bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inhibitory effect of calcium phosphate‐associated proteins on calcium oxalate crystallization: α2‐HS‐glycoprotein, prothrombin‐F1 and osteopontin
Authors: Nishio S. , Iseda T. , Takeda H. , Iwata H. , Yokoyama M. 
Published: March 2003

Objective To analyse urinary calcium phosphate‐ associated proteins and assess their inhibitory effects on calcium oxalate crystallization. Materials and methods Urine samples were collected over 24 h from five healthy men and calcium phosphate crystallization induced with NaOH solution. The bound proteins were separated on a cellulose column. To examine the effect of urinary calcium phosphate‐associated proteins on calcium oxalate crystallization, 60 L of urine was collected from the healthy men. The effect of the separated fractions was studied in a mixed suspension/mixed product removal system. Results The separated proteins were identified as α2‐HS‐glycoprotein, prothrombin fragment 1 and osteopontin. Prothrombin fragment 1 and osteopontin strongly inhibited the growth of calcium oxalate crystals in artificial urine. Conclusionα2‐HS‐glycoprotein, prothrombin fragment 1 and osteopontin selectively bound with calcium phosphate crystals in urine. Prothrombin fragment 1 and osteopontin in urine may strongly influence stone formation.
The effect of fasting or desmopressin before treatment on the concentration of mitomycin C during intravesical administration
Authors: Cliff A.M. , Heatherwick B. , Scoble J. , Parr N.J. 
Published: March 2003

Objective To evaluate two methods of reducing the urine output during treatment (the most easily manipulated variable) in patients undergoing intravesical instillation with mitomycin C, where the concentration‐time curve also depends upon dose, diluent volume, residual urine volume, and drug absorption and degradation. Patients and methods The study comprised 20 consecutive patients undergoing a course of six weekly instillations of mitomycin C (40 mg in 40 mL for 1 h) for superficial bladder carcinoma. Urine production during treatment was calculated by adding the voided volume and ultrasonographically measured residual urine after treatment, and subtracting 40 mL; the patient's bladder was emptied before instillation. Before the first and second visit the patients were asked to drink normally. Before the third and fourth visit patients fasted for 6 h before treatment. For the fifth and sixth visit the patients had not fasted, but 200 µg of desmopressin was given orally 1 h before instillation. Any urinary side‐effects were graded on a four‐point scale. Results There were 17 patients with complete data; one patient failed to take desmopressin, one had detrusor instability and one developed chemical cystitis. The mean (
sd) urine production in unprepared patients was 209 (123) mL, which decreased to 143 (80) mL (P = 0.039, t‐test) after fasting and 103 (51) mL (P < 0.001) with desmopressin. This equates to a 20% increase in mean intravesical drug concentration with fasting and a 38% increase with desmopressin. Urinary side‐effects were graded as mild in each group. Conclusion Unprepared patients produce variable and often substantial volumes of urine during intravesical chemotherapy. There was a significant reduction in urine output after fasting or by administering desmopressin before instillation. These measures increase the area under the concentration‐time curve for mitomycin C and potentially increase the efficacy of treatment.
Placebo‐associated remissions in a multicentre, randomized, double‐blind trial of interferon γ‐1b for the treatment of metastatic renal cell carcinoma
Authors: Elhilali M. M. , Gleave M. , Fradet Y. , Davis I. , Venner P. , Saad F. , Klotz L. , Moore R. , Ernst S. , Paton V. ,   Canadian Urologic Oncology Group
Published: March 2003

Objective To determine the validity of using an historical maximum spontaneous regression rate (reportedly 0–1.1% in those with lung metastases after nephrectomy) in clinical trials of treatments for patients with metastatic renal cell carcinoma (RCC), as the eligibility criteria for most studies will select patients with better performance status (and thus excluding those who are unlikely to respond) and more modern staging methods would potentially reduce the number of false‐positives. Patients and methods A multicentre randomized,placebo‐controlled, double‐blind trial was recently completed in which 197 patients with metastatic RCC from 17 study centres across Canada were randomized to receive placebo or recombinant interferonγ‐1b (60 µg/m2) subcutaneously once every 7 days until disease progression. All tumour responses were validated by an independent response committee unaware of the treatment. Results The median (95% confidence interval) overall response rate (complete, CR, and partial, PR) for those on interferon‐γ was 4 (1.4–11.5)% and for those on placebo was 6 (2.5–13.2)% (P = 0.75). In the six patients who were receiving placebo the CR and PR (three each) was considered to represent spontaneous remission. Of these six patients (aged 44–64 years) five had undergone nephrectomy, one a tumour embolization, four had clear cell carcinoma and one an adenocarcinoma, and all had regression of lung and/or lymph node metastases. Conclusion The lack of efficacy of interferon‐γ in this trial underlines the importance of continued research to identify alternative therapeutic agents or combinations of agents in phase II studies. However, the threshold response rate for initiating phase III trials should be increased to 18% in the phase II trials, i.e. three times the response rate on placebo.
An evaluation of Bosniak's radiological classification of cystic renal masses
Authors: Koga S. , Nishikido M. , Inuzuka S. , Sakamoto I. , Hayashi T. , Hayashi K. , Saito Y. , Kanetake H. 
Published: March 2003

Objective To determine the clinical usefulness of Bosniak's classification of cystic renal masses, the differentiation of which remains difficult despite significant advances in diagnostic imaging. Patients and methods The computed tomography (CT) findings of all histopathologically examined cystic renal masses diagnosed at our institution were analysed retrospectively; 35 patients with cystic renal masses were treated between 1986 and 1998. Tissues surgically removed were examined pathologically and the final diagnosis compared with the preoperative CT category of Bosniak's classification. Results The histopathological examined showed cystic renal cell carcinoma in 21 patients, a benign renal cyst in 12, haemangiosarcoma in one and transitional cell carcinoma in one. Most of the 35 masses (26, 74%) were found incidentally during evaluation for an unrelated disease or a routine health check. All 11 masses of Bosniak category I were benign and one category II mass was malignant. All 10 masses of category III and 12 of category IV were malignant. Conclusions Bosniak's classification is useful for differentiating category I, III and IV cystic renal masses. There were too few samples to allow meaningful conclusions to be drawn for category II renal masses. It is critical to differentiate between complicated cysts of category II and III because of the major implications for prognosis and clinical management.
Adjuvant mitozantrone chemotherapy in advanced prostate cancer
Authors: Wang J. , Halford S. , Rigg A. , Roylance R. , Lynch M. , Waxman J. 
Published: March 2003

Objective To assess the role of mitozantrone, active in relapsed prostate cancer, as an adjuvant to hormonal treatment in patients with advanced prostate cancer. Patients and methods Between October 1990 and May 1995, 96 patients were entered into a stratified, randomized, single‐institution study of hormonal therapy with a luteinizing hormone‐releasing hormone agonist and flutamide, with or without four cycles of adjuvant mitozantrone. Of these, 93 patients were evaluable and the results were analysed in June 1999. Results Patients with localized prostate cancer receiving adjuvant chemotherapy had a higher initial objective response rate (95% vs 53%, P = 0.008) and median survival (80 vs 36 months, P = 0.04) than patients who were treated with hormonal therapy alone. There was no advantage to adjuvant chemotherapy in patients with metastatic prostate cancer. There were insignificant advantages to chemotherapy in overall response rates (55% vs 39%, P = 0.3) and PSA responses (82% vs 64%, P = 0.11). There was no difference between the patient groups in time to treatment failure. Conclusion There was a survival advantage in using adjuvant mitozantrone in patients with locally advanced prostate cancer. Although the study comprised relative few patients, the follow‐up period was long and the advantage significant. We recommend that the study be extended to include more patients.
Patient selection before endopyelotomy: can it improve the outcome?
Authors: Keeley F.X. , Tolley D.A. , Moussa S.A. 
Published: March 2003

Objective To compare endopyelotomy and primary reconstructive procedures in patients with pelvi‐ureteric junction (PUJ) obstruction and with risk factors for endopyelotomy failure. Patients and methods Nineteen patients (eight female and 11 male, mean age 34.5 years, range 15–82) underwent endoluminal ultrasonography (US) before treatment for PUJ obstruction; the US findings were used to direct the treatment. Patients with unavoidable crossing vessels, massive hydronephrosis and crossing vessels associated with previous failed endopyelotomy were selected for reconstructive surgery. The clinical results of these patients (group 1) were compared with 12 consecutive patients who had undergone endopyelotomy before the use of endoluminal ultrasonography (group 2). Results Imaging detected 17 crossing vessels in 13 of the 19 patients. Six patients underwent primary reconstructive surgery and 13 underwent endopyelotomy. The endoluminal US findings changed treatment in some way in nine patients. Endopyelotomy was successful in 12 of the 13 patients and reconstructive surgery successful in five of six patients. The success after endopyelotomy improved from eight in 12 patients in group 2 to 12 of 13 in group 1 (P = 0.16, NS). Conclusions Endoluminal US can be used to select patients in whom endopyelotomy is likely to fail. Using primary reconstructive procedures in these patients might improve the overall outcome, but these preliminary findings need to be confirmed in a larger study.
The control of haemolysis during transurethral resection of the prostate when water is used for irrigation: monitoring absorption by the ethanol method
Authors: Hultén J.O. , Tran V.T. , Pettersson G. 
Published: March 2003

Objective To determine whether the addition of ethanol to water for irrigation during transurethral resection of the prostate (TURP) and monitoring breath ethanol could be used to detect irrigant absorption and to limit free plasma haemoglobin in cases of absorption. Patients and methods One hundred patients (46 in Piteå, Sweden and 54 in Uong bi, Vietnam) underwent surgery for benign prostatic hyperplasia (BPH) under an intermittent irrigation technique using water containing 2% ethanol. An expired breath alcohol meter was used to monitor ethanol in the patients' breath every 5 min. Blood samples taken after TURP were assessed for free haemoglobin in 99 patients, and other markers of haemolysis were also evaluated in the Swedish group. Results Thirty‐two patients had detectable ethanol in their breath. There was a close correlation between the maximum ethanol reading during surgery and the level of free plasma haemoglobin after TURP (r = 0.90, P < 0.001). There was no correlation between the duration of TURP and the free haemoglobin level. Conclusion Monitoring breath ethanol during TURP assesses absorption and so can help to keep control of haemolysis. It is suggested that the value on the alcohol meter should not be allowed to exceed 0.15 (corresponding to a blood ethanol level of 0.15‰), which should maintain the free plasma haemoglobin level at < 1.0 g/L after TURP. Restricting the operative duration per se is not a reliable safety measure.
A comparison of radical retropubic with perineal prostatectomy for localized prostate cancer within the Uniformed Services Urology Research Group
Authors: Lance R.S. , Freidrichs P.A. , Kane C. , Powell C.R. , Pulos E. , Moul J.W. , Mcleod D.G. , Cornum R.L. , Brantley Thrasher J. 
Published: March 2003

Objective To review and compare the outcome of patients undergoing radical retropubic prostatectomy (RRP) or radical perineal prostatectomy (RPP) for clinically localized prostate cancer. Patients and methods From 1988 to 1997, 1382 men who were treated by RRP and 316 by RPP were identified from databases of the Uniformed Services Urology Research Group. The following variables were assessed; age, race, prostate‐specific antigen (PSA) level before surgery, clinical stage, biopsy Gleason sum, estimated blood loss (EBL), margin‐positive rate, pathological stage, biochemical recurrence rate, short and long‐term complication rates, impotence and incontinence rates. To eliminate selection bias, the analysis was concentrated on pairs of patients matched by race, preoperative PSA level, clinical stage and biopsy Gleason sum. Results In the 190 matched patients there were no significant differences between the RRP and RPP groups in either organ‐confined (57% vs 55%), margin‐positive (39% vs 43%), or biochemical recurrence rates (12.9% vs 17.6% at a mean follow‐up of 47.1 vs 42.9 months), respectively. The mean EBL was 1575 mL in the RRP group and 802 mL in the RPP group (P < 0.001). The only significant difference in complication rates was a higher incidence of rectal injury in the RPP group (4.9%) than in the RRP group (none, P < 0.05). Conclusions In similar populations of patients, RPP offers equivalent organ‐confined, margin‐positive and biochemical recurrence rates to RRP, while causing significantly less blood loss.
The overactive bladder in children: a potential future indication for tolterodine
Authors: Hjälmås K. , Hellström A‐L. , Mogren K. , Läckgren G. , Stenberg A. 
Published: March 2003

Objective To determine the safety, efficacy and pharmacokinetics of tolterodine in children with an overactive bladder.Patients and methods Thirty‐three children (20 boys and 13 girls, aged 5–10 years) with an overactive bladder and symptoms of urgency, frequency and/or urge incontinence were enrolled in an open, dose‐escalation study. Patients were treated with oral tolterodine 0.5 mg (n = 11), 1 mg (n = 10) or 2 mg (n = 12) twice daily for 14 days. The primary safety endpoint was the change in residual urinary volume, as determined by ultrasonography. In addition, voiding diary variables (frequency and incontinence episodes) and pharmacokinetics were evaluated. Other safety endpoints included laboratory variables, electrocardiogram recordings and reported adverse events.Results There were no safety concerns in terms of the change in residual urinary volume for any of the three dosage groups; values were comparable with baseline after 2 weeks of treatment for all three dosages. Adverse events were reported by 20 patients (six on 0.5 mg, five on 1 mg, and nine on 2 mg). Most adverse events were not considered to be drug‐related; of the 13 possibly related events, 10 occurred in those taking 2 mg. Headache was the most commonly reported adverse event. No serious adverse events were reported and there were no general safety concerns. There was an improvement in voiding diary variables in all treatment groups after 2 weeks of treatment, although the efficacy was greatest in those taking 1 mg and 2 mg. Pharmacokinetic findings were consistent with dose linearity over the range 0.5–2 mg.Conclusion The results support the use of 1 mg twice daily as the optimal dose of tolterodine for treating children aged 5–10 years with an overactive bladder.
Is the vanished testis always a scrotal event?
Authors: Belman A.B. , Rushton H.G. 
Published: March 2003

Objective To determine if perinatal testicular torsion resulting in a vanished testis is an event that primarily occurs in the scrotum.Patients and methods The records of 54 boys identified as having a solitary testis were reviewed. The side of absence, size of the solitary testis, method of surgical evaluation (scrotal, inguinal or abdominal), surgical findings and histology of the tissue removed were noted.Results The testis was absent twice as often on the left side, the solitary testis was hypertrophic in 25 of 42 boys in whom it was evaluated, and tissue grossly or histologically consistent with a testicular ‘nubbin’ was removed in 52 boys. Scrotal (47) or inguinal (seven) exploration was carried out in all. Laparoscopy (28) or abdominal exploration (two) was undertaken to confirm that no testicular tissue was present in the abdomen in 30 boys, including the two in whom no tissue was found on scrotal or inguinal exploration.Conclusions Perinatal testicular torsion occurs after descent but before fixation of the tunica vaginalis to the scrotal wall. These testes atrophy, leaving a remnant of tissue in the scrotum that can be identified on scrotal exploration in almost all cases. Therefore, it is recommended that the evaluation of the child with a solitary palpable testis start with scrotal exploration. Laparoscopy should be reserved for those in whom no tissue consistent with a testicular nubbin is found in the scrotum.
Corporal plication for penile curvature caused by Peyronie's disease: the patients' perspective
Authors: Chahal R. , Gogoi N.K. , Sundaram S.K. , Weston P.M.T. 
Published: March 2003

Objective To determine the acceptability by patients of corporal plication for Peyronie's disease. Patients and methods A postal questionnaire was sent to 69 patients who had undergone corporal plication for Peyronie's disease between 1992 and 1999, to ascertain the subjective outcome and acceptance by the patients and their sexual partners of the results of the procedure. Of the 65 patients who were still alive, 44 (68%) returned the questionnaire. Results The mean (range) follow‐up was 4.1 (0.5–7.25) years and the mean age of the patients 54.6 (32–80) years. Of the 44 patients responding, 24 (55%) were sexually active; after surgery, 16 (36%) had significant impairment of erections, seven (16%) continued to have significant penile discomfort and 15 (34%) could feel nodules at the suture site. Twenty‐five (57%) patients reported a mild and six (14%) a severe persistent penile deformity; 40 (90%) reported having a shorter penis, of whom 22 (55%) thought it significant. Overall, 14 (32%) reported ‘numbness’ of the glans penis. Only 23 (52%) of the patients would recommend the surgery, with 25 (57%) reporting a deterioration in their overall quality of life. Of the partners of the evaluable patients, 38 (86%) responded, and a significant deterioration in sexual performance was reported by 19 (35%). Conclusions Overall, the long‐term results of corporal plication appear to be disappointing. These poor results could be related to a current lack of understanding of the natural history and progression of the disease, to case selection, or to the surgery. We intend to use these results to counsel our patients before such surgery and inform them of the possible outcome in the long term.
Laparoscopic partial upper pole nephrectomy in infants and children
Authors: Horowitz M. , Shah S.M. , Ferzli G. , Syad P.I. , Glassberg K.I. 
Published: March 2003

Objective To retrospectively review 5 years' experience of transperitoneal laparoscopic partial nephrectomy (LPN) in infants and children.Patients and methods Between January 1995 and December 1999, 14 upper‐pole partial nephrectomies (seven right and seven left) were undertaken in 13 children (mean age 3.8 years, range 0.4–14). One patient underwent bilateral upper‐pole LPN. No children required a lower‐pole partial nephrectomy during the study period. Evaluation included renal ultrasonography, voiding cystourethrography, renal scintigraphy and contrast‐enhanced computed tomography in some cases. Three ports (10, 5 and 5 mm) were used in all except two patients, who required an additional 2 mm port for liver retraction. The diseased parenchyma was transected with electrocautery or harmonic scalpel. The distal ureter was simply transected in the absence of reflux, but tied adjacent to the bladder if reflux was present.Results The mean operative duration for LPN was 100 min, with an estimated blood loss of < 30 mL. A liquid diet was tolerated on the first morning after surgery and age‐appropriate regular diet that evening in all except one patient. The mean hospital stay was 2.6 days. One patient had a significant decrease in haematocrit, which was managed conservatively, not requiring transfusion. Follow‐up telephone interviews with the patients' parents showed that all were satisfied with the medical and cosmetic outcome.Conclusion Transperitoneal LPN is preferable to open partial nephrectomy because: (i) The magnification provided by laparoscopy provides excellent vision for the precise dissection of the parenchyma and distal ureter, avoiding injury to the healthy tissue; (ii) There is minimal blood loss, fast recovery and less surgical scarring, and when upper‐pole partial nephrectomy is required, LPN is less damaging to the lower‐pole. Unlike total nephrectomy, where debate remains about open vs laparoscopic methods, the specific advantages of LPN make it clearly preferable.
The modified Koyanagi repair for severe proximal hypospadias
Authors: Hayashi Y. , Kojima Y. , Mizuno K. , Nakane A. , Kohri K. 
Published: March 2003

Objective To report the method and results of a modified one‐stage Koyanagi repair (urethroplasty with a parameatal‐based and fully extended circumferential foreskin flap) to preserve the vascularity to the peripheral portion of the neourethra, in the repair of severe hypospadias. Patients and methods Using a skin‐incision line as in the original Koyanagi repair, a circumferential incision is made ≈ 5 mm proximal to the corona and the urethral plate incised as for repair of chordee. A U‐shaped skin incision is then made surrounding the meatus, extended to the dorsal prepuce for ≈ 8 mm and parallel to the first incision. The tissue between the prepuce and dartos is dissected on the dorsal side to fix the prepuce as a neourethra to the dartos and to maintain blood supply. After mobilizing the loop‐shaped skin flap through the button‐hole of the pedicle, the internal and external sides of the loop are sutured to construct a neourethra. Twenty patients (aged 10 months to 9 years) with severe proximal hypospadias underwent the one‐stage modified Koyanagi repair. Results The repair was successful after the initial procedure in 14 patients, but urethrocutaneous fistulae developed in three and meatal stenosis in three. The overall success rate was thus 70%. Conclusions There were fewer complications than reported with the original Koyanagi repair, suggesting that the attempted vascular preservation of the neourethra was effective.