bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spinal abnormalities in classic bladder exstrophy
Authors: CADEDDU J.A. , BENSON J.E. , SILVER R.I. , LAKSHMANAN Y. , JEFFS R.D. , GEARHART J.P. 
Published: November 2003

Objective To determine the frequency and clinical sequelae of significant spinal malformations in children born with classic bladder exstrophy.Patients and methods All patients evaluated or treated for classic bladder exstrophy at this institution were reviewed retrospectively. Radiographs or reports pertinent to the spine were retrieved and reviewed with a paediatric radiologist and all vertebral abnormalities categorized. Clinical charts of those with spinal anomalies were reviewed to determine any clinical neurological disorders associated with the radiographic findings.Results Of 423 patients with classic bladder exstrophy who were identified, 299 had radiographs or reports available for adequate review. Of these, 34 (11%) normal variants, e.g. spina bifida occulta and lumbarization or sacralization of vertebrae, were identified. Abnormalities of spinal curvature were identified in eight patients (2.7%), all with uncomplicated scoliosis. Spinal dysraphism was diagnosed in 12 patients (4%) and included myelomeningocele, lipomeningocele, scimitar sacrum, posterior laminal defects in two or more vertebrae, vertebral fusion and hemivertebrae. The one patient with myelomeningocele had clinical neurological dysfunction, giving an overall incidence of 0.3%.Conclusions Spinal anomalies, excluding normal variants, occur in children born with classic bladder exstrophy at a rate of about 6.7%. The incidence of this association is much less than that for cloacal exstrophy. Although rare, neurological dysfunction can occur in the case of spinal dysraphism. Paediatric urologists and neurologists should be aware of this significant difference between patients with classic bladder and cloacal exstrophy to properly diagnose, evaluate and treat the attendant neurological problems.
Effects of sildenafil, a type‐5 cGMP phosphodiesterase inhibitor, and papaverine on cyclic GMP and cyclic AMP levels in the rabbit corpus cavernosum in vitro
Authors: JEREMY J.Y. , BALLARD S.A. , NAYLOR A.M. , MILLER M.A.W. , ANGELINI G.D. 
Published: November 2003

Objective To investigate further the mechanisms of action of sildenafil, a highly selective and potent inhibitor of type 5 cGMP phosphodiesterase (PDE5) that has proved effective in the treatment of erectile dysfunction, by assessing its effect on the in vitro formation of cGMP and cAMP in the corpus cavernosum of the rabbit.Materials and methods Male New Zealand White rabbits (2.5 kg) were killed and their penises rapidly excised, cut into segments and pooled. Penile segments were then incubated with various concentrations of sildenafil or papaverine. The formation of cGMP was stimulated with increasing concentrations of sodium nitroprusside (SNP) and the cGMP and cAMP concentrations measured by radioimmunoassay. Responses were compared to those obtained with papaverine, which is used therapeutically as an erectogen.Results In the presence or absence of SNP, sildenafil increased cGMP concentrations in rabbit penile tissue with increasing dose; the increase was greatest (about 28‐fold) when cGMP was stimulated with SNP (up to 10 μmol/L). At all stimulatory concentrations of SNP, the effective concentrations for 50% stimulation (EC50 ) of sildenafil were 430–520 nmol/L. Concentrations of cAMP were unaltered by sildenafil. Papaverine enhanced cGMP formation in response to SNP, but at much higher concentrations than did sildenafil (≥10 μmol/L).Conclusions Sildenafil specifically increases cGMP levels in rabbit corpora cavernosa; the increase is greater in the presence of SNP indicating that, in vivo, sildenafil may enhance erection by the augmentation of nitric oxide‐mediated relaxation pathways. The erectogenic effect of sildenafil is mediated by a specific enhancement of cGMP accumulation in the corpus cavernosum, consistent with the known activity of sildenafil as a potent and highly selective inhibitor of cGMP‐specific PDE.
Ischaemia‐reperfusion injury in the rat kidney: the effect of preconditioning
Authors: ISLAM C.F. , MATHIE R.T. , DINNEEN M.D. , KIELY E.A. , PETERS A.M. , GRACE P.A. 
Published: November 2003

Objectives To design and establish a model to examine whether brief periods of renal artery occlusion (ischaemic preconditioning, IP) confers protection from the effects of a subsequent period of ischaemia and reperfusion of the rat kidney.Materials and methods Ninety rats were randomized into six groups, i.e. sham‐operated controls; IP alone; a 20 or 40 min period of left renal ischaemia (RI) alone; and IP followed by a 20 or 40 min period of RI. Preconditioning involved the sequential clamping of the left renal artery for 4 min and its release for 11 min, a total of four times, a ‘critical interval’ of 30 min before the ischaemic insult. Left renal tissue integrity was determined by dimercapto‐succinic acid (DMSA) radionuclide imaging on a γ‐camera both immediately (day 0) and 2 and 9 days later. Acute tubular necrosis was also assessed histologically.Results RI for 20 min resulted in a significant decrease in left renal tissue integrity on day 2 only (P<0.001), whereas RI for 40 min caused significant left renal dysfunction on day 0, day 2 and day 9 (P≤0.01). For a given duration of ischaemia, there was no significant difference between results from (IP+RI) rats compared with RI‐only rats at any of the three times. There was no significant alteration in renal tissue integrity in the IP‐only rats compared with sham‐operated controls. Histological findings paralleled the data obtained from DMSA uptake.Conclusions The IP regimen and 30 min ‘critical interval’ confers no protection to the kidney from a 20 or 40 min ischaemic episode. The IP regimen itself appears to have no effect, confirming the validity of our experimental model.
Which patients will benefit from psychosocial intervention after cystectomy for bladder cancer?
Authors: MÅNSSON Å. , COLLEEN S. , HERMERÉN G. , JOHNSON G. 
Published: November 2003

Objectives To investigate: (i) if early psychosocial intervention after cystectomy for bladder cancer can assist psychosocial rehabilitation; (ii) if the outcome of such intervention correlates with the patient’s psychological defensive strategies as revealed with the meta‐contrast technique (MCT); and (iii) if the patient’s general philosophical outlook is important in this context.Patients and methods Of 50 patients who had undergone radical cystectomy for bladder cancer, 17 received an ileal conduit, 17 a continent urinary reservoir with abdominal stoma and 16 an orthotopic neobladder. Twenty‐four of the patients were randomized to psychosocial intervention, comprising weekly counselling 4–9 weeks after surgery. All patients were then evaluated with the Sickness‐Impact Profile (SIP) standard questionnaire and the MCT (a projective test of percept‐genetic model) was used to reflect individual defensive strategies at the subconscious or unconscious level. The patient’s general philosophical outlook was recorded before and after surgery.Results There was no significant difference in the results of the SIP between the intervention and the non‐intervention group, as a whole or in its psychosocial dimension. However, intervention benefited patients with continent cutaneous diversion, whose scores on the psychosocial SIP dimension were lower than in the groups with ileal conduit diversion or orthotopic bladder replacement (P<0.05). The MCT analysis of defensive strategies identified three clusters of patients characterized mainly by isolation and repression, repression and stereotypy or sensitivity and stereotypy. Analysis for cluster identification showed no significant SIP score differences between intervention and non‐intervention groups. In an analysis of single defensive strategies, stereotypy was associated with higher total SIP score, but not significantly. Three clusters of philosophical outlook were identified; in one cluster, characterized by a belief in a supernatural power and philosophical interest, the psychosocial SIP scores were lower in the patients who obtained emotional support and the reverse in a cluster with contrary attitudes, although neither differences were significant.Conclusion Psychosocial intervention assisted the psychosocial rehabilitation of patients with continent cutaneous urinary diversion. Defensive strategies and philosophical outlook generally did not influence the outcome of intervention. However, such programmes may be helpful for some patients, mainly those with a basically pessimistic disposition, a general interest in philosophical questions and often using defensive strategies of stereotypy and repression.
On the enlargement of the normal congenitally solitary kidney
Authors: MALUF N.S.R. 
Published: November 2003

Objective To determine the anatomy of the normal congenitally solitary kidney and to complement an earlier investigation of the major functional parameters of congenitally and acquired normal solitary kidneys.Materials and methods A healthy congenitally solitary kidney was compared anatomically with a normal control kidney from an equal pair in a man of similar height and age.Results The solitary kidney was about 1.8 times heavier than the control; the diameter of its glomeruli and convoluted tubules were similar to those of the control kidney but there were twice as many glomeruli in the solitary kidney than in the control. The total mass of glomeruli, as a percentage of the renal mass (about 5%), was the same for both kidneys and essentially similar to that for mammals in general. However, the total mass of glomeruli as a percentage of cortical mass was considerably greater in the congenitally solitary kidney than in the control, suggesting a relative deficit of convoluted tubular mass in the solitary kidney.Conclusion The normal congenitally solitary kidney is hyperplastic, i.e. there are more elements (nephrons), and apparently not hypertrophic, i.e. having larger nephrons.
Significantly increased complication risks with mass circumcisions
Authors: ÖZDEMIR E. 
Published: November 2003

Objectives To present the most serious complications from circumcision and to compare the complications caused during mass and single circumcisions performed by medically trained or untrained operators.Patients and methods The study comprised both a retrospective and prospective analysis of 220 cases of complications from circumcisions occurring during the last decade and a comparison of the frequency and distribution of complications in mass (n=700) and single (n=600) circumcisions.Results Traditional (medically untrained) circumcisers were responsible for 85% of the complications and almost all the disastrous ones. The frequency of complications from mass circumcision was statistically significantly higher than that from circumcisions performed singly in operating room conditions (relative ratio 3.05 and P<0.001).Conclusion Circumcision can have serious life‐threatening and prolonged complications. It should only be performed in medical institutions by suitably trained surgeons. Mass circumcisions organized for any purpose carry significantly greater risk and should be prevented.
Co‐localization of nitric oxide synthase, neuropeptides and tyrosine hydroxylase in nerves supplying the human post‐natal vas deferens and seminal vesicle
Authors: JEN P.Y.P. , DIXON J.S. , GOSLING J.A. 
Published: November 2003

Objective To determine the distribution and patterns of co‐localization of nitric oxide synthase (NOS), neuropeptides and tyrosine hydroxylase (TH) in intrinsic nerves of the human post‐natal vas deferens and seminal vesicle.Materials and methods Double and triple immunolabelling methods were used in tissue from 10 male infants and children (age range 2 months to 3 years) obtained at post‐mortem examinations carried out within 12 h of death.Results Most nerves supplying the muscle coat of either organ were TH‐immunoreactive (‐IR), most of which also contained neuropeptide Y (NPY) while a smaller proportion contained both NPY and NOS. Minor populations of the TH/NPY‐IR intramuscular nerves contained calcitonin gene‐related peptide (CGRP), galanin (GAL), met‐enkephalin (m‐ENK) or vasoactive intestinal polypeptide (VIP). Non‐TH‐IR intramuscular nerves were relatively infrequent and most contained NPY and either VIP or NOS. Presumptive secretomotor nerves formed subepithelial plexuses in both organs, most of which contained NPY co‐localized with either VIP or NOS, with minor populations containing CGRP and/or GAL. TH‐ and substance P (SP) ‐IR nerves were not observed subepithelially. Perivascular nerve plexuses were mainly formed by TH‐IR varicose nerves, most of which contained co‐localized NPY and CGRP, with a smaller proportion containing NPY and NOS and minor populations containing VIP, m‐ENK, SP or GAL.Conclusion These results indicate that the autonomic control of the human vas deferens and seminal vesicle is provided by several immunohistochemically distinct nerve populations. Furthermore, NOS is present in a proportion of both the noradrenergic and non‐noradrenergic nerves. Pharmacological studies are now required to elucidate the precise roles of nitric oxide and neuropeptides in the functional control of these organs.
Combined chemotherapy and radiation with selective organ preservation for muscle‐invasive bladder carcinoma. A single‐institution phase II study
Authors: FELLIN G. , GRAFFER U. , BOLNER A. , AMBROSINI G. , CAFFO O. , LUCIANI L. 
Published: November 2003

Objective To assess in a phase II trial the effectiveness and toxicity of combined chemotherapy and radiation with selective bladder preservation by response in the treatment of muscle‐invasive bladder carcinoma.Patients and methods Fifty‐six eligible patients with T2–4 M0 transitional cell bladder cancer suitable for radical surgery and multi‐agent chemotherapy received two courses of methotrexate, cisplatin and vinblastine, followed by 40 Gy of pelvic radiotherapy in 1.8 Gy fractions with concomitant cisplatin. Tumour response was evaluated by cystoscopy and biopsy. Those responding completely were given a 24 Gy bladder boost plus cisplatin; patients with residual tumour were assigned to immediate cystectomy.Results After induction therapy, 28 patients (50%) responded completely; 22 operable patients with residual tumour underwent immediate cystectomy, while 34 patients were consolidated with cisplatin and radiation. Bladder relapses developed in 16 patients; seven had successful endovesical therapy for superficial disease and salvage cystectomy was possible in four of nine cases with invasive recurrence. Distant metastases occurred in 22 cases (39%). After a median follow‐up of 46 months, the 5‐year actuarial disease‐specific survival was 59%, disease‐free survival 54% and local control without cystectomy (bladder preservation) 41%. There were no treatment‐related deaths; grade 3 late complications occurred in two patients.ConclusionThis combined chemotherapy–radiotherapy regimen with selective organ preservation should be considered as an option for muscle‐invasive bladder carcinoma. The initial results suggest the possibility of retaining a functioning bladder in many patients, without compromising survival, compared with elective cystectomy approaches. A longer follow‐up and quality‐of‐life assessment remain essential for a better definition of selection criteria and long‐term results of this combined modality.
Tumour size measured by transrectal ultrasonography in the staging of prostate cancer before radical prostatectomy
Authors: RØRVIK J. , ALBREKTSEN G. , HALVORSEN O.J. , HAUKAAS S. 
Published: November 2003

Objective To assess the diagnostic accuracy of transrectal ultrasonography (TRUS) in predicting the local extent of prostate cancer before radical prostatectomy.Patients and methods From April 1990 to April 1993, 59 consecutive patients (mean age 63 years, range 49–71) with clinically localized prostate cancer were examined using TRUS before radical prostatectomy. Primary tumours were clinically categorized according to the TNM classification and biopsies graded histologically. Tumour size was measured as length on a longitudinal and height and width on a transverse ultrasonogram. The results from TRUS were compared with those from the histopathological examination of whole‐mount step sections of the surgical specimens.Results In 50 patients, TRUS using standard criteria achieved sensitivity, specificity, positive‐ and negative predictive values (PPV, NPV) of 0.47, 0.63, 0.73 and 0.36, respectively, in predicting pathological stage. Dimensions were obtained from 45 patients with hypoechoic tumours; in a multivariate linear discriminant analysis the TRUS estimate of width was the best predictor of pathological stage. The sensitivity, specificity, PPV and NPV for tumour width from TRUS, using a threshold of 19 mm, were 0.42, 0.93, 0.93 and 0.43, respectively.Conclusion Tumour width measured by TRUS may improve the assessment of the local extent of prostate cancer.
The staging pelvic lymphadenectomy: implications as an adjunctive procedure for clinically localized prostate cancer
Authors: ALAGIRI M. , COLTON M.D. , SEIDMON E.J. , GREENBERG R.E. , HANNO P.M. 
Published: November 2003

Objectives To evaluate the utility of staging pelvic lymphadenectomy and to identify factors associated with nodal metastases in which a node dissection would be of clinical benefit.Patients and methods A retrospective analysis (1989–1993) was performed on 303 consecutive patients who underwent staging bilateral modified pelvic lymph node dissection for clinically localized prostate cancer. Multivariate logistic regression analysis was used to evaluate age, race, clinical stage, prostate‐specific antigen (PSA) level and Gleason score for predicting nodal metastases.Results Twenty‐eight patients had nodal metastases, giving an overall prevalence of 9.2%. PSA and Gleason score (both P<0.001) were significantly predictive of nodal involvement when combined or as independent variables. Relative to PSA and Gleason score, the patients’ age, race and clinical stage were less relevant. Sensitivity analysis determined that combining a PSA of ≥20 ng/mL (normal 0–4) and a Gleason score of ≥8 gave a negative predictive value of 92% with a specificity of 99%, a positive predictive value of 67% and an overall accuracy of 91% for predicting nodal metastases.Conclusion From this data, lymph node metastases are unlikely in patients with clinically localized prostate cancer who have a PSA of <20 ng/mL and a Gleason score <8, and that a pelvic lymph node dissection as an adjunctive procedure should be avoided in such individuals.
Anaemia associated with androgen deprivation in patients with prostate cancer receiving combined hormone blockade
Authors: STRUM S.B. , McDERMED J.E. , SCHOLZ M.C. , JOHNSON H. , TISMAN G. 
Published: November 2003

Objectives To describe the incidence, time to onset and extent of anaemia occurring in patients with prostate cancer receiving combined hormone blockade (CHB) and the timing and extent of recovery from anaemia in those patients where CHB was discontinued.Patients and methods Patients with prostate cancer were evaluated prospectively by physical examination and laboratory tests at baseline and at routine intervals while receiving CHB. Of 142 patients who received CHB, 133 were evaluable for the assessment of anaemia; CHB was discontinued in 76 patients, of whom 64 were assessable for recovery from their anaemia.Results Haemoglobin levels declined significantly in all patients from a mean baseline of 149 g/L to means of 139 g/L, 132 g/L and 131 g/L at 1, 2 and 3 months, respectively. Haemoglobin levels continued to decline during CHB to a mean nadir of 123 g/L at a mean of 5.6 months of CHB, representing a mean absolute haemoglobin decline at nadir of 25.4 g/L. In 120 of the 133 (90%) patients, the relative decline in haemoglobin at nadir was ≥10% and was ≥25% in 17 (13%) others, representing a mean absolute haemoglobin decline in this subset of 42.7 g/L. Significant symptoms related to anaemia occurred in 17 patients (13%). Anaemia and symptoms in these patients were easily corrected with the subcutaneous administration of recombinant human erythropoietin.Conclusions The anaemia associated with androgen deprivation is significant and occurs routinely in men receiving CHB. It is normochromic, normocytic, temporally‐related to the initiation of androgen blockade and usually resolves after CHB is discontinued. We suggest that patients receiving CHB undergo haematological testing at baseline, 1–2 months after initiating CHB and periodically thereafter. Patients developing anaemia should be questioned about symptoms reflecting physiological compromise (e.g. angina, dyspnoea on exertion). In the absence of other causes, CHB should be suspected in the development of anaemia in patients receiving this treatment.
Transurethral needle ablation of the prostate for the treatment of benign prostatic hyperplasia: a collaborative multicentre study
Authors: RAMON J. , LYNCH T.H. , EARDLEY I. , EKMAN P. , FRICK J. , JUNGWIRTH A. , PILLAI M. , WIKLUND P. , GOLDWASSER B. , FITZPATRICK J.M. 
Published: November 2003

Objective To assess the efficacy and safety of transurethral needle ablation of the prostate (TUNA) for patients with symptomatic benign prostatic hyperplasia (BPH) in a multicentre trial.Patients and methods Seventy‐six patients were recruited from five centres; all were treated with the TUNA system consisting of a powered radiofrequency generator and a TUNA catheter. The patients were evaluated prospectively using the international prostate symptom score (IPSS), uroflowmetry, quality‐of‐life score, and other variables, and followed for a mean of 12 months after treatment.Results Sixty‐eight patients were available for follow‐up; TUNA produced significant improvements in the IPSS (median 22 before, to 7.5 after treatment), urinary flow rate (mean 8.7 before, to 11.6 mL/s after treatment) and quality‐of‐life score (median 5 before, to 2 after treatment) at 12 months.Conclusions If these early promising results are maintained in the medium to long term, TUNA therapy will be a useful low‐morbidity alternative for patients with symptomatic BPH.
Detection of telomerase activity in human prostate: a diagnostic marker for prostatic cancer?
Authors: SCATES D.K. , MUIR G.H. , VENITT S. , CARMICHAEL P.L. 
Published: November 2003

Objective To assess the role of telomerase activity as a marker for the development of prostate cancer in men with existing benign prostatic hyperplasia (BPH), a known risk factor for prostatic carcinoma.Materials and methods Telomerase activity was assayed, using a highly sensitive polymerase‐chain reaction‐based assay, in nine biopsies from patients with prostatic cancer, 16 from patients clinically diagnosed with BPH and 11 from patients with no evidence of prostatic disease.Results Telomerase activity was detectable in eight of the nine prostate cancer biopsies, in none of the normal prostates and in six of the 16 BPH biopsies.Conclusion The finding of telomerase activity in six of 16 biopsies from patients with BPH could indicate early prostate cancer and suggests that telomerase activity may be of use as a biomarker in patients diagnosed with BPH and who may subsequently develop prostate cancer.