patients with no IC were analysed and compared with each other and with bladder tissue from 12 rats. Immuno‐histochemistry and image analysis were used to examine the density of SP‐positive nerve fibres and their relationship with MCs. Results SP‐containing nerve fibres were present in the bladder of both rats and humans. They were increased only in the submucosa, but not in the detrusor, of IC patients and were frequently seen in juxtaposition to MCs. Conclusion SP, a neuropeptide secreted from sensory nerve endings, has been implicated in the pathophysio‐logy of pain and has been shown to trigger MC secretion. Moreover, MC secretion by SP is augmented by oestradiol and bladder MCs have been shown to express high affinity oestrogen receptors. A functional relationship between SP and MCs may explain the pathophysiology of the neuro‐inflammatory and painful nature of IC.
Anterior bladder neck tube reconstruction at radical prostatectomy preserves functional urethral length — a comparative urodynamic study
Authors: Connolly J.A. , Presti J.C. , Carroll P.R. 
Published: November 2008

Objectives To characterize the continence mechanism of anterior bladder neck tube reconstruction at the time of radical prostatectomy using urodynamic evaluation. Patients and methods Prospective pre‐ and postoperative urodynamic profiles were performed in patients receiving conventional posterior ‘racket handle’ closures (control group — eight patients) and those receiving anterior bladder neck tube reconstruction at radical prostatectomy (study group — nine patients). Bladder neck tube reconstruction was performed by constructing 2 cm anterior bladder neck tubes over 22 F catheters. Results A significantly longer post‐operative functional urethral length was demonstrated using urodynamic assessment in patients receiving an anterior bladder neck tube closure (4.6 vs 3.4 cm; P<0.01). Conclusion The anterior bladder neck tube reconstruction may promote urinary continence in patients undergoing radical prostatectomy by preservation of functional urethral length.
Use of dexamethasone for ureteric obstruction in advanced prostate cancer: percutaneous nephrostomies can be avoided
Authors: Hamdy F.C. , Williams J.L. 
Published: November 2008

Objective To evaluate the effectiveness of dexamethasone in relieving bilateral lower ureteric obstruction in the acute phase of renal failure secondary to locally advanced prostate cancer. Patients and methods This study comprised 11 patients (median age 72 years, range 52‐84) presenting with advanced prostate cancer, bilateral ureteric obstruction and gross renal failure. Their response to immediate administration of intravenous followed by oral dexamethasone for 4 weeks, in conjunction with definitive treatment and final outcome, was evaluated. Results Renal function improved in 10 patients within 72 h, avoiding the need for insertion of percutaneous nephrostomies. However, four of 10 patients whose renal failure initially improved, failed to respond to definitive therapy, and died 3 to 4 weeks after cessation of the steroids. Conclusion When administered in the acute phase of renal failure from prostate cancer, dexamethasone may obviate the need for urinary diversion in patients with bilateral ureteric obstruction, particularly in men who will not respond favourably to available forms of therapy for advanced and aggressive disease.
Objective measurement of the effectiveness, therapeutic success and dynamic mechanisms of the vacuum device
Authors: Bosshardt R.J. , Farwerk R. , Sikora R. , Sohn M. , Jakse G. 
Published: November 2008

Objectives To determine the efficacy and possible beneficial effects of the Catalyst® vacuum device (VD) in the treatment of impotence, the ischaemic state of the penis after application of a constriction ring and the origin of the blood in the corpus cavernosum after application of the VD. Patients and methods Thirty men (mean age 62 years; range 46‐76) suffering from erectile dysfunction were selected for the trial after using the VD for 2 weeks at home. Changes in penile tumescence and rigidity before, during and after using the VD were assessed using the Rigiscan® monitor. Blood gas analysis (BGA) was performed in selected patients whilst using the VD, allowing calculation of the proportional contribution of venous and arterial blood to the increase in penile volume. The efficacy of the VD was also assessed by questionnaires completed before treatment and at the 6 month follow‐up. Results Four patients were lost to follow‐up but the 26 impotent men who used the VD for 6 months were able to have sexual intercourse after using the VD. The average rigidity measured at the base and tip of the penis after application of the VD was > 80%. The duration and extent of nocturnal penile tumescence and rigidity at the start and the end of the study improved, although only one variable increased significantly. Patients reporting spontaneous morning erections showed significant improvements in total erection‐time, erection‐phase and plateau‐phase duration, effective rigidity and tumescence increase. BGA determined 30 min after applying a constriction ring showed ischaemia of the penile blood and the mean contribution of arterial and venous blood to penile blood volume was by 58 and 42%, respectively. Conclusion The efficacy of the Catalyst® vacuum device was objectively determined and the quality of the nocturnal erections improved in some patients. After application of a constriction ring an ischaemia of the penis developed. In contrast to previous reports, the increased penis volume during the application of the VD is caused not only by arterial inflow but also by venous backflow.
Renal cell carcinoma metastases to the skin: a not so rare case?
Authors: Kouroupakis D. , Patsea E. , Sofras F. , Apostolikas N. 
Published: November 2008

Objective To describe the clinical, histological, immunohistochemical and behavioural patterns of the metastases of renal cell carcinoma to the skin.Patients and methods In a retrospective review of 132 cases of renal cell carcinoma submitted for examination to the Anticancer Institute ‘St Savas’ nine patients with metastatic disease to the skin were discovered. Clinical data and follow‐up information were collected and correlated to tumour behaviour and patient survival. Immunohistochemical studies with epithelial membrane antigen (EMA), vimentin, keratin and carcino‐embryonic antigen (CEA) were performed.Results In six of the nine patients the skin metastasis was the first evidence of a tumour. Histology of the skin nodule led to identification of the primary site. Histological proof of the renal origin of the tumour was obtained using the above immunohistochemical studies. All patients died from their disease within 3 years of presenting with the skin metastases.Conclusion Metastases to the skin from a renal cell carcinoma as first evidence of the disease may not be as rare as the literature describes. Definite proof of the origin of the tumour requires specialized immunohistochemical techniques.
Khat chewing and bladder neck dysfunction. A randomized controlled trial of α1‐adrenergic blockade
Authors: Nasher A.A. , Qirbi A.A. , Ghafoor M.A. , Catterall A. , Thompson A. , Ramsay J.W.A. , Murray‐Lyon I.M. 
Published: November 2008

Objective To assess whether the effect of chewing khat leaves (Catha edulis) on the urodynamics of healthy males is altered by the selective α1‐adrenergic blocking agent indoramin in a prospective randomized double‐blind controlled trial.Subjects and methods The urodynamics of 11 healthy males were studied before and during a khat chewing session preceded by indoramin or placebo.Results Khat chewing produced a fall in average and maximum urine flow rate. This effect was inhibited by indoramin.Conclusions The urinary side‐effects of khat chewing are probably mediated through stimulation of α1 adrenergic receptors. Keywords Khat, Catha edulis, α1adrenergic blocker, indoramin, urodynamics.
Psychological reactions in men screened for prostate cancer
Authors: Gustafsson O. , Theorell T. , Norming U. , Perski A. , Öhström M. , Nyman Cr. 
Published: November 2008

Objective To investigate the possible negative psychological impact of screening for prostate Cancer with special focus on the impact of false positive and true positive test results.Subjects and methods As part of an early detection study for prostate Cancer psychological and psycho‐physiological reactions to various phases of the diagnostic procedures were examined in 2400 randomly selected men divided into various groups. Their psycho‐physiological reactions were assessed by measurements of serum cortisol and their psychological reactions by questionnaires directed at determining emotional states and sleep disturbance. In a stratified sample of the population (100 men) measurements were made at the time of the screening examination and again 2 weeks later. In patients undergoing biopsy (307 men) measurements were made 2 weeks after screening, but before they were informed of the biopsy results, and again 4 and 16 weeks after screening.Results Serum cortisol levels at the screening examination were higher than corresponding levels of a comparable sample of Swedish men during normal daily activity, indicating that an invitation to examination for prostate Cancer per se might create emotional stress. Two weeks after the screening the elevated levels had decreased to normal. The highest cortisol levels were found in men who had undergone biopsy, immediately before they were informed of the results 2 weeks after screening. After they were informed, cortisol levels fell, regardless of the results of the biopsy. The patterns of emotional state and sleep disturbance were similar except that sleep disturbance was delayed.Conclusion In screening programmes for prostate Cancer it is important to define clearly the high‐risk groups to minimize the risk of adverse psychological reactions in those subjects with a low risk of having the disease. The results also emphasize the need to reduce the number of false positive results by choosing diagnostic tests of high specificity. The interval between a test and informing the subject of the results should be minimized to decrease the duration of the increased emotional stress