bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Rigid and Flexible Transbronchial Needle Aspiration in the Staging of Bronchogenic Carcinoma
Authors: Bilaceroglu Semra , Cagiotariotaciota Ufuk , Günel Özden , Bayol Ümit , Perim Kunter 
Published: April 2003

In staging bronchogenic carcinoma by transbronchial needle aspiration (TBNA), rigid histology needles are generally preferred to flexible cytology needles owing to the widespread opinion that rigid needles have higher diagnostic yield and less false-positive results. The objective of this study was to compare the efficacy and safety of the rigid and flexible TBNAs in staging bronchogenic carcinoma to establish whether a flexible cytology needle method can replace the rigid needle. A prospective study was conducted in 138 consecutive patients with extra- or endobronchial masses suggestive of bronchogenic carcinoma and amenable to surgical procedures. All 8 mm and larger paratracheal, carinal, hilar and/or main bronchial lymph nodes determined before bronchoscopy by computed tomography (CT) were sampled by successive 18-gauge rigid and 21-gauge flexible TBNAs in the same session. The anatomic landmarks were followed precisely during TBNAs, and a proper technique applied in sampling and specimen processing. Malignant lymph node involvement was specified in 97 (72%) cases of bronchogenic carcinoma by rigid, and in 89 (66%) by flexible TBNA. There were 4 (100%) benign cases (3 with tuberculosis and 1 with sarcoidosis) of 101 (73%) with positive rigid TBNAs (82 with histological and 19 with cytological specimens). TBNAs determined malignant lymph node involvement in a total of 104 (78%) patients. Of 30 TBNA-negative patients, 14 were proven to have false-negative TBNAs by mediastinoscopy/mediastinotomy/minithoracotomy, and 16 to have true-negative TBNAs by thoracotomy. Thoracotomy confirmed true positivity in 52 rigid and 49 flexible TBNAs, and false negativity in 4 rigid and 7 flexible TBNAs. Further staging was confirmed in these 7 cases. Four had proven false-negative results by both methods. The presence of small cell carcinoma (21) or N<sub>3</sub> disease (27) presented a contraindication to thoracotomy in 48 TBNA-positive patients. Adequate-quality and malignant lymph node specimens were more frequently obtained by both techniques at advanced tumor and node stages. However, malignant lymph node invasion was significantly more frequent in rigid and flexible TBNA specimens only in the presence of advanced tumor status and abnormal endoscopic appearance. The sensitivities of rigid and flexible TBNAs were 74 and 70%, respectively (p > 0.05), but both had a specificity of 100%. Neither false-positive results nor serious complications other than hemorrhage of 30–100 ml (rigid: 5%, flexible: 2%) were encountered with either technique. These results indicate that in bronchogenic carcinoma, hilar and mediastinal lymph nodes can be staged by 21-gauge flexible TBNA (76%) as accurately as by 18-gauge rigid TBNA (79%) if a proper technique is applied and anatomic landmarks are followed precisely (p > 0.05).
Using <sup>99m</sup>Tc-DTPA Radioaerosol Inhalation Lung Scintigraphies to Detect the Lung Injury Induced by Consuming <i>Sauropus androgynus</i> Vegetable and Comparison with Conventional Pulmonary Function Tests
Authors: Kao C.H. , Ho Y.J. , Wu C.L. , ChangLai S.P. 
Published: April 2003

Consuming Sauropus androgynus, a Malaysian plant, to reduce body weight began to become fashionable in Taiwan in 1994. According to some reports, people consuming this vegetable developed lung injuries. From July to November 1995, there were 81 nonsmoking women admitted to our hospital. Thirty-six cases had respiratory symptoms/signs and the remaining 45 had no symptoms/signs. We investigated these patients with pulmonary function tests (PFT) and technetium-99m DTPA radioaerosol inhalation lung scintigraphies (DTPA lung scan), a test to evaluate the lung ventilation and alveolar epithelial permeability. Eighteen patients had abnormal results in PFT, including obstructive type (n = 17), restrictive type (n = 5), and both (n = 4). There were 33 patients with abnormalities in DTPA lung scans, including unhomogeneous deposition of DTPA radioaerosols (n = 19), faster clearance of radioaerosols from lung (n = 26), and both (n = 12). Analyzing the results, we found that the patients with respiratory symptoms had a higher incidence of abnormal results of PFT and DTPA lung scans than the patients without respiratory symptoms (p < 0.05). Besides, we found that the DTPA lung scan was more sensitive than chest x-ray and PFT in detecting the lung injuries related to the consumption of S. androgynus (p < 0.05). Consuming S. androgynus can result in symptomatic or asymptomatic lung injuries, manifested as obstructive or restrictive ventilatory impairment, unhomogeneous radioaerosol distribution, and increased alveolar epithelial permeability. In addition, measurement of the <sup>99m</sup>Tc-DTPA clearance is the most sensitive test to detect the lung injuries caused by consuming S. androgynus.
Comparison of the Bronchodilator Effects of Salbutamol Delivered via a Metered-Dose Inhaler with Spacer, a Dry-Powder Inhaler, and a Jet Nebulizer in Patients with Chronic Obstructive Pulmonary Disease
Authors: Ikeda Akihiko , Nishimura Koichi , Koyama Hiroshi , Tsukino Mitsuhiro , Hajiro Takashi , Mishima Michiaki , Izumi Takateru 
Published: April 2003

The aim of this study was to compare the bronchodilator effects of salbutamol delivered via three different devices: a dry-powder inhaler (DPI), a metered-dose inhaler (MDI) with a large-volume spacer and a jet nebulizer (NEB) in patients with stable chronic obstructive pulmonary disease (COPD). Ten male patients with stable COPD [age: 67.2 ± 3.8 years, forced expiratory volume in 1 s (FEV<sub>1</sub>): 1.56 ± 0.32 liters] were studied in a randomized, double-blind and crossover manner. Each patient received 200 or 1,000 µg salbutamol via an MDI with an InspirEase<sup>TM</sup> spacer, a Rotahaler<sup>TM</sup>, or a DeVilbiss 646<sup>TM</sup> nebulizer (NEB), or matching placebo on 7 separate days. Spirometry was performed before and 15, 30, 60, 90, 120, and 240 min after inhalation. With the 200-µg dose, only DPI produced a small but greater response in maximum FEV<sub>1</sub> and in area under the time-response curve (AUC-FEV<sub>1</sub>) compared with placebo. With the 1,000-µg dose, DPI and MDI produced equally greater improvements in both maximum FEV<sub>1</sub> and AUC–FEV<sub>1</sub> than NEB. An equal bronchodilating effect can be obtained using either DPI or MDI with a spacer device, whereas the NEB was less effective when the same dose was administered.
Repetitive Hemodilution in Chronic Obstructive Pulmonary Disease and Pulmonary Hypertension: Effects on Pulmonary Hemodynamics, Gas Exchange, and Exercise Capacity
Authors: Borst Mathias M. , Leschke Matthias , König Ursula , Worth Heinrich 
Published: April 2003

<i>Background:</i> In cor pulmonale associated with severe chronic obstructive pulmonary disease (COPD), disturbances of pulmonary microcirculation may contribute significantly to hypoxemia, pulmonary hypertension, and exercise intolerance. <i>Objective:</i> It was tested whether reduction of blood viscosity induced by repetitive hemodilution might improve pulmonary hemodynamics and oxygen uptake. <i>Methods:</i> Seven patients with stable COPD (forced expiratory volume in 1 s 33 ± 3 % of predicted, means ± SE) and pulmonary hypertension were phlebotomized 5–6 times over a period of 3 months with substitution of 6% hydroxyethyl starch (molecular weight 40,000). This resulted in a stepwise reduction of the hematocrit from 53.3 ± 2.6 to 45.8 ± 3.1% and a reduction of whole blood viscosity from 9.8 ± 0.6 to 8.8 ± 0.7 mPa × s at a shear rate of 2.0 s<sup>–1</sup>. Before and after the treatment period, patients underwent cardiopulmonary exercise testing and right heart catheterization. <i>Results:</i> Mean pulmonary artery pressure (PA<sub>m</sub>) decreased from 30 ± 3 to 22 ± 2 mm Hg and arterial oxygen partial pressure (Pa<sub>O2</sub>) increased from 63.2 ± 2.2 to 71.8 ± 3.7 mm Hg at rest. During peak exercise, PA<sub>m</sub> decreased from 59 ± 7 to 53 ± 7 mm Hg and Pa<sub>O2</sub> increased from 54.0 ± 5.7 to 63.2 ± 2.4 mm Hg after hemodilution. Peak oxygen consumption rose from 573 ± 84 to 750 ± 59 ml × min<sup>–1</sup>, corresponding to an increase in cardiac index from 4.25 ± 0.5 to 5.88 ± 0.76 liters × min<sup>–1</sup> × m<sup>–2</sup>. Pulmonary vascular resistance fell from 345 ± 53 to 194 ± 32 dyn × s × cm<sup>–5</sup>. The patients’ peak exercise capacity increased from 9.2 ± 2.0 before to 13.5 ± 3.2 kJ at the end of the study (p < 0.05 for all differences, paired t test). <i>Conclusion:</i> The findings suggest that a prolonged improvement of pulmonary microcirculation by reducing blood viscosity may improve pulmonary gas exchange, central hemodynamics, and exercise tolerance in patients with severe COPD and pulmonary hypertension.
Successful Use of Gonadotropin-Releasing Hormone Agonist in a Patient with Pulmonary Endometriosis
Authors: Koizumi Tomonobu , Inagaki Hiroshi , Takabayashi Yasuki , Kubo Keishi 
Published: April 2003

A 26-year-old single female was admitted to hospital with recurrent chest pain, cough and hemoptysis. The symptoms developed 5 months before admission coinciding with menstruation. The disease was diagnosed as pulmonary endometriosis. She was treated with a long-acting gonadotropin-releasing hormone analogue (GnRH agonist; sustained-release leuprolide acetate, 3.75 mg/month, i.m.) for 6 months. She remained asymptomatic for 16 months with regular menstruation even after discontinuing the treatment. This indicates that the initial treatment of pulmonary endometriosis with a GnRH agonist is an acceptable medical alternative, especially in patients with a short duration of the disease from the onset of the chest symptoms.
Geriatric Men at Altitude: Hypoxic Ventilatory Sensitivity and Blood Dopamine Changes
Authors: Serebrovskaya T.V. , Karaban I.N. , Kolesnikova E.E. , Mishunina T.M. , Swanson R.J. , Beloshitsky P.V. , Ilyin V.N. , Krasuk A.N. , Safronova O.S. , Kuzminskaya L.A. 
Published: April 2003

<i>Background:</i> Short-term exposure to high-altitude hypoxia increases hypoxic ventilatory sensitivity (HVS) in healthy humans. Dopamine (DA) is the implicated neurotransmitter in carotid body (CB) chemoreceptor response, and the microenvironmental conditions in CB tissue are comparable to blood. Continuous DA infusion affected ventilation in animals and humans. Age-related oscillations in blood DA levels may influence peripheral chemoreflexes. <i>Objective:</i> Hypoxic ventilatory responses (HVR) relative to blood DA concentration and its precursor, dihydroxyphenylalanine (DOPA) was measured in young and elderly men during short-term altitude adaptation. <i>Methods:</i> Nine elderly climbers (group 1: 61 ± 1.4 years) and 7 young healthy subjects (group 2: 23 ± 2 years) were tested at sea level on day 0, on day 3 after passive transport to 2,200 m, and on day 14 after climbing to 4,200 and 5,642 m. <i>Results:</i> Sea level HVR in group 1 was 47% lower than in group 2, accompanied by higher blood DOPA (300%) and DA (37%) content. Initial DA and DOPA concentrations showed a negative correlation with initial HVR but a positive correlation with age. Passive transport to middle altitude (2,200 m) increased HVS, doubling HVR slopes in groups 1 and 2 and producing increased maximum expired minute ventilation during isocapnic rebreathing (29 and 28%, respectively). Day 3 2,200-meter blood DOPA content decreased by 22% in group 1 and increased by 300% in group 2. DA increased in both groups. <i>Conclusion:</i> The relationship between HVR and the reciprocal DA and DOPA values seen in both groups is associated with age, producing decreased DA receptor sensitivity and enhanced DA reuptake during adaptation to high altitude.
Clinical Features Associated with a Delayed Diagnosis of Cystic Fibrosis
Authors: McCloskey M. , Redmond A.O.B. , Hill A. , Elborn J.S. 
Published: April 2003

<i>Background:</i> The majority of patients with cystic fibrosis (CF) are diagnosed in the first decade of life. In a small number of patients, the diagnosis is not made until later. <i>Objective:</i> In this study, the clinical and genetic features of patients diagnosed after the age of 10 were examined. <i>Methods:</i> All living patients in Northern Ireland diagnosed prior to 1983, when neonatal screening was introduced, were studied. A total of 103 patients were identified of whom 18 were diagnosed after the age of 10. The relationships between late diagnosis and clinical presentation, sputum microbiology, pancreatic sufficiency, nutritional status, genotype and distance from the regional CF centres was determined by multiple regression analysis. <i>Results:</i> All 18 late-diagnosed patients had a sweat (chloride >70 mmol/l). Late diagnosis was significantly related to carriage of the R117H mutation (r<sup>2</sup> = 0.45) and pancreatic sufficiency (r<sup>2</sup> = 0.37). There was a weak relationship with pulmonary function (r<sup>2</sup> = 0.09). <i>Conclusions:</i> In Northern Ireland, late diagnosis in mainly associated with pancreatic function and carriage of the R117H mutation.
Anatomical Structures in the Leksell Pallidotomy Target
Authors: Patil Arun-Angelo , Hahn Francis , Sierra-Rodriguez Jeorge , Traverse John , Wang Stephanie 
Published: April 2003

<b>Objective:</b> Because interruption of pallidal outflow signals by pallidotomy is believed to play an important role in the motor improvement in Parkinson’s disease, the anatomical relationship of the two major pallidofugal tracts, namely the ansa lenticularis (AL) and the fasciculus lenticularis (FL) to the Leksell pallidotomy target (LPT) were studied. <b>Methods:</b> Magnetic resonance (MR) scans of 20 patients with Parkinson’s disease were studied. The scans were obtained in the inversion recovery and fast spin echo sequences and viewed in the reverse video mode. <b>Results:</b> The pallidofugal tracts appeared as bands of high intensity on MR scan. FL was wide and extended from the posterior half of the globus pallidus interna (GPi) medially into the internal capsule. AL was narrow, parallel and posterior to the anterior commissure, parallel to and 3 mm above the optic tract, and just beneath the FL. The part of the FL immediately lateral to the internal capsule overlapped the lateral end of the AL. The center of this overlapping area was termed the ‘operlapping point’ (OP). In all cases, the OP was within the range of LPT. <b>Conclusion:</b> It is concluded that the structures in the LPT are FL and AL; and therefore, this procedure could also be known as ‘fasciculoansatomy’.
Comparison of Actual Pallidotomy Lesion Location with Expected Stereotactic Location
Authors: Tsao KuoJen , Wilkinson Steve , Overman John , Kieltyka Jennifer , Tollefson Travis , Koller William C. , Pahwa Rajesh , Troster Alexander I. , Lyons Kelly E. , Batznitzky Solomon , Wetzel Louis , Gordon Michael A. 
Published: April 2003

Accuracy of pallidotomy lesion placement was assessed by comparing actual lesion locations with expected pallidotomy lesion locations based on stereotaxy. Actual and expected lesions were compared in anteroposterior, dorsoventral and lateral axes. In 22 pallidotomies, actual lesion locations were determined using axial MR images. Expected lesion locations were calculated using a starting point derived from preoperative computerized tomography, displacements from the starting point based on microelectrode-driven electrophysiological refinement, and the trajectory angle of the lesioning tract relative to the anterior-posterior commissural plane. On average, actual lesion locations were found 2.91 ± 2.23 mm posterior, 3.22 ± 2.49 mm ventral, and 0.05 ± 1.80 mm lateral compared to the expected lesion location. Discrepancies between the actual lesion and expected lesion locations may be mostly accounted for by posterior and ventral lesion spread from the exposed electrode tip, in-plane and volume averaging effects associated with MR images, and possible brain shifting during surgery. However, despite the remaining small differences between actual and expected lesion location, good clinical outcome of reduced dyskinesias and ‘off’ time along with UPDRS-based improvement in mentation, motor and activity of daily living measures was observed.
Interactive Image-Guided Surgery System with High-Performance Computing Capabilities on Low-Cost Workstations: A Prototype
Authors: Roldan P. , Barcia-Salorio J.L. , Talamantes F. , Alcañiz M. , Grau V. , Monserrat C. , Juan C. 
Published: April 2003

We present a new frameless stereotatic system prototype that has been initially validated in functional neurosurgery operations and that makes use of an optical position tracker for image-guided neurosurgery. Several devices for tracking different surgical instruments have been designed and manufactured. These devices include an array of infrared light-emitting diodes that are tracked by three charge-coupled device cameras. The system presents several new approaches for surgery planning. For high-quality 3D images of the patient’s anatomy, we have developed a parallel version of a volume-rendering algorithm, thus enabling real-time 3D anatomy manipulation on low-cost PC workstations. In order to test the accuracy of the system, the localization of the target by means of a stereotatic frame has been compared with frameless techniques, obtaining a difference of about 1 ± 1 mm.
Transurethral Ureterolithotomy in 100 Lower Ureteral Stones
Authors: Hamano Satoshi , Tanaka Masashi , Suzuki Noriyuki , Shiomi Kou , Igarashi Tatzuo , Murakami Shino 
Published: April 2003

A total of 100 patients with lower ureter stones received transurethral ureterolithotripsy (TUL) using a pulsed dye laser and/or a pneumatic lithotriptor. Extracorporeal shock wave lithotripsy treatment was added in 15 patients because fragments larger than 4 mm had been pushed back to the renal pelvis. The median stone size was 8 mm (range 3–22 mm). Operative time ranged between 3 and 157 min with a median of 30 min. Stone size correlated well with impaction, when impaction was defined as the inability of a guidewire to pass over the stone. Complete removal was defined as total clearance at 1 month without retreatment. The overal stone-free rate was 93%. Among the 7 not-stone-free cases, 5 cases were considered to have been treated successfully because asymptomatic residual fragments were smaller than 4 mm, 1 case required retreatment to become stone free, and 1 case with a silent residual fragment of 8 mm had been followed up for 3 months. The success rate was 98% when successful treatment was defined as total clearance or the presence of asymptomatic residual fragments of 4 mm or less without retreatment. Impaction was not a significant determining factor of stone-free rate (95.7 and 86.7%, respectively, p >0.05) and in situ stone-free rate (TUL alone; 85.7 and 76.7%, respectively, p >0.05). Two minor ureteral perforations were encountered. No patient required percutaneous nephrostomy or open surgery, or showed any late complications. TUL is a safe and successful method in managing lower ureteral stones.
Biphasic Action of Phenylephrine on the Ca<sup>2+</sup>-Activated K<sup>+</sup> Channel of Human Prostatic Smooth Muscle Cells
Authors: Kurokawa Yasushi , Kojima Keiji , Kagawa Susumu , Minami Kazushi , Nakaya Yutaka 
Published: April 2003

The elevation of cytosolic Ca<sup>2+</sup> ([Ca<sup>2+</sup>]<sub>i</sub>) is known to regulate smooth muscle contractility. A physiological concentration of phenylephrine induced the elevation in [Ca<sup>2+</sup>]<sub>i</sub> of human prostatic smooth muscle cells; however, contraction of prostatic tissues in vitro needs a higher concentration of phenylephrine than the physiological level. To investigate this discrepancy, we investigated the functional importance of the Ca<sup>2+</sup>-activated K<sup>+</sup> channel (K<sub>Ca</sub> channel) of human prostatic smooth muscle cells in phenylephrine-induced contraction. Using the patch-clamp technique, the K<sub>Ca</sub> channel of human prostatic smooth muscle cells was activated by phenylephrine at a physiological concentration (10<sup>–7</sup>–10<sup>–5</sup> <i>M</i>) but was inhibited at a higher concentration (10<sup>–4</sup>–10<sup>–3</sup> <i>M</i>). Phenylephrine (10<sup>–3</sup> <i>M</i>) also inhibited the K<sub>Ca</sub> channel which was activated by 10 µ<i>M</i> A23187, a calcium ionophore. Similar inhibition was obtained with 1 µ<i>M</i> phorbol 12-myristate 13-acetate, an activator of protein kinase C (C-kinase). Both inhibitions were reversed by subsequent application of 1 n<i>M</i> staurosporine, a protein kinase inhibitor. These results suggested that C-kinase mediated the phenylephrine-induced inhibition of the K<sub>Ca</sub> channel. In this study, a physiological concentration of phenylephrine induced activation of the K<sub>Ca</sub> channel of human prostatic smooth muscle cells, which brought about membrane hyperpolarization and relaxation of human prostatic smooth muscle cells. The regulation of the K<sub>Ca</sub> channel by phenylephrine may explain the need of a high concentration of phenylephrine for the contraction of prostatic tissue.
Absorption of Epirubicin Instilled Intravesically Immediately after Transurethral Resection of Superficial Bladder Cancer
Authors: Tsushima Tomoyasu , Miyaji Yoshiyuki , Noda Masatoshi , Nasu Yasutomo , Kumon Hiromi , Ohmori Hiroyuki 
Published: April 2003

As postoperative adjuvant therapy for superficial bladder cancer, intravesical instillation therapy is commonly conducted. In this case, from the view point of prevention of intraoperative dissemination, commencement of instillation therapy at an early postoperative period is preferred. However, increased drug permeability is suspected because of damage to the bladder mucosa during operation. Therefore, this study was conducted to investigate the plasma level of epirubicin (EPI) instilled immediately after transurethral operation. EPI (20 mg/40 ml or 50 mg/100 ml) was instilled immediately after a transurethral operation, and retained in the bladder for 1 h. Blood samples were obtained before instillation, as well as 30, 60, 120 and 240 min after instillation, and EPI levels were assayed. The mean EPI concentrations (ng/ml) among the 20-mg/40 ml group (n = 5) were <2.5 and <2.0 at 30 and 60 min, respectively, after which they were undetectable. The 50-mg/100 ml group (n = 5) recorded 5.0, 4.4 and <3.0 after 30, 60 and 120 min, respectively, and after 240 min it was undetectable. Intravesical instillation of EPI immediately after a transurethral operation causes a small increase in the plasma level and it is thought to cause small systemic side effects.
Enhanced External Counterpulsation as a New Treatment Modality for Patients with Erectile Dysfunction
Authors: Froschermaier S.E. , Werner D. , Leike S. , Schneider M. , Waltenberger J. , Daniel W.G. , Wirth M.P. 
Published: April 2003

Enhanced external counterpulsation (EECP) is a noninvasive treatment modality which can increase arterial blood flow in peripheral and coronary arterial disease. Several studies have demonstrated an increase in the flow of the internal iliacal artery and in carotid and renal perfusion during EECP treatment. We investigated the effect of EECP in patients with erectile dysfunction (ED). Thirteen patients were treated with EECP for 20 days, 1 h per day. Patients reported a significant improvement of penile rigidity after completion of the EECP treatment and a significant improvement of penile peak systolic flow was measured by Doppler sonography. No adverse effects were observed. In conclusion, EECP seems to be an effective treatment modality in patients with ED.