bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of various combinations of free, complexed and total prostate‐specific antigen levels as predictors of the pathologic stage of prostate cancer
Authors: Okegawa Takatsugu , Noda Haruhisa , Ohta Masaya , Kato Moriaki , Nutahara Kikuo , Higashihara Eiji 
Published: March 2003

Abstract Background: The efficacy of various combinations of total, free and complexed prostate‐specific antigen (PSA) levels were assessed to predict the pathologic stage of prostate cancer.Methods: Total PSA (tPSA), free PSA (fPSA) and complexed PSA (cPSA) levels were measured preoperatively in 52 patients with clinical localized prostate cancer who had undergone radical prostatectomy. Pathologic stages were classified as: organ‐confined (n = 27); capsular penetration (n = 14); seminal vesicle involvement (n = 8); involvement of the surgical margins (n = 10); and lymph node involvement (n = 3).Results: The fPSA/tPSA and fPSA/cPSA ratios significantly differed between patients with organ‐confined disease and non‐organ‐confined disease (P = 0.035, P = 0.033, respectively) and between those with favorable versus unfavorable pathology (P = 0.001, P = 0.014, respectively), but tPSA, cPSA, fPSA and the cPSA/tPSA ratio did not. Using a fPSA/tPSA cutoff level of 11%, the prediction of organ‐confined disease would increase from 52 to 67% and the rate of predicting favorable pathology would increase from 42 to 62%. A fPSA/cPSA cutoff level of 12% would increase the rate of predicting organ‐confined disease to 79% and the rate of predicting favorable pathology would increase to 69%. The positive predictive value of the fPSA/cPSA ratio was higher than that of the fPSA/tPSA ratio, although the receiver operating characteristic curve of the fPSA/cPSA ratio was not different from that of the fPSA/tPSA ratio.Conclusion: Although there was no predictive difference found between fPSA/tPSA and fPSA/cPSA ratio, both ratios may help predict the pathologic stage of prostate cancer.
Equivalent efficacy of mitomycin C plus doxorubicin instillation to bacillus Calmette‐Guerin therapy for carcinoma in situ of the bladder
Authors: Sekine Hideaki , Ohya Kazuhiro , Kojima Sin‐ichi , Igarashi Kazumasa , Fukui Iwao 
Published: March 2003

Abstract Background: To elucidate the most efficient topical therapy for carcinoma in situ of the bladder, the efficacy of intravesical mitomycin C plus doxorubicin therapy was compared with bacillus Calmette‐Guerin (BCG) therapy. The clinical behavior of the tumor was analysed according to the histological grade.Methods: Forty‐two patients with carcinoma in situ of the bladder were randomized to intravesical BCG (21 patients) or mitomycin C plus doxorubicin sequential therapy (21 patients) as first line treatment. The non‐responders underwent the subsequent instillation of the other intravesical therapy alternately. Of the patients, 27 had grade 2 and 15 had grade 3 cancer.Results: Both topical therapies were equally effective with initial response rates of 86% (18/21) for BCG and 81% (17/21) for mitomycin C plus doxorubicin, irrespective of the tumor grade. Of seven initial non‐responders, five patients achieved a complete response by subsequent instillation, resulting in a total response rate of 95%. After a mean follow‐up of 47 months, five patients (12%) developed disease progression. The progression rates were not different between the topical therapies, but were significantly higher in grade 3 than in grade 2 cases.Conclusion: It appears likely that mitomycin C plus doxorubicin instillation has an equivalent efficacy to BCG as the initial therapy of carcinoma in situ and the combination of them would be the most efficient tr eatment for the disease. Moreover, histological grading would be clinically useful in defining the tumor characteristics and behavior of carcinoma in situ of the bladder.
Solitary fibrous tumor of renal pelvis
Authors: Yazaki Tsunetada , Satoh Satoshi , Iizumi Tatsuo , Umeda Takashi , Yamaguchi Yutaka 
Published: March 2003

Abstract A 70‐year‐old Japanese man was referred because of a right renal mass of 2 years in duration. Imaging studies, including magnetic resonance imaging, revealed an ovoid mass, with relatively abundant vascularity, in the right renal pelvis. Right radical nephrectomy was done and a tumor measuring 6.0 × 4.5 × 4.0 cm was found in the renal pelvis. Solitary fibrous tumor (SFT) was highly suspected by histology. Immunohistochemical study using a monoclonal antibody directed against the human hematopoietic progenitor cell antigen (CD34) stain confirmed SFT. This is the first case of SFT of the renal pelvis.Although SFT is extremely rare in urogenital organs, this tumor must be included in the differential diagnosis when we encounter urogenital tumors consisting of mesenchymal elements.
Endoscopic ureteral incision using the holmium:YAG laser
Authors: HIBI HATSUKI , KATO KEITARO , MITSUI KENJI , TAKI TOMOHIRO , YAMADA YOSHIAKI , HONDA NOBUAKI , FUKATSU HIDETOSHI 
Published: March 2003

Abstract Background: We reviewed the results of endoscopic ureteral incision for benign ureteral stricture, ureteropelvic junction obstruction and ureteroenteroanastomotic stricture using the holmium laser.Methods: We carried out endoscopic ureteral incision using the holmium laser through an 8‐Fr semirigid or 6.9‐Fr flexible ureteroscope on 17 ureters in 15 patients. Balloon dilatation was not necessary before insertion of the ureteroscope. The stricture was incised with the holmium laser using a 200–365 μm fiber through the working channel of the ureteroscope. After completion of the incision, a 12‐Fr double‐J catheter was left for 6 weeks. Thereafter patients were followed by renal scan and/or ultrasound and excretory urography at 3–6 month intervals.Results: The mean operative time was 65 min (18–135 min). The stricture resolved completely in 86.7% of cases at an average follow up of 20.5 months (11–32 months).Conclusions: The holmium laser endoscopic ureteral incision was associated with a good outcome in our series. We recommend this procedure to be employed initially because it is less invasive and has a favorable outcome.
Prognosis of conservative therapy of advanced interstitial cystitis: Experience of five cases
Authors: YAMADA TETSUO , MURAYAMA TETSUO 
Published: March 2003

Abstract Background: It is generally believed that surgical procedures, particularly the more invasive ones, should be reserved for patients who fail to respond to conservative therapy by several established modalities. We studied whether conservative therapy was applicable to patients with interstitial cystitis (IC) in which an individual's awake bladder capacity decreases to 100 mL or less with vesicoureteral reflux (VUR).Methods: Five cases that satisfied the criteria proposed by the National Institutes of Health were examined. The maximum awake bladder capacity was 50–100 mL (average, 74 mL). The bladder capacity under anesthesia was 70–300 mL (average, 199 mL). Only conservative treatments were carried out.Results: The observation period ranged from 3 to 16 years with an average of 9 years. The awake bladder capacity ranged from 200 to 300 mL (average, 250 mL). The symptom index total score, which was previously 18.5, decreased to 5.5 and the problem index total score, which was previously 14.3, decreased to 3.5. Symptoms of bladder irritation improved. In four cases, VUR disappeared as the bladder capacity increased. Vesicoureteral reflux persisted in one case although its severity decreased and there was no fever.Conclusion: The patients treated with conservative therapy were able to maintain an awake bladder capacity that was sufficient for acceptable quality of life and their symptoms of bladder irritation improved. This suggests that we should regenerate the original remaining bladder using conservative therapy, even if IC is in a late stage.
Arterial blood gases in extraperitoneal laparoscopic urethrocystopexy
Authors: Kocoglu Hasan , Goksu Sitki , Erbagci Ahmet , Pirbudak Lutfiye , Yuksek Mustafa Sahin , Oner Unsal 
Published: March 2003

AbstractBackground: The aim of this study was to investigate the effects of extraperitoneal laparoscopy and carbon dioxide insufflation on hemodynamic parameters, arterial blood gases and complications in urethrocystopexy operations.Methods: Twenty‐five female patients who underwent extraperitoneal laparoscopic mesh urethrocystopexy operation for the correction of urinary incontinence were allocated to the study. Hemodynamic parameters were noted and blood gas analyzes were performed before the induction of anesthesia, 10 min after induction, 5 and 10 min after the beginning of carbon dioxide insufflation, at the end of carbon dioxide insufflation and 30 min after exsufflation.Results: There was no significant change in mean arterial pressure, peripheral oxygen saturation, arterial carbon dioxide pressure, and arterial oxygen saturation compared to preinsufflation and preinduction values. End‐tidal carbon dioxide pressure did not increase above 45 mm/Hg during carbon dioxide insufflation. Arterial oxygen saturation and partial oxygen pressure did not decrease. Subcutaneous emphysema, pneumothorax, pneumomediastinum and pleural effusion were not noted in any patient.Conclusion: We conclude that, extraperitoneal laparoscopic urethrocystopexy is not associated with hemodynamic and respiratory impairment.
Kidney autotransplantation in a patient with renal pelvic and bladder carcinomas
Authors: Hayakawa Kunihiro , Ashimine Satoshi , Aoyagi Teiichiro , Miyaji Keisuke , Hata Makoto , Okano Tatsuya 
Published: March 2003

AbstractA 66‐year‐old Japanese woman, whose left kidney was non‐functioning, was referred to us with a diagnosis of invasive bladder carcinoma and right renal pelvic carcinoma. The latter tumor was clearly packed in the renal calyx and was considered to be of low‐grade malignancy. Nephron preserving surgery of the right kidney was performed, followed by radical cystectomy and construction of an ileal conduit. The postoperative course was good, without significant complications. Renal function was restored and a postoperative imaging study showed a well‐functioning transplanted kidney. At present (20 months after surgery), the patient is doing well and has presented no signs of recurrence of the disease.
Prevalence of snoring and sleep‐disordered breathing in a group of commercial bus drivers in Hong Kong
Authors: Hui D. S. C. , Chan J. K. W. , Ko F. W. S. , Choy D. K. L. , Li T. S. T. , Chan A. T. , Wong K. K. , Lai C. K. W. 
Published: March 2003

Abstract Objectives: To assess the prevalence of sleep‐­disordered breathing (SDB) and its associated symptoms in a group of commercial bus drivers in Hong Kong. Methods: Two hundred and sixteen of 410 bus drivers from three different shifts were interviewed with the Sleep & Health Questionnaire (SHQ) and the Epworth sleepiness scale (ESS) at a Hong Kong bus depot. Seventeen subjects from each shift were then randomly selected for at‐home sleep study using the Mesam IV device (Madaus Medizin−Elektronik, Freiburg, Germany). Results: There were 207 men and nine women (mean age 42.4 ± 7.5 years; body mass index (BMI) 25.4 ± 4.5 kg/m2; ESS 5.3 ± 4.2). From the SHQ it was discovered that: (i) daytime sleepiness was reported by 87 subjects (40%), (ii) snoring ≥ 3 times per week was reported by 80 subjects (37%), (iii) witnessed apnoea was reported by 17 subjects (7.9%) and (iv) 29 subjects (13.4%) reported having fallen asleep during driving. Among the 51 subjects who underwent the at‐home sleep study: (i) 31 subjects (61%) had respiratory disturbance index (RDI) ≥ 5 per hour of sleep, (ii) 21 subjects (41%) had RDI ≥ 10 per hour of sleep, (iii) 12 subjects (24%) had RDI ≥ 15 per hour of sleep and (iv) 35 subjects (68.6%) snored objectively ≥ 10% of the night. Ten subjects (20%) had RDI ≥ 5 and sleepiness at work, while five subjects (9.8%) had RDI ≥ 5 and ESS > 10. No significant differences were noted in the SHQ responses, ESS, objective snoring or RDI among the three groups. Multiple regression analysis showed that BMI and witnessed apnoea were the only positive independent predictors of RDI. Conclusions: This study showed a high prevalence of objective snoring and SDB in a group of commercial bus drivers. Neither self‐reported sleepiness nor the ESS could identify subjects with SDB. (Intern Med J 2002; 32: 149−157)
Aminoglycosides in cystic fibrosis: a descriptive study of current practice in Australia
Authors: Phillips J. A. , Bell S. C. 
Published: March 2003

Abstract Aim: To determine the diversity of clinical practice with respect to aminoglycosides in cystic fibrosis (CF) units within Australia. Method: In April 1999, a questionnaire on the use of aminoglycosides was sent to 30 CF units across Australia. Information was collected about drug selection, dosing, monitoring and toxicity with intravenous administration. Results: Completed surveys were received from 26 of the 30 units (response rate = 86%) and all units with > 40 patients. Tobramycin was the drug of choice in all but two centres where there was equivalent use of gentamicin and tobramycin. The survey demonstrated a trend in recent years to reduce the number of doses per day with 54% of centres prescribing once daily, 23% twice daily and 23% thrice daily regimens. Initial dosing was generally based on mg/kg per day (mean 8.8, range 7.5–10 mg/kg per day). Dosing by infusion occurred in 11 of 14 units using once‐daily dosing and there was equivalent use of bolus and infusion methods for multiple‐daily regimens. Drug monitoring depended on dosing regimen. Units using multiple daily regimens monitored using trough ± peak levels, whereas 50% of units using once‐daily dosing used two postdose levels to alter dose. Actual toxicity, in particular nephrotoxicity, ototoxicity and vestibular toxicity was reported by 19, 27 and 12% of units, respectively. Conclusion: The prescribing, dosing and monitoring of aminoglycosides in CF across Australia varies greatly. This is likely to be due to a lack of definitive evidence as to the optimum use in this patient group. (Intern Med J 2001; 31: 23–26)
Chemotherapy and granulocyte colony stimulating factor‐mobilized blood cell infusion followed by interferon‐α for relapsed malignancy after allogeneic bone marrow transplantation
Authors: Grigg A. , Kannan K. , Schwarer A. P. , Spencer A. , Szer J. 
Published: March 2003

Abstract Background: Interferon‐α (IFN) is known to promote graft‐versus‐host disease (GVHD) after allogeneic bone marrow transplantation (allo BMT). This property may also be used to enhance a graft‐versus‐leukaemia effect (GVL) after donor leucocyte infusion (DLI), a mode of therapy increasingly offered to patients relapsing after allo BMT. Aim: The aims of the present study were to examine the efficacy and toxicity of IFN therapy administered after granulocyte colony‐stimulating factor (G‐CSF)‐stimulated blood cells given as DLI in patients with acute myeloid leukaemia (AML), chronic myeloid leukaemia (CML), acute lymphoblastic leukaemia (ALL), acute undifferentiated leukaemia (AUL) and multiple myeloma relapsing after allo BMT. Methods: Between October 1996 and September 1999, 27 patients (16 AML, four ALL, three CML, three multiple myeloma, one AUL) who relapsed after allo BMT were treated with chemotherapy followed by DLI, collected after G‐CSF stimulation in all but two cases. Subsequently, IFN was given to patients without significant GVHD or rapidly progressive disease. The outcome after DLI with regard to remission rate, disease‐free survival and GVHD was analysed. Results: Eighteen patients received IFN following DLI, 14 of whom developed significant GVHD (grade II–IV acute or extensive chronic); thereafter, GVHD resolved with cessation of IFN alone in four patients, but 10 required systemic immunosuppression. Twenty‐three patients were given chemotherapy and DLI as initial treatment of relapse; 10 achieved complete remission (CR), in four patients this was only after the onset of GVHD. The other four patients received chemotherapy and DLI as a consolidation of a chemotherapy‐induced remission. The CR was durable only in patients with CML (3 of 3) and AML (4 of 8). Conclusions: Treatment with IFN induced GVHD in the majority of patients receiving DLI. The induction of GVHD and GVL by this approach produced excellent results in patients with CML and modest results in AML, but appeared to be less effective in myeloma and ALL. (Intern Med J 2001; 31: 15–22)
Urinary symptoms and incontinence in an urban community: prevalence and associated factors in older men and women
Authors: Muscatello D. J. , Rissel C. , Szonyi G. 
Published: March 2003

Abstract Background: There is increasing recognition of the importance of a wide range of urinary symptoms in both men and women and that these symptoms are undertreated. Aims: To determine the prevalence of and factors associated with urinary symptoms, including nocturia, urgency, urge and stress incontinence and, in men, urinary stream difficulties; and the prevalence of being bothered by the symptoms and ever seeking treatment for them. Method: Household survey by computer‐assisted telephone interviews of people aged 41 years and over and living in inner metropolitan Sydney. Results: Fifty‐three per cent (95% confidence interval (CI) 46–60) of men and 61% (95% CI 55–67) of women reported one or more symptoms in the previous month. In men, the most frequently reported symptoms were urgency (30%, 95% CI 24–36) and nocturia (25%, 95% CI 19–31). In women, stress incontinence (35%, 95% CI 29–41) and urgency (33%, 95% CI 27–39) were the most common symptoms reported. In men, the significant factors associated with reporting one or more symptoms, after adjustment for other variables, were age 60 years or more, no private medical insurance, obesity and fair or poor self‐rated health. For women, the significant associations were age 50–59 years, age 70 years or more, no private health insurance, high psychological distress and fair or poor self‐rated health. Conclusions: Urinary symptoms are experienced by more than half of men and women aged over 40 in the central Sydney community, but many do not seek treatment. Such symptoms should be considered more broadly than the traditional focus on male ‘prostatism’ and female incontinence. (Intern Med J 2001; 31: 151–160)
On patient judgement
Authors: Mcdonald I. G. , Daly J. 
Published: March 2003

Abstract Clinical judgement, the keystone of medical expertise, is a hot topic. By contrast, patient judgement, also of central importance in health care, receives little attention. Patients have the last say concerning whether or not they seek medical treatment for symptoms, follow a doctor’s advice or accept reassurance. Delay in seeking help for serious symptoms, non‐compliance with treatment advice and failure of doctors to reassure many of the ‘worried well’ have long been recognized as serious problems. We argue that what is common to these important problems is patient judgement. Surveys yielding information about the average influence of a large number of individual variables do not do justice to the complex interaction of influences that can influence the judgements of an individual person under particular social circumstances. This is what explains the wide variety of patient reactions. From the medical standpoint, such unpredictable patient behaviour seems irrational. The patient perspective on the meaning of their actions is a hiatus in our knowledge, which is hampering the planning of effective interventions. Too few studies have sought the perspective of patients by asking them why they acted as they did. Thus, the wide spectrum of patient response in these situations in relation to personality, life experience and social context cannot be studied without interpretive field studies that include interview of patients with qualitative interpretation. (Intern Med J 2001; 31: 184–187)
An audit of the use of granulocyte colony‐stimulating factor in septic shock
Authors: Stephens D. P. , Fisher D. A. , Currie B. J. 
Published: March 2003

Abstract Background: Granulocyte colony‐stimulating factor (G‐CSF) stimulates the production of neutrophils and modulates the function and activity of developing and mature neutrophils. In septic shock, the immune system can be considered one of the failing organ systems.G‐CSF improves immune function and may be a useful adjunctive therapy in patients with septic shock. Aim: To evaluate the introduction of G‐CSF as an adjunct to our standard treatment for community‐acquired septic shock. Methods: We performed a prospective data collection and analysis to determine whether the addition of G‐CSF to our standard treatment for community‐acquired septic shock was associated with improved hospital outcome, compared with an historical cohort ofsimilar patients. We included all patients admitted to the Intensive Care Unit (ICU) with community‐acquired septic shock between December 1998 and March 2000. Patients received 300 µg G‐CSF intravenously daily for 10 days in addition to ourstandard treatment for community‐acquired septic shock. G‐CSF was discontinued early if the patient was discharged from ICU before10 days or if the absolute neutrophil count exceeded 75 × 106/mL. Results: A total of 36 patients with community‐acquired septic shock, an average Apache 2 score of 26.7, and a predictedmortality of 0.79, were treated with G‐CSF from December 1998 to March 2000. Hospital mortality was 31% compared with an historical cohort of 11 similar patients with a hospital mortality of 73% (P = 0.018). In the subgroup of patients with melioidosis septic shock, the hospital survival improved from 5% to 100% (P < 0.0001).No significant adverse events occurred as a result of the administration of G‐CSF. Conclusion: G‐CSF is a safe adjunctive therapy in community‐acquired septic shock and may be associated with improved outcome. The use of G‐CSF in septic shock should undergo further investigation to define subgroups of patients who may benefit from G‐CSF. The use of G‐CSF in patients with septic shock due to Burkholderia pseudomallei is recommended. (Intern Med J 2002; 32: 143−148)
Management of complicated parapneumonic effusions and thoracic empyema
Authors: Cameron R. J. 
Published: March 2003

AbstractThe optimal management of loculated para­pneumonic effusions and empyema includes breakdown of adhesions to effect drainage of infected pleural fluid. The use of fibrinolytics intrapleurally appears to enhance intercostal tube drainage, reducing the requirement for subsequent surgical mechan­ical debridement. This article discusses the evidence for intrapleural fibrinolytics, their good safety profile and the practicalities of dose and administration. It also reviews early surgical intervention, which may be indicated for medical treatment failure and, some would argue, as a suitable alternative to other medical interventions. (Intern Med J 2002; 32: 408−414)
Beyond angioplasty: novel developments in interventional cardiology
Authors: Lowe H. C. , Burkoff D. , Khachigian L. M. , MacNeill B. D. , Hayase M. , Oesterle S. N. 
Published: March 2003

AbstractTwo specific areas in interventional cardiology have, until recently, remained problematic. First is the emerging issue of the so‐called ‘no option’ patient, considered untreatable by conventional percutaneous coronary intervention (PCI) or surgery. Second is the long‐standing dilemma of restenosis following PCI. Strategies addressing these two critical areas have been the subject of intense research efforts recently. Several important breakthroughs are being made in the important areas of novel revascularization techniques, antirestenotic agents and stent‐based delivery methods. It is conceivable that these novel developments will soon mean that a broader range of patients can be treated, and that the issue of restenosis will now be seriously challenged. (Intern Med J 2002; 32: 470−474)