bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrastructure of the mature spermatozoon of the musky rat‐kangaroo, Hypsiprymnodon moschatus (Potoroidae: Marsupialia)
Authors: Lloyd S. , Carrick F. , Hall L. 
Published: March 2003

AbstractIt is currently accepted that Hypsiprymnodon moschatus is a basal macropod, retaining several primitive features from the ancestral phalangeroid that gave rise both to modern possums and macropods. Sperm ultrastructure is frequently found to provide informative characters for phylogenetic analysis as these features are not strongly selected for and are thus unlikely to be confounded by effects such as convergence. Caudal epididymal biopsies were taken from two male H. moschatus and prepared for transmission and scanning electron microscopy in order to study mature spermatozoan ultrastructure. Within the diprotodont group, several features were found to be unique to H. moschatus. These were an unusual acrosome covering nearly 100% of the dorsal nuclear surface, a midpiece fibre network which is loose, indistinct and extends to the anterior‐most aspect of the midpiece, a nucleus that is very streamlined, while the principal piece is comparatively short, and a mitochondrial helix and annulus which are similar to those of dasyurids. Also reported is the presence of a fibrous network in the connecting piece, not previously reported for any marsupial.
Serum chromogranin‐A in advanced prostate cancer
Authors: Ferrero‐Poüs M. , Hersant A.M. , Pecking A. , Brésard‐Leroy M. , Pichon M.F. 
Published: March 2003

Objective To determine the value of serum chromogranin A (CgA), a marker of neuroendocrine differentiation, for monitoring prostate cancer; CgA levels were related to three other tumour markers, i.e. total prostate‐specific antigen (tPSA), prostatic acid phosphatase (PAP), neurone‐specific enolase (NSE), and to testosterone, to assess the importance of hormone withdrawal. Patients and methods Serum samples (218) were obtained from 118 patients with prostate cancer, including 111 patients with advanced prostate cancer; 103 presented to our centre for systemic radionuclide therapy of painful skeletal metastases. CgA concentrations were measured using a new immunoradiometric assay (IRMA; Cis Bio International, Gif sur Yvette, France) and a threshold of 70 ng/mL was determined after receiver operating characteristic curve analysis. Testosterone was also measured with an IRMA assay; tPSA, PAP and NSE were assayed using the time‐resolved amplified cryptate emission. Results Serum marker levels were high in 64% of the patients for CgA, 24% for NSE, 89% for tPSA and 81% for PAP. Patients resistant to endocrine treatments and with elevated tPSA (i.e. hormone‐independent) showed increased CgA and NSE in 62% and 29%, respectively. Patients with hormone‐dependent prostate cancer (i.e. with a normal tPSA level) had elevated CgA in 59% but no abnormal NSE. All patients of the latter group except one showed clinical progression of their disease. However, the mean (sd) concentrations of CgA in hormone‐independent (146) or hormone‐dependent (22) patients, at 185.3 (449.1) and 160.9 (293.9) ng/mL, respectively, were not statistically different (P = 0.8, Mann–Whitney U‐test). For 30 patients, blood samples were drawn and markers measured before and after systemic radionuclide therapy. There was a significant increase in the CgA and tPSA concentrations after treatment (P = 0.0146 and 0.0025, respectively). Conclusions In association with tPSA, serum CgA appears to be a promising marker for monitoring patients with prostate cancer.
Upper and mid‐ureteric stones: a prospective unrandomized comparison of retroperitoneoscopic and open ureterolithotomy
Authors: Goel A. , Hemal A.K. 
Published: March 2003

Objectives To review our experience of retroperitoneoscopic ureterolithotomy (RPUL) and to compare the results with those from open surgery. Patients and methods Between March 1994 and mid‐December 2000, 55 patients with large (mean 2.1 cm) upper and mid‐ureteric calculi, and with normal renal values, underwent RPUL. In 22 patients, earlier attempts with extracorporeal shock wave lithotripsy and ureteroscopy had failed. These patients were compared with 26 (mean stone size 2.4 cm) who underwent open ureterolithotomy during the same period. The two groups had similar distributions for age, sex, stone size and stone location; most stones were calcium‐based. Results The mean operative duration and blood loss for RPUL and open surgery were 108.8 and 98.8 min, and 58.5 and 50.5 mL, respectively (not significant). The mean analgesic (pethidine) requirement and hospital stay for RPUL and open surgery were 41.1 and 96.9 mg, and 3.3 and 4.8 days, respectively (P < 0.001). The duration of convalescence was significantly less after RPUL than open surgery (1.8 weeks vs 3.1). There were 10 conversions, which occurred early in the series, and one significant complication amongst patients who underwent RPUL. Conclusions RPUL is comparable with open surgery for operative duration and blood loss, but the laparoscopic procedure has significant advantages over open surgery for analgesia, hospital stay, recuperation and cosmesis. RPUL is a viable alternative for large upper and mid‐ureteric calculi and in those patients where a previous attempt at endourological management has failed. However, the technique requires significant training and experience before good results can be obtained.
The URO Mentor: development and evaluation of a new computer‐based interactive training system for virtual life‐like simulation of diagnostic and therapeutic endourological procedures
Authors: Michel M.S. , Knoll T. , Köhrmann K.U. , Alken P. 
Published: March 2003

Objective To overcome the current disadvantages of traditional training methods for ureterorenoscopy and percutaneous nephrolitholapaxy, using the URO Mentor (Simbionix, Tel Aviv, Israel) computer‐assisted simulator. Methods The URO Mentor device for training and quality control in ureterorenoscopy was developed using virtual reality, multimedia technology and intelligent tutoring systems. The central software system features a proprietary visualization engine (the SVE) which allows real‐time simulation by offering a high‐level object‐orientated application program interface (written in C++) available for use with either Microsoft®, DirectX 7® or OpenGL as platforms. The SVE includes general procedures to allow two‐ (2D) and three‐dimensional (3D) rendering, collision detection, collision correction, 3D morphing, 2D image manipulation, texture mapping, ‘bump’ mapping, video texture, X‐ray rendering, special effects (blood, smoke, stone fragments and more) and reflections. Results The system allows a complete training session on a wide range of procedures by offering different types of cases and virtual patients, and features a full representation of the endourological procedures under direct vision and by using interactive fluoroscopy with a contrast agent. The supported tools include: baskets, graspers, intracorporal lithotripters, guidewires, catheters, stents, biopsy and dilatation devices. The endourological procedures that can be performed are lithotripsy, tumour resection, treatment of strictures and obstructions, stent placement and biopsies. Conclusion The URO Mentor introduces a new generation of mannequin equipped with a special haptic device, providing trainees with an unparalleled life‐like sensation while training for diagnostic and therapeutic endourological procedures. By bringing key advances into urological simulation (e.g. with the real‐time X‐ray renderer) and by integrating in a single system both high‐quality simulation and learning tools, the URO Mentor provides new perspectives for computer‐based urological training systems and methods.
A study comparing various noninvasive methods of detecting bladder cancer in urine
Authors: Saad A. , Hanbury D.C. , McNicholas T.A. , Boustead G.B. , Morgan S. , Woodman A.C. 
Published: March 2003

Objectives To compare the nuclear matrix protein (NMP)‐22 assay, bladder tumour specific antigen (BTAstat) test, telomerase activity (using the telomeric repeat amplification protocol assay, TRAP) and a haemoglobin dipstick test for their ability to replace voided urine cytology (VUC) for detecting bladder cancer. Patients and methods The study included 120 urological patients prospectively recruited and assessed before surgery. A single freshly voided urine sample (≈100 mL) was collected from each patient and aliquoted for each test. All assays were conducted according to the manufactures' guidelines; 79 patients were tested for telomerase activity. The results were then compared with VUC and the diagnosis confirmed by cystoscopy and histology. Results Fifty‐two patients had histologically confirmed transitional cell carcinoma. The overall sensitivity for BTAstat, NMP22, telomerase, VUC and dipstick testing was 63%, 81%, 84%, 48% and 50%, respectively. Combining the results for telomerase and NMP22 gave a sensitivity of 100%. For G1 tumours the respective sensitivities were 23%, 62%, 56%, 23% and 15%, for G2 tumours, 68%, 86%, 92%, 50% and 41% and for G3 tumours 88%, 88%, 100%, 71% and 82%. For pTa tumours the respective detection rates were 48%, 70%, 84%, 39% and 30%, for pT1 tumours 80%, 90%, 90%, 50% and 50%, for pT2/pTis tumours, 100/100%, 100/100%, 100/100%, 88/100% and 88/83%. The overall specificity for the respective tests was 82%, 87%, 93%, 87% and 54%; combining the results of NMP22 and telomerase activity increased the specificity to 96%. Conclusions There was significantly better detection than VUC when using the NMP22 and TRAP assay, especially for well‐differentiated (P < 0.001 and 0.0027, respectively) and superficial tumours (P < 0.001 and 0.034, respectively). Combining the results of NMP22 and telomerase activity yielded values comparable with cystoscopy.
Resistive index: an experimental study of the effects of diuretic stimulation in the unobstructed porcine kidney
Authors: Rawashdeh Y.F. , Hørlyck A. , Djurhuus J.C. , Frokiaer J. , Mortensen J. 
Published: March 2003

Objective To study the effects of diuretic stimulation with frusemide and mannitol on the renal resistive index (RI) of the undilated unobstructed porcine kidney. Materials and methods Experiments were carried out on 14 pigs divided into two equal groups (A and B), under general anaesthesia. In all pigs both ureters were catheterized, thereby allowing urine output to be measured on each side separately, and an indwelling catheter in a femoral artery used to continuously measure the systemic blood pressure. Furthermore, in five pigs from each group, right renal blood flow was measured by ultrasonic flow probes placed around the renal arteries. The right kidney RI was measured at baseline and at 5‐min intervals after frusemide (group A) and mannitol (group B) stimulation, for 75 min. Results Frusemide caused significant increases in diuresis (P < 0.001) and renal blood flow (P = 0.009). This was accompanied by a significant decrease in mean arterial pressure (P < 0.001). The RI was unaffected (P = 0.706), with mean values in group A of 0.58–0.65. Mannitol also caused a significant increase in diuresis (P < 0.001) and a subtle but significant decrease in mean arterial pressure (P < 0.001). However, renal blood flow was unaffected by the diuretic (P = 0.820); the mean RI values were unaffected, at 0.61–0.66 (P = 0.375). Conclusions These results show that diuretic stimulation with frusemide or mannitol does not affect the RI of the unobstructed undilated porcine kidney, despite significant changes in diuresis, renal blood flow and mean arterial pressure.
Functional results of pyeloplasty in patients with ante‐natally diagnosed pelvi‐ureteric junction obstruction
Authors: Cornford  , Rickwood  
Published: March 2003

Objective To assess the outcome after pyeloplasty in children with an ante‐natal diagnosis of hydronephrosis, shown on post‐natal renography to be due to pelvi‐ureteric junction (PUJ) obstruction, and in particular to review the outcome of those who had initially been managed expectantly.Patients and methods Between 1984 and 1995, 321 patients were diagnosed as having PUJ obstruction, after investigating ante‐natal hydronephrosis. Of these, 47 had undergone pyeloplasty and also had a normal contralateral kidney; 26 patients had early pyeloplasty because of impaired function and 21 underwent surgery after a period of expectant management. Renal function was assessed renographically before and at least one year after surgery.Results Relative renal function was stabilized in those patients who underwent early pyeloplasty (mean differential function 28.1% before and 32.7% after surgery). In patients who underwent pyeloplasty after a period of expectant management, the mean relative function decreased from 44.8% initially to 30.5% before surgery; this recovered to 37.5% at the post‐operative reassessment, representing a statistically significant loss of function (P<0.01).Conclusion In patients born with PUJ obstruction and impaired renal function, pyeloplasty failed to significantly improve function, possibly because of cortical loss. In patients with ante‐natal PUJ obstruction managed expectantly there is a small but significant risk of a modest loss of renal function
Anatomical correction of the exstrophy–epispadias complex: analysis of 34 patients
Authors: Nicholls  , Duffy  
Published: March 2003

Objective To evaluate the surgical procedures required for anatomical reconstruction of the bladder and penis in the exstrophy–epispadias complex.Patients and methods All primary exstrophy–epispadias repairs carried out by one surgeon between 1987 and 1997 were reviewed. Bladder closure consisted of full extraperitoneal mobilization, transpositional omphaloplasty, drainage with ureteric and urethral catheters and immobilization with a ‘frog‐leg’ plaster‐cast or ‘mermaid’ dressings. Osteotomies were always performed when bladder closure was attempted after 37 h of age. Before 1990 the osteotomies were posterior vertical iliac (one patient) and subsequently anterior oblique iliac (10 patients). Pre‐peritoneal herniotomies, in the absence of a clinical hernia, were included in the primary procedure after 1992. A modified Cantwell technique was used for epispadias repair and this was undertaken at a median of 16 months after bladder closure (range 6–30).Results Thirty‐four patients (27 male) were reviewed; one patient had a chromosomal abnormality, a deletion in the short arm of chromosome 4. The male infants required a median of four procedures (range 2–5) for bladder closure, epispadias reconstruction and herniotomies, while the females needed a median of two (range 2–5). Complete bladder dehiscence, requiring re‐closure with osteotomies, occurred in three cases (9%, two male). There were no dehiscences in the primary osteotomy group. Fistulae after epispadias repair occurred in four patients (17%). The bladder capacity increased to >60 mL in 10 of 15 males by 36 months after epispadias repair. Only two of seven female infants attained a capacity of >60 mL. Of the 15 infants who did not undergo herniotomy at primary closure, 13 subsequently developed inguinal hernias (one uni‐ and 11 bilateral) with incarceration occurring in two. Twelve infants underwent herniotomy at primary closure and six developed subsequent hernias (two uni‐ and four bilateral; P=0.05) with documented incarceration in two.Conclusions Anatomical correction of the exstrophy‐ epispadias complex remains challenging, but can be achieved with complication rates of <20% for each stage. Bladder volumes large enough to permit adequate bladder neck reconstruction can be anticipated after epispadias repair in a large proportion of male infants, but remains small in female infants with low outlet resistance. Inguinal herniotomy at the time of bladder closure significantly reduces the incidence of subsequent herniation, which nevertheless remains high.
Pharmacokinetics and effects of intravesical oxybutynin on the paediatric neurogenic bladder
Authors: Åmark  , Eksborg  , Juneskans  , Bussman  , Palm  
Published: March 2003

Objective To evaluate the pharmacokinetics of both oxybutynin and its active metabolite, N‐desethyl oxybutynin (NDO), when the drug is instilled directly into the bladder in children with myelodysplasia and neurogenic bladder disturbance, in whom it may improve continence and decrease the risk of upper urinary tract deterioration.Patients and methods The study comprised 13 children (five girls and eight boys, mean age 9.3 years, range 1–15) with neurogenic bladders who were treated using clean intermittent catheterization and intravesical instillation of a sterile, pharmacy‐produced solution of oxybutynin. Steady‐state minimum plasma levels of oxybutynin and NDO, together with their effect on urodynamic variables and incontinence, were evaluated. The dose (0.04–0.17 mg/kg, mean 0.1 mg/kg) was instilled twice daily.Results The effects of the drug on incontinence and urodynamic variables were pronounced, improving both in most cases. Minimum plasma levels were <0.3–7.2 ng/mL for oxybutynin and 0.8–14 ng/mL for NDO. The ratio of oxybutynin to NDO was 0.29–0.83 (mean 0.47).Conclusion There was no clear relationship between minimum plasma levels of the drug or NDO and their clinical effects; however, the combination of oxybutynin and NDO seemed to be more strongly correlated with the clinical effects.
Long‐term use and tapered dose reduction of intranasal desmopressin in the treatment of enuretic children
Authors: Riccabona M. , Oswald J. , Glauninger P. 
Published: March 2003

ObjectiveTo determine the time taken to achieve complete dryness, the management of desmopressin dosage to reduce the relapse rate, the mean dosage in those responding and any side effects of long‐term treatment.Patients and methodsEnuretic children (155, 68% boys and 32% girls, mean age 8 years, range 5–19) were treated with desmopressin and assessed. Treatment (intranasal spray) was started with 20 μg desmopressin and titrated to 40 μg (maximum 50 μg) after 2 days if the child did not become dry within 48 h. The maximum dosage was maintained for at least 4–6 weeks. After 4 weeks of complete dryness, the dosage was reduced by 10 μg initially, and after each additional 4 dry weeks, by a further 10 μg; medication was stopped only after 4 dry weeks at 10 μg.ResultsOf the children, 85% responded to intranasal desmopressin therapy; 71% achieved complete dryness with no relapses, remaining dry with no further treatment, 7% achieved dryness after relapses during or after therapy, 7% improved (no more than two wet nights per week) and 15% did not respond to therapy or improved only slightly (>2 wet nights per week). The mean duration of therapy was 28 weeks, the mean dose of desmopressin was 30 μg and the median follow‐up 18 months. There were no significant side‐effects.ConclusionThis study indicates that rapid titration until dryness within 1–3 days, a long maintenance therapy of at least 4–6 weeks and a slow stepwise reduction of dose decreases the frequency of relapse and improves the outcome.
A new thermo‐expandable shape‐memory nickel‐titanium alloy stent for the management of ureteric strictures
Authors: Kulkarni  , Bellamy  
Published: March 2003

ObjectiveTo assess the ease on insertion, patient tolerance, undesirable side‐effects, degree of encrustation and duration of upper tract decompression with a new thermo‐expandable shape memory alloy ureteric stent.Patients and methodsFrom November 1996 to October 1998, 15 patients with ureteric strictures were treated with a new nickel‐titanium shape‐memory alloy stent, the Memokath 051 (Engineers & Doctors A/S, Hornbaek, Denmark). A total of 22 insertions were carried out. Ureteric obstruction was caused by recurrent colorectal carcinoma in four patients; two patients each with transitional cell carcinoma of the bladder, iatrogenic injury or ischaemia at the uretero‐ileal anastomosis; and one patient each with metastatic lymph nodes from prostatic carcinoma, radiation‐induced fibrosis, pelvi‐ureteric junction obstruction, metastatic carcinoma of the vagina and extra‐luminal endometriosis. The stent has a shaft diameter of 9 F and its proximal end expands to 17 F. The first three patients were treated with the original version, which expanded to 14 F. The unexpanded stent is inserted into the ureter after initial dilatation of the stricture to 12 F. The stent is expanded by injection with sterile water preheated to 50 °C. The procedures were carried out under a general anaesthetic and patients were allowed home the next day. The follow‐up protocol included initial intravenous urography (IVU) at 6 weeks, with assessment of a mid‐stream urine sample and renal function tests. These were repeated at 3‐monthly intervals. Isotopic renography was performed when indicated.ResultsThe mean (range) follow‐up was 10.6 (2–21) months; there was complete relief of upper tract obstruction in all patients. No stent‐related symptoms, e.g. pain, sepsis, haematuria or frequency, were noted and no encrustation has occurred so far. The stent migrated in the first three patients with the original smaller diameter of stent but decompression of the upper tracts was maintained. None of the modified wider stents have migrated. The return of peristalsis in the proximal ureter was detected during IVU. There was no apparent endothelial growth through the stent material and no re‐admissions for stent‐related complications.ConclusionEarly experience with this new stent is very encouraging. All patients have maintained satisfactory decompression of their upper tracts with no need for repeated hospitalization for stent changes. There have been no untoward side‐effects so far. This stent appears to have a valuable place in the long‐term management of ureteric strictures; it is probably most suited for malignant ureteric obstruction. It should be considered in the management of selected benign strictures that require long‐term JJ stenting.
Minimally invasive treatment of urinary tract calculi in children
Authors: Fraser  , Joyce  , Thomas  , Eardley  , Clark  
Published: March 2003

ObjectiveTo report experience of a broad multimodality approach to the treatment of calculi in children using extracorporeal shock wave lithotripsy (ESWL), ureteroscopy/laser lithotripsy, lithoclast and percutaneous nephrolithotomy (PCNL).Patients and methodsThe treatment and outcome were reviewed in 43 children managed by a range of minimally invasive modalities, either singly or in combination, between 1990 and 1997. These patients represent a selected group deemed suitable for minimally invasive management during a period of developing experience with these techniques. Of this cohort, six children had previously undergone open stone surgery and contributory metabolic abnormalities were identified in seven. ESWL was the sole treatment modality in 24 children (56%). In five children (12%) ureteroscopy/laser lithotripsy was combined with ESWL, eight (18%) underwent ureteroscopy/laser lithotripsy alone, whilst three with bladder stones were treated with the lithoclast. Combined therapy including PCNL was required in three patients.ResultsOf the 43 children treated, 38 (88%) were rendered stone‐free. Metabolic disorders accounted for three of the five cases of residual calculi. Complications requiring intervention occurred in two children (7%) and three subsequently underwent open pyelolithotomy or ureterolithotomy after unsuccessful minimally invasive treatment.ConclusionsUsed selectively, the range of minimally invasive procedures available for adults, including ureteroscopy and PCNL, can be safely and effectively extended to the treatment of urinary tract calculi in children. The role of open surgery will diminish further with the availability of specialized instruments for paediatric PCNL.