bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparison of methods of repairing the symphysis pubis in bladder exstrophy by tensile testing
Authors: SUSSMAN J.S. , SPONSELLER P.D. , GEARHART J.P. , VALDEVIT A.D.C. , KIER‐YORK J. , CHAO E.Y.S. 
Published: November 2003

Objective To compare the efficacy of several fixation techniques in the reconstruction of diastasis of the symphysis pubis in bladder exstrophy.Materials and methods The symphyses of 32 pelves removed from piglets about 1 month old were disrupted and repaired using one of eight methods. After repair, each pelvis was tested biomechanically for load‐to‐failure, stiffness and energy‐to‐failure. The various repair techniques were compared with one another and to a group of six pelves tested intact.Results Four of the methods tested, including a #2 nylon suture placed through bone in a horizontal mattress arrangement, several loops of #2 nylon suture tied around the pubes, Mersilene tape tied around the pubes, and Mitek G‐II suture anchors placed into the superior pubic rami, showed the highest stiffness and load‐to‐failure. All methods were very weak compared with the intact symphysis; the best load‐to‐failure (#2 nylon horizontal mattress suture) was less than half of that for intact bone, and the best stiffness (mersilene tape) was less than one‐third that for the intact symphysis.Conclusion The repairs varied greatly in the variables tested and those which are most promising merit further investigation to assess methods of improving their performance.
The role of free prostate‐specific antigen in the diagnosis of prostate cancer
Authors: AKDAS A. , CEVIK I. , TARCAN T. , TURKERI L. , DALAMAN G. , EMERK K. 
Published: November 2003

Objective To determine whether the free/total prostate‐specific antigen (PSA) ratio can discriminate between patients with prostate cancer or benign prostatic hyperplasia (BPH).Patients and methods A prospective study was conducted using free and total PSA assays in patients who underwent transrectal‐ultrasound guided biopsies indicated by a total serum PSA level of >4 ng/mL and/or a positive digital rectal examination. Sixty‐nine men (median age 68 years, range 57–86) who presented to our out‐patient department with symptoms of prostatism were included in the study. Blood samples were drawn from all patients before biopsy.Results Histopathological examination detected prostate cancer in 17 of 69 (25%) patients and 13 of these 17 patients had a free/total PSA ratio of <0.15; only 12 of 52 (23%) patients with BPH had a ratio of <0.15. Receiver operating characteristic analysis indicated a threshold free/total PSA ratio of ≤0.15 was the optimum discriminatory level. In the whole study group, this threshold had sensitivity, specificity, positive‐ and negative‐predictive values of 76%, 77%, 52% and 91%, respectively. There were 40 patients with serum PSA levels of 4–10 ng/mL and 17.5% (7/40) of these were diagnosed with cancer. Using a free/total PSA ratio of 0.15 would have failed to diagnose two patients of seven with prostate cancer but 30 patients would have avoided a biopsy. In this subgroup, the threshold ratio of 0.15 had sensitivity, specificity, positive‐ and negative‐predictive values of 71%, 85%, 50% and 93%, respectively. The rates for a PSA density (PSAD) at a threshold of ≥0.15 were 71%, 76%, 38%, 93%, respectively.Conclusion These results indicate that using the free/total PSA ratio gives a significant improvement over PSAD and total PSA values alone in the diagnosis of prostate cancer; its use may also enhance the diagnostic accuracy in patients with intermediate PSA levels.
Which indwelling urethral catheters resist encrustation by Proteus mirabilis biofilms?
Authors: MORRIS N.S. , STICKLER D.J. , WINTERS C. 
Published: November 2003

Objective To test the resistance of currently available types of indwelling urethral catheters to blockage by encrustation with mineralized Proteus mirabilis biofilms.Materials and methods Encrustation was studied in a simple laboratory model of the catheterized bladder. Artificial urine was supplied to the bladder chamber at 0.5 mL/min. The bladder urine was inoculated with a clinical strain of P. mirabilis that had been isolated from an encrusted catheter. The models were operated until the catheters blocked and atomic absorption spectrometry was used to assess the amounts of calcium and magnesium deposited on the catheters. Scanning electron microscopy was also used to locate and assess the degree of encrustation.Results The mean times to blockage ranged from 21 h for the Bard hydrogel/silver‐coated latex catheter to 56 h for the Eschmann Folatex S all‐silicone catheter. The calcium and magnesium salts were mainly deposited on the 10 cm below the eye‐holes of the catheters, complete blockage generally occurring in the 2 cm immediately below the eye‐hole.Conclusion None of the 18 types of catheter tested, including those coated with hydrogel or silver, were capable of resisting encrustation by P. mirabilis biofilm.
High‐energy transurethral microwave thermotherapy for large severely obstructing prostates and the use of biodegradable stents to avoid catheterization after treatment
Authors: DAHLSTRAND C. , GRUNDTMAN S. , PETTERSSON S. 
Published: November 2003

Objective To assess the use of high‐energy transurethral microwave thermotherapy (TUMT) for large severely obstructing benign prostatic hyperplasia (BPH) and to compare the use of a biodegradable stent with that of a urethral Foley catheter after TUMT.Patients and methods The study comprised 30 men (mean age 71 years, range 49–82) scheduled for prostatectomy for symptomatic BPH. Pre‐operative investigations included the measurement of urinary free flow rate, residual urine volume (ultrasonographically), a digital rectal examination, transrectal ultrasonography, a symptom score, cystoscopy, cystometry and pressure‐flow. The obstruction was graded according to the Schäfer nomogram. The patients were treated using the Prostatron (EDAP‐Technomed, France) TUMT system; the software used provided a maximum power of 70 W. Patients were catheterized after treatment with either a Foley catheter or a biodegradable stent. After 3 months, the measurements and obstruction grading were repeated, and the effect of the stent assessed.Results In the entire group, the mean (sd) free flow increased from 7.7 (2.4) to 14.0 (3.3) mL/s, the residual urine decreased from 125 (86) to 23 (25) mL and the symptom score decreased from 16 (8) to 5 (4). The mean (sd) degree of obstruction decreased from 81.0 (16) to 62.6 (15). The biodegradable stent completely avoided post‐treatment retention.Conclusion High‐energy TUMT can be used on large severely obstructing prostates with major subjective and objective improvements. The biodegradable stent is useful in relieving the problems of catheterization after treatment.
Vesico‐ureteric reflux in adult patients with spinal injury
Authors: FOLEY S.J. , MCFARLANE J.P. , SHAH P.J.R. 
Published: November 2003

Objectives To review the incidence, aetiology, treatment and prognosis of vesico‐ureteric reflux (VUR) in patients in a regional spinal injuries centre.Patients and methodsA retrospective review of radiological investigations revealed 34 of 447 (8%) patients with VUR on at least one study. The notes of these patients were examined to determine their management and outcome.ResultsMost patients developed VUR within 4 years of injury; the underlying intravesical pressure was high in half the patients studied. Patients were managed aggressively with a variety of medical and surgical techniques. The VUR of 15 patients resolved completely and in three patients there was some improvement. Renal function deteriorated in three patients as assessed by isotopic scanning. Two patients were transferred to our unit in end‐stage renal failure associated with VUR and died within one year.ConclusionsVUR continues to be a problem in patients with spinal injury and remains potentially fatal through the effects of high transmitted pressure and infection. Renal failure does not always develop as a consequence of the combination of VUR and high intravesical pressure. No single aetiological factor for VUR was found. With active early treatment, the incidence of VUR can be minimized and long‐term complications avoided.
Comparison of tamsulosin with alfuzosin in the treatment of patients with lower urinary tract symptoms suggestive of bladder outlet obstruction (symptomatic benign prostatic hyperplasia)
Authors: BUZELIN J.M. , FONTEYNE E. , KONTTURI M. , WITJES W.P.J. , KHAN for the European Tamsulosin Study Group (see appendix) A. 
Published: November 2003

Objective To compare the efficacy and tolerability of the &agr;1A‐subtype selective drug tamsulosin with the non‐subtype‐selective agent alfuzosin in the treatment of patients with lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO), often termed symptomatic benign prostatic hyperplasia (BPH).Patients and methods The study comprised 256 patients with benign prostatic enlargement and LUTS suggestive of BOO (symptomatic BPH) who received tamsulosin 0.4 mg once daily or alfuzosin 2.5 mg three times daily during 12 weeks of treatment. The response was assessed by measurements of maximum urinary flow rate (Qmax ), a symptom score (Boyarsky) and blood pressure at regular intervals.Results Tamsulosin and alfuzosin produced comparable improvements in Qmax and total Boyarsky symptom score. Both treatments were well tolerated with respect to adverse events. Tamsulosin had no statistically significant effect on blood pressure compared with baseline but alfuzosin induced a significant reduction in both standing and supine blood pressure, compared with baseline (P<0.05).Conclusion Tamsulosin is the first adrenoceptor antagonist that is selective for the &agr;1A‐subtype; this specificity may explain its lack of effect on blood pressure compared with alfuzosin, an agent that is not receptor subtype specific. Moreover, this finding may partly explain why tamsulosin, in contrast to other currently available &agr;1‐adrenoceptor antagonists, can be administered without dose titration. Another advantage compared with alfuzosin (and prazosin) is the once‐daily dosing regimen of tamsulosin.
Effects of isoniazid on the proliferation and cytokine production of bladder cancer cells in vitro induced by bacille Calmette‐Guérin
Authors: BEVERS R.F.M. , DE BOER E.C. , KURTH K‐H. , SCHAMHART D.H.J. 
Published: November 2003

Objective To determine the effects of isoniazid (isonicotinic acid hydrazide), used to reduce the serious side‐effects of immunotherapy of superficial bladder cancer with bacille Calmette‐Guérin (BCG), on the proliferation and constitutive BCG‐induced synthesis of interleukins 6 (IL6) and 8 (IL8) in human bladder cancer cells cultured in vitro.Materials and methods Three poorly differentiated human cell lines, T24, TCC‐SUP and BT‐B, were used to study the effect of isoniazid on cell proliferation. Cells were inoculated in tissue culture plates and various concentrations of isoniazid added to the medium. Cell density was then monitored for up to 6 days using a colorimetric assay. To determine the effects of isoniazid on constitutive and BCG‐induced cytokine synthesis, cells were cultured in medium containing no additions, BCG, isoniazid or BCG with isoniazid, at various concentrations. Samples of medium were collected regularly for 6 h and the cytokine content (IL6 and IL8) determined using enzyme‐linked immunosorbent assays.Results Continuous incubation of proliferating T24, TCC‐SUP and BT‐B cells with isoniazid at concentrations of 0–100 μg/mL did not affect the rate of proliferation. Unlike TCC‐SUP and BT‐B cells, T24 cells released more IL6 and IL8 during incubation with BCG. At 6 h after the addition of BCG, the cumulative mean (sd) IL6 and IL8 production of T24 cells was 2.6 (0.1) and 2.3 (0.4) ng per 3×105 cells, compared with a constitutive level of 0.1 (0.0) and 1.3 (0.2) ng, respectively. There was no significant effect of isoniazid (1–100 μg/mL) on either the constitutive or BCG‐induced synthesis of IL6 and IL8 in T24 cells.Conclusion Assuming an essential role of (tumour) epithelial cells in the local immune response induced by BCG, these in vitro results suggest that the administration of isoniazid does not interfere with this part of the mechanism by which BCG operates.
Carcinoma of the penis — appraisal of a modified tumour‐staging system
Authors: HEYNS C.F. , VAN VOLLENHOVEN P. , STEENKAMP J.W. , ALLEN F.J. , VAN VELDEN D.J.J. 
Published: November 2003

Objective To evaluate variables for the prediction of lymph node metastases in carcinoma of the penis, using a recently proposed modified tumour‐staging system that combines the histological degree of differentiation and extent of local invasion of the primary tumour.Patients and methods Thirty‐five patients with squamous carcinoma of the penis and histo‐ or cytological staging of the inguinal lymph nodes were reviewed. A clinical TNM staging system was used in which the size (diameter) of the primary tumour and the clinical extent of invasion were considered. Subsequently, the tumours were also staged according to a modified T‐system in which the histological degree of differentiation and pathological extent of tumour invasion were combined.Results Penectomy was performed in 34 patients (partial amputation in 20 and radical penectomy in 17). Inguinal lymphadenectomy was performed in 31 patients and in four the presence of lymph node metastases was confirmed by aspiration cytology. Using the clinical TNM staging system, lymph node metastases were histo‐ or cytologically present in no patients with T1, in five of 19 with T2, in 10 of 13 with T3 and in both patients with T4 tumours. Lymph node metastases were present in two of eight patients without clinically palpable inguinal nodes, in three of 14 with nodes clinically thought to be infective and in 11 of 12 nodes clinically considered to be malignant. Lymph node metastases were present in five of 17 patients with grade 1, in nine of 13 with grade 2 and in three of five with grade 3 tumours. Using the modified histological T‐staging system (T1=grade 1–2, invasive through dermis; T2=any grade, invasion of corpus spongiosum or cavernosum; T3=any grade, invasion of urethra; T4=grade 3, regardless of invasion) lymph node metastases were present in one of nine patients with T1, in eight of 16 with T2, in all five with T3 and in three of five with T4 tumours.Conclusion The modified T‐staging system, which combines histological differentiation with pathological extent of invasion, provided the best predictive distinction between T1 and T2–4 tumours, indicating that lymphadenectomy can be avoided in T1 tumours, but should be performed in all patients with T2–4 tumours. We recommend bilateral inguinal lymphadenectomy 6–8 weeks after penectomy in such patients.
Transition zone ratio and prostate‐specific antigen density as predictors of the response of benign prostatic hypertrophy to alpha blocker and anti‐androgen therapy
Authors: KURITA Y. , MASUDA H. , SUZUKI K. , FUJITA K. , KAWABE K. 
Published: November 2003

Objective To determine whether transrectal ultrasonography (TRUS) can predict the clinical response of patients with benign prostatic hypertrophy (BPH) to α1‐blocker and anti‐androgen therapy.Patients and methods From April 1994 to July 1995, 128 patients with BPH were randomized to treatment for 6 months with either tamsulosin (a long‐acting selective α1‐blocker) or allylestrenol (an anti‐androgen), with 64 patients receiving tamsulosin (0.2 mg/day) and 64 receiving allylestrenol (50 mg/day). The results of TRUS, uroflowmetry and the American Urologic Association (AUA) symptom score were compared before and after treatment. TRUS was used to calculate the transition zone (TZ) volume, transition zone ratio (TZ ratio=TZ volume/total prostate volume), total prostate volume and prostate‐specific antigen density (PSAD).Results Both groups showed a statistically significant improvement in the AUA symptom score, quality‐of‐life (QOL) score and peak urinary flow rate (Qmax ) at 6 months (P<0.001). In the tamsulosin group, there was a significant negative correlation between the pretreatment PSAD and the percentage change in Qmax (r=−0.640, P<0.001), while there was a positive correlation between PSAD and the percentage change in the AUA symptom score (r=0.589, P<0.001). On the other hand, the allylestrenol group showed a significant positive correlation between PSAD and the percentage change in Qmax (r=0.397, P<0.01) and a negative correlation between PSAD and the AUA symptom score (r=−0.313, P<0.01).Conclusion Patients with a high pretreatment PSAD responded well to anti‐androgen therapy, while those with a low PSAD responded better to α1‐blocker therapy.
Prognostic relevance of intracaval neoplastic extension for patients with renal cell cancer
Authors: KUCZYK M.A. , BOKEMEYER C. , KÖHN G. , STIEF C.G. , MACHTENS S. , TRUSS M. , HÖFNER K. , JONAS U. 
Published: November 2003

Objective To assess the diagnosis of vena caval thrombosis (VCT) in patients with renal cell carcinoma (RCC) as an independent indicator of prognostic importance and when combined with additional tumour characteristics in a controlled multivariate analysis.Patients and methods The clinical course of 53 patients (41 men and 12 women, mean age 60 years, range 35–79) with RCC and VCT was compared with that of a control group of 47 patients (37 men and 10 women, mean age 57 years, range 32–76) with RCC but no neoplastic extension into the vena cava.Results With a follow‐up of 1–154 months and a mean long‐term survival of 32 and 35 months, respectively, for patients with and without VCT, neither the propagation of the tumour into the vena cava (P=0.391) nor the cranial extension of the thrombosis (P=0.158) were identified as having any prognostic value during univariate or multivariate statistical analysis. The presence of regional lymph node (P<0.001) or distant metastases (P=0.009) was an independent prognostic variable for patients with RCC, with a significant decrease in long‐term survival (13 and 14 months for patients with lymph node and distant metastases, respectively).Conclusion A radical surgical approach is essential as standard therapy for the treatment of patients with RCC and neoplastic extension into the vena cava. Because they have a significantly decreased life expectancy, asymptomatic patients with lymph node or distant metastases should be treated conservatively.
Predictive value of serum immunosuppressive acidic protein for staging renal cell carcinoma: comparison with other tumour markers
Authors: MASUDA H. , KURITA Y. , SUZUKI K. , FUJITA K. , ASO Y. 
Published: November 2003

Objective To examine the usefulness of serum immunosuppressive acidic protein (IAP) as a predictor for staging renal cell carcinoma (RCC), using receiver‐operator characteristic (ROC) analysis, and to compare IAP with other tumour markers.Patients and methods From September 1983 to December 1995, serum IAP was measured in 133 untreated patients with RCC (mean age 60.1 years, sd 11.4, range 31–84). The erythrocyte sedimentation rate (ESR), the levels of fibrinogen, C‐reactive protein (CRP), and α2‐globulin were also measured. To compare these markers as predictors of local involvement of the renal capsule, lymph node and distant metastasis, the area under the corresponding ROC curve was calculated. Tumour size at the time of resection was added in this analysis for comparison with the levels of these tumour markers.Results The final pathological stage was T1 or T2 in 101 patients and T3 or T4 in 32, while it was N0 in 122 patients, N1–3 in seven, M0 in 114 patients and M1 in 19. The area of the ROC curve for tumour size was greatest (0.843) for staging of the local extent (T1/T2 versus T3/T4) and that for IAP was 0.714, similar to the values for fibrinogen, ESR and CRP. For predicting lymph node metastasis, IAP and fibrinogen were the most important (0.864). However, IAP alone (0.894) was the most important predictor of distant metastasis. Using an IAP threshold of 600 μg/mL gave a high sensitivity and specificity for detecting lymph node and distant metastasis.Conclusion IAP is a valuable predictor of lymph node and distant metastasis in patients with RCC, although it is inferior to tumour size in predicting local involvement of the renal capsule. The appropriate threshold value of IAP for detecting lymph node and distant metastasis is 600 μg/mL.
Further experience with the periurethral expander:
Authors: LIMA S.V.C. , ARAÚJO L.A.P. , VILAR F.O. 
Published: November 2003

Objective To determine the long‐term effects of the periurethral expander, a new device for the treatment of urinary incontinence in children.Patients and methods Twenty‐five patients (mean age 11.2 years, range 3–22) had a periurethral expander implanted around the bladder neck within the last 41 months. Twelve of these patients had neurogenic bladders as a result of myelomeningocele, 12 had undergone unsuccessful exstrophy reconstructions and one had megalourethra. Bladder augmentations were carried out in 23 of the patients. The mean follow‐up was 23 months.Results Ten patients had the device removed due to erosion and/or infection; patients with exstrophy were more susceptible to complications. Patients with neurogenic bladders use clean intermittent catheterization and the remainder void spontaneously. The mean pressure in the cuff was 58.7 cmH2O.Conclusion The periurethral expander seems to be a valid option in the treatment of selected cases of urinary incontinence in children and young adults. There were more complications in patients with exstrophy/epispadias and such patients must be considered unsuitable for this treatment.
The role of cigarette smoking in prostatic enlargement
Authors: KÜPELi B. , SOYGÜR T. , AYDOS K. , ÖZDiLER E. , KÜPELi S. 
Published: November 2003

Objective To investigate the association between cigarette smoking and sex hormone concentrations in men with benign prostatic hyperplasia (BPH) and thus provide some understanding of the underlying mechanism of the effects of cigarette smoking on prostatic enlargement.Patients and methodsThe association between cigarette smoking and prostatic volume was investigated in 68 men with BPH (mean age 59 years, range 52–74) by assessing changes in serum levels of oestradiol, testosterone, dihydroepiandrosterone (DHEA) and dihydro‐epiandrosterone sulphate (DHEA‐S). Possible enzymatic mechanisms in the prostate gland that might be affected by cigarette smoking were assessed.ResultsThe mean prostate volume was greater in non‐smokers than smokers. Current cigarette smokers had significantly higher mean serum oestradiol levels than did the non‐smokers (33.8 and 26.7 pg/mL, respectively, P< 0.01). Cigarette smoking was inversely but not significantly related to testosterone level. These differences persisted after adjusting for body mass index. There was no significant difference in serum DHEA and DHEA‐S levels between smokers and non‐smokers. There was a weak correlation between the degree of prostatic enlargement, the presence of obstructive symptoms and urinary flow rates.ConclusionThese results indicate that cigarette smoking may affect the size of the enlarging prostate, but through indirect effects of smoking on factors provoking the development of BPH.