bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anesthesia for pediatric lithotripsy
Authors: ALDRIDGE RODERICK D. , ALDRIDGE ROLAND C. , ALDRIDGE LOUISE M. 
Published: February 2006

SummaryBackground:  We describe 7 years experience of providing anesthesia for children undergoing lithotripsy in a hospital without pediatric inpatient facilities. A pediatric team, including anesthetist, pediatric nurse along with the equipment travel across the city with the patient from the children's hospital. As a high incidence of postoperative vomiting and discomfort was observed, the effect of increasing intraoperative analgesia and the use of antiemetic medication was examined.Methods:  From 1998 to 2004, 69 children (49 boys and 20 girls) were anesthetized for 120 procedures: 67 extracorporeal shock wave lithotripsy (ESWL) and 53 endosurgical procedures, consisting of percutaneous nephrolithotomy (29), ureteroscopic laser lithotripsy (17) and percutaneous bladder litholapaxy (7).The mean age was 5.4 years (10 months to 13 years) and weight 23.7 kg (7.1–59 kg). ESWL was performed initially with a Wolf Piezolith 2300, and after 1999, a Dornier Compact Delta.Results:  Increased administration of intraoperative analgesia resulted in reduced postoperative analgesia requirements in all the groups, with a significant reduction (P < 0.05) in the endosurgical group. Those who required more postoperative analgesia had more vomiting significantly (P < 0.05).Conclusions:  For ESWL postoperative pain is dependent on the type of lithotriptor and the resultant stone fragment size created. This study suggests that postoperative vomiting could be reduced more effectively by the increased administration of intraoperative analgesia, than by a single intraoperative dose of an antiemetic drug.
20  VEL015: a novel inhibitor of PI3k/Akt signalling inhibits the progression of prostate cancer and sensitises to existing therapies
Authors: CORCORAN N.M. , MARTIN D. , COSTELLO A.J. , HOVENS C.M. 
Published: February 2006

Introduction:  Overactivity of PI3K/Akt signalling is firmly implicated in the progression of lethal prostate cancer. We report on VEL015, a water soluble, orally active agent that blocks PI3K/Akt signalling at the level of Akt and its effects on the progression of experimental prostate cancer.Methods:  The effects of VEL015 on key components of PI3K/Akt signalling were determined by western blotting with activation state‐specific antibodies and direct in vitro enzymatic assays. Resultant biological effects were determined by proliferation and apoptosis assays. In vivo effects were determined using human prostate cancer cell lines (PC3 and LNCaP) xenografted both subcutaneously and orthotopically. Interaction with androgen deprivation therapy and chemotherapy was explored both in vitro and in vivo.Results:  In PTEN negative prostate cancer lines VEL015 induces dephosphorylation of Akt. This block is functional in that it induces G1 cell cycle arrest associated with upregulation of p21Cip1 and p27Kip1, and can induce apoptosis in a mechanism that involves a reduction in Bcl‐2 levels. At a daily dose of 0.5 mg/kg po it inhibits the growth of androgen independent prostate cancer by 40–70% at both orthotopic and heterotopic sites without toxicity, and further sensitises these tumours to taxane‐based chemotherapy. By knocking down Akt activation and Bcl‐2 expression, it significantly delays the emergence of androgen independent growth in in vitro and in vivo. Tumour analysis confirms knockdown of the predicted targets, with significant effects seen both in the tumour cells and associated microvasculature.Conclusions:  VEL015 is a water soluble, orally active agent that inhibits the progression of experimental human prostate cancer.
24  EMT in human bladder cancer: the fundamental role of snail transcriptional repression
Authors: GILMARTIN B. , FOX E. , MCARDLE E. , DALY P. , HOPKINS A. , HARRISON M. , KAY E. , FITZPATRICK J. , DERVAN P. , MCCANN A. 
Published: February 2006

Introduction:  The zinc finger protein Snail is a recognised transcriptional repressor of E‐cadherin (CDH1), resulting in development of the epithelial mesenchymal transition (EMT); a phenotype associated with increased invasiveness and metastatic potential. Snail transcriptionally represses CDH1 by binding to conserved E‐box elements in its promoter sequence. A number of EMT‐related genes exist possessing evolutionarily conserved, promoter‐associated, E‐box elements. We hypothesise that transcriptional repression of these genes by Snail is also instrumental in EMT.Materials and Methods:  Phylogenetic analysis, using the Database of Transcriptional Start Sites website (http://dbtss.hgc.jp/), was performed to identify candidate genes. Genes were selected for experimental characterisation based on functional relevance to EMT and/or promoter structure similarity to CDH1. For each candidate gene promoter, primers were designed to amplify the putative E‐box containing region. We employed the chromatin immunoprecipitation (CHiP) assay to demonstrate the DNA binding ability of Snail to a number of these candidate genes. E‐cadherin negatively expressing cell lines sourced from the American Type Culture Collection served as models to investigate transcriptional repression of candidate genes by Snail using realtime PCR.Results:  Transcriptional repression of a number of candidate genes by Snail was demonstrated using the CHiP assay.Conclusion:  Transcriptional repression of E‐cadherin by Snail is established. We have shown that Snail also causes downregulation of novel EMT‐related genes. Snail downregulation of a combination of these genes may prove to be an expression signature of recurrence in low grade urothelial carcinoma of the bladder.
27  Pathological classification of urothelial neoplasms: practical choices for patient care
Authors: CAMPBELL P.A. , CAMPBELL C.M. , NICOL D.L. , MACTAGGART P. 
Published: February 2006

Introduction:  Morphological classifications systems that stratify neoplasms according to biological potential must define categories that are reproducible among practitioners, otherwise they create the heterogeneous population that they wish to avoid. This is particularly important for the classification of bladder neoplasms where follow‐up protocols are based on the risk of recurrence and progression. This risk is assessed according to their morphological classification.Materials and Methods:  Previously forty‐nine cases of superficial bladder cancer (G1‐3pTa) representing an initial diagnosis of transitional cell carcinoma made in 1990 were identified and re‐graded using the 1998 WHO/ISUP classification by two pathologists. Inter‐observer agreement was assessed using Cohen weighted K statistics. After re‐classification the clinical follow‐up was reviewed retrospectively, and episodes of recurrence and progression noted. This paper compares those results to the same group of patients classified using the 1973 WHO scheme and followed up in a similar manner to try to determine if one system show better patient benefit over the other.Results:  The interobserver agreement of pathologists using the 1998 WHO/ISUP scheme is moderate overall, but there is high disagreement when pathologists are asked to differentiate papillary urothelial neoplasms of low malignant potential from low grade carcinoma. The progression rates were very low for PUNLMPs and low grade carcinoma, but moderate for high grade carcinoma.Conclusions:  The 1998 WHO/ISUP classification of urothelial neoplasms requires certain discriminations that cannot be reliably made by practitioners. Modifying the scheme to create categories of low grade neoplasm and high grade neoplasm would markedly increase its practical value to patients without significantly altering patient care.
29  Changing patterns of radical cystectomy at St. Vincent's Hospital, Melbourne
Authors: BRENNAN J.P. , SLAVIN J. , TEMELCOS C. , CLARKE A. , NIALL O. , ASOPA R. , WILLIAMS E.D. , GOAD J. 
Published: February 2006

Purpose:  To collect clinical, pathological and outcome data on all patients who have undergone radical cystectomy at St. Vincent's between 1985 and 2005.Methodology:  A retrospective chart review was performed of all patients who had undergone cystectomy (patients identified using ICD codes). Detailed information was obtained from operation reports and inpatient notes. Further information was obtained from other treating hospitals and private rooms. Outcome data was checked against the Cancer Council of Victoria Deaths Registry. This series was then compared against other large published series, including a St. Vincent's Hospital cohort (1963–1977).Results:  One hundred and seventeen patients underwent total cystectomy during this 20 year period. The main indication for radical cystectomy was muscle‐invasive transitional cell carcinoma (TCC), with 55% of patients having T3 or T4 disease. Only 12% of patients had node positive disease, which is a reflection of the selective use of pelvic lymphadenectomy (56% patients Nx). Median follow up of cancer survivors was 71 months (6.5–132). 30% of patients had a history of superficial TCC. The postoperative mortality rate (occurring within 60 days or before discharge) was 6%. Only 14% patients had adjuvant chemotherapy. 57% of patients developed a recurrence with an overall five‐year survival of 38%.Conclusion:  In comparison to North American and European series, our five‐year survival is lower but a higher proportion of patients have muscle‐invasive (T2–T4) disease. Postoperative mortality rates are comparable to other institutions, and importantly, a 60% reduction in postoperative mortality has occurred at our institution over the last 40 years.
40  A reliable method for simplifying flexible uretero‐renoscopy in patients with urinary diversions
Authors: ELMES M.R. , LAWRENTSCHUK N. , BOLTON D.M. 
Published: February 2006

Introduction:  Access to the upper urinary tract to exclude or treat recurrent transitional cell carcinoma (TCC) is not infrequently required in patients who have previously undergone urinary diversion in the management of invasive bladder carcinoma. This can be a technically difficult procedure. We describe a method which simplifies the diagnosis and treatment of upper tract TCC posturinary diversion.Patients and Methods:  Four patients who had previously required urinary diversion (3 ileal conduit, 1 ileal neobladder) underwent flexible uretero‐renoscopy after antegrade skinny‐needle renal puncture and placement of a guidewire down the ureter into the ileal conduit. The guidewire is then externalised. A second guidewire is placed in a retrograde fashion using a double lumen catheter or an exchange guidewire set, and this second guidewire is then used as a guide for insertion of the flexible ureteroscope. This guidewire may be replaced repeatedly during the procedure to facilitate multiple biopsies.Results:  All patients were treated successfully and without complication from placement of the percutaneous guidewire. Operating time was under one hour in all cases.Conclusions:  Flexible uretero‐renoscopy of the upper urinary tract postileal urinary diversion can be made easier and less time consuming by preliminary placement of a percutaneous antegrade guidewire.
43  Large animal models of renal warm ischaemia/reperfusion injury. Comparison of dog versus pig
Authors: FORMAN C.J. , NICOL D. , JOHNSON D. 
Published: February 2006

Introduction:  With the advent of laparoscopic partial nephrectomy interest has focused on renal tolerance of, and treatments for, warm I/R injury. Most in vivo work is done in rodent models, but findings are often not replicated in humans. Thus experiments often need to be replicated in a higher mammalian model, prior to human trials. Here I present the pros and cons of two of the most commonly used higher models.Materials and Methods:  Eleven dogs underwent nephrectomy and clamping of the contralateral renal artery for one hour. They were followed up with daily blood tests for 5 days. Seven pigs underwent a 2‐stage procedure. First a right nephrectomy, followed a week later by clamping of the left renal artery for one hour. They were then followed up with 24 h urine collections and daily blood tests.Results:  Serum creatinine concentration expressed as mean ± SEM in micromoles / litre.

Pre‐op
Day 1
Day 2
Day 5

Dog
82 ± 3
239 ± 38
279 ± 61
266 ± 71

Pig
92 ± 9
132 ± 14
123 ± 13
89 ± 7

Conclusion:  The choice of animal model can make or break a project. The researcher should consider availability, homogeneity, cooperativeness and cost of the animal, together with correlation of the histological pattern of injury with humans, when choosing. On balance, pigs are more effort, but reward the researcher with better results, using fewer animals.
45  Pretransplant CT estimated renal volume is not a predictor of graft function post transplantation
Authors: HADLEY A.J. , HAWLEY C. , NICOL D. 
Published: February 2006

Introduction:  There appears to be a critical nephron mass required to handle the metabolic demands of the body. The relationship between an individual's glomerular number and their weight is called the ‘nephron dose’. Inadequate nephron dose results in hyperfiltration and renal dysfunction. In healthy kidneys, there is a linear relationship between the renal weight and the glomerular number, but as it is impossible to measure the donor renal weight prior to excision, various surrogate measures have been reported. These include BMI, ultrasound and MRI volume studies. No studies assessing CT estimated renal volumes have previously been reported.Methods:  In this retrospective cohort study, we analysed the data from 48 patients receiving live‐donor renal transplants between June 2001 and November 2003 at our institution. The donor renal volume‐recipient weight (Vol/Wt) ratio was calculated for each patient and compared to the GRF at 1, 3 and 6 months posttransplantation. Vol/Wt ratio to GFR was analysed as continuous, categorical and tertile variables.Results:  There was no relationship found between Vol/Wt ratio and GFR at 1, 3 or 6 months posttransplantation.Conclusion:  Using CT renal volume estimations as a surrogate for nephron number does not allow one to predict short term renal function after living donor transplantation.
46  Laparoscopic versus open living donor nephrectomy: a contemporary series from a single centre
Authors: POWER R.E. , PRESTON J.M. , MARTIN I. , WALL D. , GRIFFIN A. , NICOL D.L. 
Published: February 2006

Introduction:  Laparoscopic living donor nephrectomy offers potential advantages to the donor and has become a routine procedure for live kidney procurement worldwide. Since 2000 our live donor patients have been offered a laparoscopic nephrectomy.Patients and Methods:  Between February 2000 and August 2005 we performed 183 donor‐recipient operations at our institution (ODN = 83 and LND = 100). We prospectively collected information on all donors and recipients for the same period to audit our experience with the first 100 LDN‘s. Patients made their operative choice following discussions regarding the unit experience and literature information. We present our findings with specific emphasis on donor operative details and early recipient graft outcome.Results:  Donor and recipient age, gender, body mass index, HLA mismatches, warm ischaemia and vascular anastomotic times did not significantly differ between the two groups. There were two conversions to an open operation in the LND group and neither impacted upon recipient graft outcome. The mean operative duration was 178 ± 38 for the LDN and 159 ± 34 min for the ODN (P < 0.05). The mean length of hospital stay was 4.7 ± 1.2 days in the LND group versus 6.8 ± 1.5 days in the ODN group (P < 0.05). There was one case of delayed graft function in both groups. Serum creatinine at 1, 6 and 12 months did not differ significantly between either groups. Vascular and ureteric complications and lymphocoele rates were similar in both groups.Conclusions:  Our contemporaneous series demonstrates the safe introduction of a laparoscopic living donor programme without compromise towards donor patient safety or allograft outcome.
5  Prostate biopsy – common practices and differences amongst Australian and New Zealand urologists
Authors: RAO R. , THOMAS B. , DUNGLISON N. , GARDINER R.A. , YAXLEY J. , PETERS J. , COSTELLO A. 
Published: February 2006

Purpose:  Studies out of the United States and United Kingdom show great variability in practices relating to prostatic biopsy. This survey was performed to evaluate current practices in Australia and New Zealand.Methods:  Questionnaires were sent to Australian and New Zealand Urologists and Trainees on the database of the Urological Society of Australasia.Results:  Significant variability exists with regard to antibiotic prophylaxis, bowel preparation; analgesic use; number of cores taken; and repeat biopsy practices. Most urologists (91%) perform their own biopsies. 9% refer to another urologist or radiologist. Transrectal biopsy is the favoured approach in 97%. Most urologists (96%) use antibiotic prophylaxis with the quinolone antibiotics being the most commonly used. Only 42% use bowel preparation for their biopsies. Analgesia is used in 79% with equal numbers using sedation and periprostatic nerve block. 77% take 10 cores or more for first biopsy. 28% do not inform their patients of a false negative rate with TRUS biopsy of the prostate. There were 36% and 60% who would not re‐biopsy for HGPIN and ASAP respectively.Conclusions:  Prostate biopsy is a commonly performed procedure to diagnose carcinoma of the prostate. Despite significant variability, most Urologists and Trainees in Australia and New Zealand have safe biopsy protocols, given the evidence that is currently available. Evidence supports the use of analgesia and repeating biopsy for HGPIN and ASAP.
51  Laparoscopic suturing: effect of instrument handling on suture strength
Authors: BARIOL S.V. , STEWART G.D. , TOLLEY D.A. 
Published: February 2006

Introduction:  The limited operative field of laparoscopic surgery necessitates repeated instrument handling of suture material, which is discouraged in conventional open surgery. The quantitative effect of instrument handling on suture material has not previously been investigated. The aim of this study was to assess the effect of instrument trauma on various suture materials by laparoscopic needle holders and forceps.Materials and Methods:  Three sutures of various gauge and material, 2‐0 and 3‐0 Polyglactin 910 and 2‐0 Poliglecaprone 25, commonly used in laparoscopic urological reconstruction, were tested. Controlled damage was performed by grasping the suture without tension between the jaws of either a toothed laparoscopic grasping forceps or a laparoscopic needle holder. Physical testing was performed using an Instron 5564 computer controlled tensile testing, which measured suture extension and tensile strength. Samples were examined using scanning electron microscopy.Results:  There was no difference in mean percentage extension or tensile strength when comparing suture types damaged with laparoscopic graspers and controls regardless of their gauge or material. Following controlled damage with laparoscopic needle holders, % extension of damaged sutures was significantly lower compared with undamaged sutures. Tensile strength was significantly lower for 3‐0 Vicryl and 3‐0 Monocryl after damage with laparoscopic needle holders compared with undamaged sutures, but not 2‐0 Vicryl.Conclusion:  The handling of suture material with laparoscopic instruments, especially needle holders, results in surface damage to the suture, which impacts on the suture mechanics. Limiting surface damage to suture material requires careful technique, avoiding shear force, minimising handling of the suture, and using shorter suture lengths.
52  Laparoscopic pyeloplasty – evolution of a new gold standard
Authors: MOON D. , EL‐SHAZLY M. , CHANG C. , GIANDUZZO T. , EDEN C. 
Published: February 2006

Objectives:  We report the largest series of laparoscopic dismembered pyeloplasty for treatment of primary and secondary uretero‐pelvic junction (UPJ) obstruction, reviewing the current status of this procedure.Methods:  A total of 170 consecutive cases of laparoscopic pyeloplasty (156 for primary and 14 for secondary UPJ obstruction) were performed or supervised by a single surgeon (C.G.E). A four port extraperitoneal approach was used in all but three cases, which were performed transperitoneally.Results:  Median operative time was 140 min. The complication rate was 7.1% and conversion rate was 0.6% with no conversion in the last 161 cases. The median postoperative hospitalisation was 3 nights. Crossing vessels were encountered in 42% of cases and in 11 patients coexisting renal calculi were successfully removed. At a median follow‐up of 12 months, the success rate was 96.2%.Conclusions:  Laparoscopic dismembered pyeloplasty produces functional results comparable to that of open surgery with the advantages of a minimally invasive procedure. Our results are consistent with previous series and support the view that laparoscopic pyeloplasty is moving rapidly towards replacing open surgery as the gold standard in treatment of UPJ obstruction.
55  Local anaesthetic reduces postoperative analgesic requirements in laparoscopic urological surgery
Authors: KHAIRA H.S. , WOLF J.S. 
Published: February 2006

Objective:  To determine if local anaesthetic reduces patient discomfort following laparoscopic urological surgery.Methods:  Sixty‐seven patients undergoing laparoscopic urological surgery were randomly assigned to either the treatment (0.5% bupivacaine) arm or the placebo (0.9% normal saline) arm. Patients, surgeon and data collector were blinded. The port sites and the hand assist port site (when present) were infiltrated at the outset of the procedure. Postoperative pain was determined with a standardized 10 point visual analog scale at consistent intervals.Results:  Thirty‐three individuals were treated with the placebo (13 standard laparoscopic [SL] and 20 hand assisted laparoscopic [HALS]) and 34 with bupivacaine (17 SL and 17 HALS). Average pain scores for the placebo vs. bupivacaine group at 4, 12, 24 h were 3.9, 3.1, 3.6 vs. 3.0, 2.1, 2.0 (P < 0.10). Mean use of morphine for the placebo group vs. bupivacaine group was: 26.1 mg (range 0–91.9) vs. 15.4 mg (range 0–49.5) at 12 h (P < 0.05), 43.5 mg (range 0–136.9) vs. 26.2 mg (range 0–71.0) at 24 h (P = 0.07) and 50.4 mg (range 0–154.9) vs. 28.3 mg (range 0–71.0) for total hospital stay (P < 0.05). In multivariable anova, use of bupivacaine, but not SL vs. HALS, was associated with reduced morphine use at all three time points (P < 0.05).Conclusions:  At the outset of laparoscopic urological surgery in the upper retroperitoneum, port site and other incision infiltration with a long acting local anaesthetic reduces postoperative parenteral opioid requirements when compared with placebo controls.