bluuebunny/crossref_metadata_2025_split huggingface dataset:
Primary adenocarcinoma of the urinary bladder:
Authors: EL‐Mekresh  , EL‐Baz  , Abol‐Enein  , Ghoneim  
Published: March 2003

Objective To evaluate the outcome after the treatment of primary non‐urachal vesical adenocarcinoma and to determine the significant prognostic factors.Patients and methods The records of 185 patients with vesical adenocarcinoma were reviewed. The pathological evaluation included the determination of pathological stage, tumour grade, presence or absence of mucin and its location, evidence of bilharzial infestation and flow‐cytometric DNA analysis. The mean follow‐up of the treated patients was 3.1 years. Disease‐free survival was estimated and the results correlated with patient and tumour characteristics (univariate analysis). Cox’s proportional hazards analysis was used to determine prognostic factors.Results The overall 5‐year disease‐free survival was 55%; only three factors had a significant impact on survival, the tumour pathological stage and grade, and lymph node involvement.ConclusionsRadical cystectomy remains the only satisfactory treatment option for primary vesical adenocarcinoma. Tumour stage, grade and lymph node involvement are the only significant prognostic factors.
Growth inhibition of prostate cell lines in vitro by phyto‐oestrogens
Authors: Hempstock  , Kavanagh  , George  
Published: March 2003

Objective To assess a range of phyto‐oestrogens as moderators of growth and metabolism in several prostate cell lines.Materials and methods Four prostate cell lines (PNT‐1/A, PNT‐2, PC‐3 and DU145) were challenged with different doses of five phyto‐oestrogens (biochanin A, daidzein, genistein, genistin and nordihydroguaiaretic acid) over 3 days in culture. Cell proliferation was assessed by incorporation of 5‐bromo‐2′‐deoxyuridine (BrdU) and metabolic activity by cleavage of a tetrazolium salt (XTT).Results Growth and metabolism were inhibited with all compounds and cell lines (e.g. the dose for 50% inhibition of proliferation of PC‐3 cells by genistein was 38 μmol/L); differences in the patterns of results suggested that different mechanisms operated, but there was no evidence for any synergistic activity on the inhibition of cell proliferation.Conclusion These results offer further support for the hypothesized role of phyto‐oestrogens as dietary protectors against prostatic cancer.
Mycobacterium vaccae (SRL172): a potential immunological adjuvant evaluated in rat prostate cancer
Authors: Hrouda  , Souberbielle  , Kayaga  , Corbishley  , Kirby  , Dalgleish  
Published: March 2003

Objective To evaluate the potential of heat‐killed Mycobacterium vaccae (SRL172) as a nonspecific immunostimulant and as an adjuvant to whole tumour cell vaccination in the rat model of prostate cancer.Materials and methods SRL172 was used as a vaccine in the prevention and treatment of subcutaneous tumours in rats. Prevention experiments were conducted using subcutaneous MAT‐LyLu tumours in Copenhagen rats, comparing vaccination with SRL172 alone, SRL172 plus autologous cells, and bacille Calmette‐Guèrin (BCG) plus autologous cells before tumour implantation. Treatment experiments were conducted using subcutaneous MAT‐LyLu tumours in the Copenhagen rat and subcutaneous PAIII tumours in the Lobund‐Wistar rat. Tumours were induced by subcutaneous injection with tumour cells. Animals were then vaccinated with autologous cells, autologous cells plus SRL172, or SRL172 alone.Results SRL172 was effective as an adjuvant to autologous whole tumour cell vaccination in the prevention of MAT‐LyLu tumours and the survival benefit was equivalent to that provided when the adjuvant was live‐attenuated BCG. SRL172 alone did not reduce tumour take or tumour growth in this model and neither strategy was effective in delaying the growth of established MAT‐LyLu tumours. In the Lobund‐Wistar rat vaccination with autologous whole tumour cells and SRL172 significantly delayed the growth of established tumours.Conclusion Mycobacterium vaccae deserves further evaluation as an adjuvant to whole tumour cell vaccination in a phase I clinical trial in patients with prostate cancer.
Efficacy of escalating doses of intravesical interferon α‐2b in reducing recurrence rate and progression in superficial transitional cell carcinoma
Authors: Giannakopoulos  , Gekas  , Alivizatos  , Sofras  , Becopoulos  , Dimopoulos  
Published: March 2003

Objective To compare the efficacy of three different doses of intravesical interferon α‐2b (IFNα‐2b) in reducing recurrence and progression rates in superficial grade II, transitional cell carcinoma (TCC).Patients and methods Eighty‐nine patients with primary or recurrent TCC stage Ta/T1, grade II, were randomly allocated into four groups after transurethral resection (TUR) of the tumour. Group A (20 patients) received no further treatment, serving as the control group; group B (22 patients) received 40 MU of IFNα‐2b, group C (24 patients) 60 MU and group D (23 patients) 80 MU. The instillations started within 48–72 h after TUR and were performed weekly for 2 months, bimonthly for the next 4 months and thereafter monthly for 6 months. The patients were followed for 36 months. The four groups were compared for the number of recurrences (simple recurrence rate), progression in stage, disease‐free interval and recurrence rate per 100 patient‐months.Results During the follow‐up, 33 patients had recurrence (13, eight, seven and five in groups A to D, respectively). The simple recurrence rate was 65% for group A, compared with 36% (P=0.06), 29% (P<0.05) and 22% (P<0.01) for groups B, C and D, respectively. The differences in simple recurrence rates between the groups treated with IFNα‐2b were not statistically significant. Eleven patients experienced progression in stage, with six, three, one and one in groups A to D, respectively. The differences were statistically significant only between groups A and C (P<0.05) and groups A and D (P<0.05). The disease‐free interval was 15 months for group A, compared with 21.4 (P<0.05), 26.1 (P<0.001) and 30 months (P<0.001) for groups C to D, respectively. The disease‐free intervals of the groups treated with IFNα‐2b were significantly different between all patients in groups B and D (P<0.01) and only for those with stage T1 between groups C and D (P<0.01). Finally the recurrence rate per 100 patient‐months was 2.91, 1.19, 0.88 and 0.63 for groups A to D, respectively (all P<0.001). The results were always in favour of the patients treated with the high dose, the only exception being the difference between groups C and D (P=0.026). No side‐effects of the drug were noted, nor was any adverse reaction reported from any patient.Conclusion These results show a significant advantage for adjuvant intravesical IFNα‐2b treatment over TUR alone for the 36 months of follow up and indicate that IFNα‐2b can modify the clinical course of superficial TCC at least in the short term. The appropriate dose was apparently 80 MU, for although 40 MU was better than TUR alone, it was less effective than 60 MU and 80 MU; the 80 MU dose was slightly better than 60 MU and thus this regimen is recommended.
Desmopressin in the treatment of severe nocturnal enuresis in adolescents — a 7‐year follow‐up study
Authors: Läckgren G. , Lilja B. , Nevèus T. , Stenberg A. 
Published: March 2003

ObjectivesTo evaluate the role of long‐term oral desmopressin (over a 7‐year follow‐up) in refractory enuretics, particularly in assessing the potential curative effect, and to analyse the results for specific types of patient to obtain clues about possible mechanisms of cure.Patients and methodsThe effect of oral desmopressin was investigated in 25 adolescents (aged 11–21 years) with severe monosymptomatic nocturnal enuresis. The long‐term study consisted of two 12‐week treatment periods, with the efficacy of the drug assessed as the reduction in the number of wet nights per week. Subsequently, the patients were followed‐up for up to 7 years. Close contact was maintained with the families over this period (‘good doctoring’ approach). At ≈3‐, 5‐ and 7‐year intervals after completing the study, patients were assessed for dryness, frequency, treatment and sleeping habits, using postal questionnaires and telephone follow‐up.ResultsAt the end of the long‐term study, 35% of the patients remained dry without therapy. Within 2 years of ending treatment, 15 patients were dry, compared with an expected estimate of six by spontaneous resolution, and after 7 years, 19 patients were cured. Nocturia occurred in 75% of the enuretic patients but in only 5% of the healthy controls.ConclusionsActive treatment of primary nocturnal enuresis with oral desmopressin has a clinically significant effect on the cure rate, which is maintained after ceasing therapy. The cure rate was higher than would be expected from spontaneous recovery alone during the first 2 years of the study and there was a significant further increase in the cure rate 7 years after ending therapy, again greater than the expected spontaneous cure rate. There also seemed to be a better response to treatment when it was prolonged. Furthermore, this therapy is safe when administered in the long–term.
Contemporary results of radical radiotherapy for bladder transitional cell carcinoma in a district general hospital with cancer‐centre status
Authors: Bell  , Lydon  , Kernick  , Hong  , Penn  , Pocock  , Stott  
Published: March 2003

ObjectiveTo assess the current efficacy and safety of definitive external beam radiotherapy (EBRT) in the treatment of invasive bladder transitional cell carcinoma (TCC) in a district general hospital with cancer‐centre status.Patients and MethodsThe case notes of all patients with bladder TCC undergoing EBRT with curative intent over an 8‐year period (1988–95) were reviewed. Additional missing outcome data were collected.ResultsIn all, 120 patients (109 men; median age 70 years, range 34–90) underwent radical EBRT (40–65 Gy; fraction median=20) over the 8‐year period. Staging, as assessed by examination under anaesthesia and computed tomography, was T1 in 16%, T2 in 43%, T3 in 38% and T4 in 3%. In 96 patients (80%) the tumour was poorly differentiated (G3). The overall morbidity at 12 months was 12%; proctitis occurred in nine patients (8%) and cystitis in five (4%). Sixty‐seven patients (59%) developed a local recurrence and in 36 (30%) this was invasive. The overall median survival was 60 months. Thirty‐three patients underwent salvage cystectomy with a subsequent median survival of 12.5 months.ConclusionModern radical multifraction EBRT in invasive bladder TCC has a low morbidity, with an overall median survival of 5 years.
Oral desmopressin for nocturnal polyuria in elderly subjects: a double‐blind, placebo‐controlled randomized exploratory study
Authors: Asplund  , Sundberg  , Bengtsson  
Published: March 2003

ObjectiveTo evaluate the decrease in nocturnal diuresis, nocturnal polyuria and the safety of oral desmopressin in elderly subjects with nocturia.Subjects and methodsAfter being identified using a population‐based questionnaire, subjects were included in the study if they; (i) were healthy and free from medication with possible influence on the diuresis or voiding pattern; (ii) had an increased nocturnal frequency (≥2 nocturnal voids/night, as reported before screening); (iii) had a nocturnal urinary output of ≥0.9 mL/min; (iv) completed and responded to an initial dose‐titration study. Twelve men and five women (mean age 67.7 years, sd 4.6 years) met these criteria and were treated with oral desmopressin or placebo at bedtime for 2 weeks on each medication in a randomized, double‐blind, crossover design.ResultsSubjects treated with desmopressin had a significantly reduced nocturnal diuresis of 0.59 mL/min compared with those on placebo (95% confidence interval, CI, 0.33–0.85). The 24‐h diuresis was unaffected by desmopressin treatment. Patients treated with desmopressin had fewer micturitions at night than had those on placebo (1.1 and 1.7, respectively; P<0.001; mean difference=0.59; 95% CI, 0.32–0.85). The reduction in nocturnal diuresis was dependent on the baseline level of night‐time diuresis (r=0.886; r2=0.785; P<0.0001) and the nocturnal part of the baseline 24 h‐diuresis (r=0.708; r2=0.502; P<0.001). After desmopressin treatment was withdrawn, diuresis returned to the levels before treatment. The time from falling asleep to first awakening was improved by 1.4 h in patients treated with desmopressin. There was no change in body weight or ankle circumference during desmopressin treatment. Overall, the treatment was well tolerated and no serious adverse events were observed.ConclusionDesmopressin was effective in reducing nocturnal diuresis and nocturnal voids in polyuric elderly subjects, with no significant adverse events or inconvenience to the patient. The length of uninterrupted sleep was also improved.
The value of central histopathological review of testicular tumours before treatment
Authors: Lee  , Mead  , Theaker  
Published: March 2003

ObjectiveTo assess the value of central histopathological review of testicular tumours.Materials and methodsThe histopathology reports of the referring hospital and central review were compared for all referred testicular specimens (201 orchidectomies and seven testicular biopsies) from 11 hospitals in one region, between 1992 and 1997.ResultsThere were two main findings: First, there was a major discrepancy of tumour type in 12 specimens (6%). The most frequent change (in five cases) was from seminoma to nonseminomatous germ cell tumour (NSGCT). There were also difficulties with uncommon tumours such as spermatocytic seminoma, lymphoma and adenocarcinoma. Treatment was changed as result of the altered diagnosis in eight of these 12 patients. Second, there were discrepancies of interpretation of vascular invasion in 12 of 59 NSGCTs (20%). Differences of tumour elements recognized in NSGCTs were frequent.ConclusionsThe errors discovered on central histopathological review of testicular tumours were significant, though small in number. This supports the idea of central review and is consistent with the specialization recommended in the Calman–Hine cancer arrangements.
Immunohistochemical detection of neuronal plexuses and nerve cells within the upper urinary tract of pigs
Authors: Rolle  , Brylla  , Tillig  
Published: March 2003

ObjectiveTo investigate the distribution and topography of nervous structures within the renal pelvis and upper part of the ureter of pigs, and thus help to determine the origin, propagation and mechanisms of the modulation of pelvi‐ureteric peristalsis.Materials and methodsWhole‐mount preparations of renal pelves from adult pigs were stained using a universal immunostaining method with streptavidin‐alkaline phosphatase. Anti‐neuron‐specific enolase antibody and anti‐neurofilament antibody were used as neuronal markers.ResultsThe patterns of neuronal structures differed between the renal calyces, renal pelvis and upper ureter. In the calyx, there was one single dense nerve plexus; this network contained relatively thin nerve fibres running both circularly and longitudinally. In the wall of the renal pelvis and upper ureter there were two neuronal plexuses, one submucosal and another within the muscular layer; these nerve fibres were mainly orientated longitudinally. Some single nerve cells were also found at the pelvicalyceal border.ConclusionsThese findings suggest a potent nervous system within the upper urinary tract of pigs that connects the renal calyces with the renal pelvis, pelvi‐ureteric junction and ureter. The presence of these dense neuronal networks and nerve cells within the wall of the renal pelvis and ureter suggests that propagation, coordination and modulation of pelvi‐ureteric peristalsis in pigs may arise through intrinsic nervous stimulation.
The role of retroperitoneoscopy in the management of renal and adrenal pathology
Authors: Hemal  , Aron  , Gupta  , Seth  , Wadhwa  
Published: March 2003

ObjectivesTo describe the technique, findings and results of retroperitoneoscopic ablation of recalcitrant renal, giant adrenal and complex peripelvic cysts, and nephrectomy for nonfunctioning congenital anomalous kidneys.Patients and methodsNine patients (six men and three women, mean age 56 years, range 44–68, five with renal, two with adrenal and two with peripelvic cysts, diameter 6–14 cm) were treated by retroperitoneoscopic cyst ablation using three 10‐mm ports. Six further patients (two male and four female, mean age 24 years, range 13–38) underwent retroperitoneoscopic nephrectomy using three or four ports for anomalous nonfunctioning kidneys; three patients had a pelvic kidney, two a horseshoe kidney and one an iliac kidney. Isthmusectomy was also performed in the patients with horseshoe kidneys.ResultsRetroperitoneoscopic cyst ablation was successful in all nine patients; the mean (range) operative duration was 69 (50–85) min in patients with simple renal and adrenal cysts, and 185 (160–210) min in patients with peripelvic cysts. The mean (range) blood loss was 130 (50–200) mL and hospital stay 2.33 (2–4) days. At the last follow‐up, 15–39 months after the procedure, all patients were asymptomatic and satisfied with the outcome, with no recurrence of cysts. Retroperitoneoscopic nephrectomy with isthmusectomy (when applicable) was successful in the six patients with anomalous kidneys, with a mean (range) operative duration of 105 (85–120) min; the mean (range) blood loss was 116 (75–150) mL and the analgesic requirement 208 (150–250) mg of diclofenac sodium. The hospital stay was 2–3 days and the delay before return to preoperative activity 7–14 days.ConclusionsRetroperitoneoscopic cyst ablation is a safe and effective method to treat symptomatic cysts of the upper urinary tract which are refractory to other forms of management. Dissection is difficult in patients with peripelvic cysts. Retroperitoneoscopic nephrectomy for anomalous kidneys is a challenging procedure because of the abnormal location, anomalous vessels and presence of an isthmus. With advances in laparoscopy and increasing experience, open surgery for such conditions is likely to become obsolete.
The pubofascial anchor sling procedure for recurrent genuine urinary stress incontinence
Authors: Kane  , Chung  , Lawrie  , Iskaros  
Published: March 2003

ObjectiveTo evaluate, in a preliminary study, the outcome of a modified pubovaginal sling operation with titanium bone anchors for recurrent genuine stress urinary incontinence (GSI) in women.Patients and methodsThis prospective study included 13 consecutive women who underwent the modified sling procedure between September 1994 and August 1996. The subjective and objective cure of urinary stress incontinence, and the occurrence of postoperative osteitis pubis, were assessed.ResultsAll 13 patients subjectively claimed complete urinary continence and 12 were objectively cured (12 patients agreed to undergo a repeat urodynamic study) during a median (range) follow‐up of 26 (19–38) months. There were no cases of postoperative osteitis pubis, bladder injury or major complications. Mild suprapubic pain was a frequent and self‐limiting complication.ConclusionsThis innovative modified sling procedure is effective for recurrent urinary stress incontinence, with no complication of osteitis pubis. We suggest that this procedure should be considered as a treatment for recurrent GSI and perhaps for primary GSI. A study incorporating a longer follow‐up and more patients has been planned.
The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences
Authors: Aytaç  , Mckinlay  , Krane  
Published: March 2003

ObjectivesTo project the likely worldwide increase in the prevalence of erectile dysfunction (ED) over the next 25 years, and to identify and discuss some possible health‐policy consequences using the recent developments in the UK as a case study.MethodsUsing the United Nations projected male population distributions by quinquennial age groups for 2025, the prevalence rates for ED were applied from the Massachusetts Male Aging Study (MMAS) to calculate the likely incidence of ED. The MMAS has the advantage of being the first study to provide population‐based rates rather than rates based on clinical samples. All the projections were age‐adjusted.ResultsIt is estimated that in 1995 there were over 152 million men worldwide who experienced ED; the projections for 2025 show a prevalence of ≈322 million with ED, an increase of nearly 170 million men. The largest projected increases were in the developing world, i.e. Africa, Asia and South America.DiscussionThe likely worldwide increase in the prevalence of ED (associated with rapidly ageing populations) combined with newly available and highly publicized medical treatments, will raise challenging policy issues in nearly all countries. Already under‐funded national health systems will be confronted with unanticipated resource requests and challenges to existing government funding priorities. The projected trends represent a serious challenge for healthcare policy makers to develop and implement policies to prevent or alleviate ED.
Intraoperative electrical stimulation of cavernosal nerves with monitoring of intracorporeal pressure in patients undergoing nerve sparing radical prostatectomy
Authors: Rehman  , Christ  , Kaynan  , Samadi  , Fleischmann  
Published: March 2003

ObjectiveTo explore the utility of intraoperative cavernosal nerve stimulation in facilitating atraumatic nerve dissection during radical prostatectomy, and thus help predict postoperative erectile function.Patients and methodsFourteen patients (aged 51–72 years) underwent nerve‐sparing radical retropubic prostatectomy (NSRRP); 10 were potent before surgery (group 1), and four had erectile dysfunction (group 2). A multi‐acquisition system (MacLab/8e) with a Macintosh computer was used for real‐time display and recording of intracavernosal pressure (ICP) during surgery. Nerves were stimulated with a bipolar probe (monophasic rectangular pulses, 10 mA, 20 Hz, 0.22 s) before and after removal of the gland. The follow‐up consisted of interviews with patients and their partners’ 12–18 months after treatment.ResultsThe mean (sem) basal ICP of 8.0 (2.0) cmH2O remained unchanged during nerve dissection. The mean increase in ICP during electrical stimulation was >50 cmH2O in seven potent patients (group 1) and was sustained as long as the nerve was stimulated. Postoperatively, these seven patients reported erections sufficient for sexual intercourse. However, the three remaining patients in group 1 had pressure rises of <30 cmH2O, of whom two reported partial erections and one reported total impotence postoperatively. The recovery time for erectile function was 6–12 months after surgery. Two patients from group 2 had transient increases in ICP to <40 cmH2O; one had an increase to 20 cmH2O and one had no response at all. All four patients remained totally impotent postoperatively. There were no complications.ConclusionsIntraoperative electrical stimulation of the cavernosal nerves with ICP monitoring before and after NSRRP is a safe and reliable method for documenting nerve continuity and its functional status. Patients who have normal preoperative erectile function and show an adequate rise in ICP upon electrical nerve stimulation during NSRRP will almost certainly be potent after surgery. This tool may be used to facilitate atraumatic nerve dissection during NSRRP.