bluuebunny/crossref_metadata_2025_split huggingface dataset:
Why the flexible cystoscope has not yet been widely introduced?: A questionnaire to Japanese urologists
Authors: Yoshimura Rikio , Wada Seiji , Kishimoto Taketoshi 
Published: March 2003

Background
: The flexible cystoscope has not been as widely accepted in the field of urology as in other fields. The results of this investigation provided implications for determining the reasons for the under‐use of flexible cystoscopy as well as for the drawbacks of the flexible cystoscope.
Methods
: We performed an investigation by sending a questionnaire to urologists asking them to compare the flexible cystoscope with the rigid cystoscope in order to determine why use of the former lags behind that of the latter.
Results
: We received answers from 420 urologists. We classified the urologist into four groups according to their years of experience. We also classified patients, for whom flexible cystoscopy was carried out, into four groups. The majority of the urologists in all groups thought that the flexible cystoscope provided a small field of vision and rough images. Urologists thought that the flexible cystoscope was inferior to the rigid cystoscope in terms of manipulability in biopsy. However, doctors who examined many patients using flexible cystoscopy believed that it was advantageous in terms of decreasing the patients’ pain and they have experienced no problem in clinical practice.
Conclusions
: Lack of experience in using the flexible cystoscope appears to be the main reason for the negative impression it generates. The flexible cystoscope can be routinely used in place of the rigid counterpart for urological investigations and it is recommended that it be used more widely for the benefit of the patients.
Metachronous bilateral torsion of the testicular appendices
Authors: Monga Manoj , Scarpero Harriette Miles , Ortenberg Joseph 
Published: March 2003

Background
: Torsion of the appendix testis is a common cause of scrotal pain in children and a common cause for surgical exploration of the pediatric scrotum. The first case of metachronous bilateral torsion of the testicular appendices managed by a non‐operative approach is reported.
Methods/Results
: A case report and a computer‐assisted review of the literature are presented. Physical findings of a tender, mobile mass over the anterior surface of the testis characterize the presentation. Doppler findings of normal blood flow to the testes with increased flow to the adjacent appendix testis can be utilized as an adjunct to diagnosis. Ultrasonographic findings of a pedunculated mass with a central hypoechoic area at the superior aspect of the testis support the diagnosis. Accurate non‐operative diagnosis of torsion of the appendix testis permits successful conservative management with non‐steroidal anti‐inflammatory agents.
Conclusions
: Improvements in ultrasonographic and Doppler imaging of torsion of the appendix testis have facilitated the diagnosis of this entity and decreased the need for surgical exploration of the scrotum.
Modified extravesical ureterocystoneostomy of the kidney transplant allograft with completely duplicated ureters
Authors: Nakatani Tatsuya , Uchida Junji , Kim Taku , Yamamoto Keisuke , Kishomoto Taketoshi 
Published: March 2003

AbstractBackground: The technique of ureterocystoneostomy for completely duplicated ureters has not yet been established. We report on a case of a living‐related transplant recipient who successfully received his mother's kidney having completely duplicated ureters.Methods/Results: The recipient was a 33‐year‐old male patient introduced to hemodialysis due to focal glomerulosclerosis. The donor was his 60‐year‐old mother having left completely duplicated ureters. We adopted the modified extravesical ureterocystoneostomy technique. Postoperative drip infusion pyelography and voiding cystography of the recipient showed no evidence of urinary tract obstruction or vesicoureteral reflux.Conclusions: We conclude that this technique is suitable for the transplantation of the kidney with complete ureteral duplication.
Characteristics of pediatric urolithiasis in south‐east Anatolia
Authors: Ece Aydin , Özdemir Enver , Gürkan Fuat , Dokucu Ali Ihsan , Akdeniz Osman 
Published: March 2003

AbstractBackground: Urolithiasis is endemic in Turkey and characteristics of urolithiasis vary in different regions of the world. The aim of the present study was to evaluate the etiological and clinical characteristics and course of pediatric urolithiasis in south‐east Turkey.Methods: The study population consisted of 81 children (52 girls) with urolithiasis at a mean age of 6.2 ± 4.2 years who were followed up for 1–32 months.Results: Metabolic disorders, anatomical defects and infection stones were found to be the etiological factor in 34.6, 29.6 and 22.2% of patients, respectively, while 13.6% of patients were considered idiopathic. Of all patients, 28.4% were admitted with acute renal failure (ARF) and 72.8% had urinary tract infection. Recurrence was seen in 19.8% of patients at presentation. The localization of the stone was found to be in the upper urinary tract, the lower urinary tract or both in 65.4, 14.8% and 17.3% of patients, respectively. Patients with multiple and bilateral stones had a higher risk for ARF than the others. The risk for chronic renal failure was significantly higher in children with multiple, bilateral or recurrent stones and with ARF at presentation.Conclusions: Early diagnosis and management of renal stones and urinary tract infections is necessary to prevent the development of ARF or chronic renal failure and to improve the quality of a patient’s life.
Pre‐emptive renal transplantation in children
Authors: Harada Hiroshi , Seki Toshimori , Nonomura Katsuya , Chikaraishi Tatsuya , Takeuchi Ichiro , Morita Ken , Usuki Tomoaki , Watarai Yoshihiko , Togashi Masaki , Hirano Tetsuo , Koyanagi Tomohiko 
Published: March 2003

AbstractBackground:Renal transplantation is a definitive therapeutic modality in end‐stage renal disease (ESRD). Most ESRD patients in Japan experience dialysis prior to renal transplantation. The present study was undertaken to examine the usefulness of pre‐emptive renal transplantation (PET).Methods:Between 1987 and 1998, 255 renal transplantations were carried out by the authors. Among those consecutive cases, 10 were cases of PET. In nine pediatric cases, demographics, graft and patient survival, height growth and benefits from successful transplantation were studied and compared with age‐matched dialyzed transplantation controls.Results:All transplantation was living‐related. There was a disparity of causes of ESRD between the two groups. In PET, acquired renal deterioration due to a congenital lower urinary tract disorder was the major cause. Graft and patient prognosis was favorable in both groups. Growth retardation in PET patients under 15 years of age was significantly less apparent at the time of transplantation and after 3 years compared to the control. The benefits from transplantation were different in the two groups. Most PET patients felt an improvement of their physical condition; however, all of the control patients felt that the major boon was the freedom from the restriction of the daily diet and time for dialysis.Conclusion:In pediatric renal transplantation, short‐term preceding dialysis does not have a detrimental effect, but PET could benefit ESRD patients by maintaining their quality of life. Moreover, PET minimizes the production of renal dwarfism in prepubertal children. Thus, PET should be taken into consideration in the choice of renal replacement therapy.
Production of parathyroid hormone‐related protein in two new cell lines of renal cell carcinoma
Authors: Ueno Munehisa , Akita Masumi , Ban Shin‐ichi , Ohigashi Takashi , Yanagita Saori , Iida Masahiro , Deguchi Nobuhiro 
Published: March 2003

Abstract Background: Hypercalcemia is the most common of all paraneoplastic syndromes and has been reported to appear in up to 20% of patients with renal cell carcinoma (RCC). Humoral hypercalcemia of malignancy is believed to be induced when parathyroid hormone‐related protein (PTHrP) is excessively produced in cancer cells and impairs the homeostasis of serum calcium concentrations.Methods: Cancer cells were isolated from a surgical specimen and successfully cultured in a monolayer. The present study describes the establishment and characterization of new cell lines of RCC.Results: Two different cell lines, designated SMRC‐1 and SMRC‐3, were established from human RCC, each of which had been continuously secreting PTHrP in vitro. The patient from whom the SMRC‐3 cells were obtained was shown to have elevated levels of PTHrP and resultant hypercalcemia. Cultured SMRC‐1 was spindle‐shaped in morphology. SMRC‐3 had pleomorphic polygonal shapes and formed typical epithelial monolayers. Both cell types secreted intact, C‐terminal PTHrP and interleukin‐6 in the culture medium. Cellular messenger RNA of PTHrP was analyzed by reverse transcriptase–polymerase chain reaction. The SMRC‐1 cells showed chromosome numbers ranging from 42 to 47 with consistent structural abnormalities of add(4)(q23~25) and add(6)(q13). The chromosomal analysis of SMRC‐3 revealed a modal number of 95 with consistent structural abnormalities of add(1)(p36) and der(1;3)(q10;p10).Conclusions: These cell lines could be good models for investigating the mechanism of PTHrP production and the relationship between this hormone and hypercalcemia.
Comparison of surgical stress between laparoscopy and open surgery in the field of urology by measurement of humoral mediators
Authors: Miyake Hideaki , Kawabata Gaku , Gotoh Akinobu , Fujisawa Masato , Okada Hiroshi , Arakawa Soichi , Kamidono Sadao , Hara Isao 
Published: March 2003

AbstractBackground: Recently, laparoscopic procedures have become more common in urological surgery, and are suggested to be less stressful compared with open surgery; however, little data on objective evaluation of surgical stress after laparoscopic surgery are available. The objective of this study was to compare surgical stress between laparoscopic and open surgery in the field of urology by measurement of humoral mediators.Methods: Blood samples were obtained from 25 patients who underwent laparoscopic surgery (laparoscopic radical prostatectomy, 10; retroperitoneoscopic nephrectomy or nephroureterectomy, seven; laparoscopic adrenalectomy, five; and hand‐assisted laparoscopic radical nephrectomy, three) and 10 who underwent open surgery (retropubic radical prostatectomy, four; radical cystectomy, three; and radical nephrectomy, three), 48 h before surgery, during surgery, and 24, 48 and 96 h after surgery. Serum levels of interleukin (IL)‐6, IL‐10 and granulocytic elastase in these samples were measured, and the results were analyzed with respect to several clinical factors.Results: In both groups, IL‐6 and granulocytic elastase levels increased during surgery and reached maximum levels 24 h after surgery; the increase in granulocytic elastase tended to be prolonged compared with that of IL‐6. Changes in IL‐10 levels in the open surgery group were similar to those of IL‐6 and granulocytic elastase levels, whereas IL‐10 levels in the laparoscopic surgery group reached a maximum level during surgery and then decreased to the same level as at 48 h before surgery, on the first postoperative day. The maximum levels of these three mediators in the laparoscopic surgery group were significantly lower than those in the open surgery group. IL‐6 was closely associated with the interval of fasting and duration of hospitalization after surgery.Conclusion: Although the present study was based on retrospective and non‐randomized analysis, the findings suggest that serum levels of IL‐6, IL‐10 and granulocytic elastase are useful as objective markers of surgical stress, and that laparoscopic surgery is markedly less stressful than open surgery.
Clinical significance of thymidylate synthase expression in bladder cancer
Authors: Nomura Takeo , Nakagawa Masayuki , Fujita Yoshitsugu , Hanada Toshikatsu , Mimata Hiromitsu , Nomura Yoshio 
Published: March 2003

AbstractBackground : The purpose of the present paper was to investigage the clinical significance of thymidylate synthase (TS) expression in bladder cancer and its association with proliferation markers, such as p53, Ki‐67, and proliferating cell nuclear antigen (PCNA).Methods : Thymidylate synthase gene expression in 54 patients with bladder cancer was measured by the reverse transcription polymerase chain reaction (RT‐PCR) method using glyceraldehyde‐3‐phosphate dehydrogenase (GAPDH) as an internal standard. The TS expression was also examined immunohistochemically. Immunohistochemical studies of p53, Ki‐67, and PCNA expression were carried out to examine the correlation between TS expression and the expression of proliferation markers in the tumors. Prognostic and clinical outcome factors such as vascular invasion and distant metastasis were also examined along with TS expression.Results : Twenty‐four patients with invasive bladder cancer had TS levels of 5.07 ± 0.77 (mean ± SE), while 30 patients with superficial bladder cancer had TS levels of 2.28 ± 0.38. There was a significant difference in TS levels between invasive and superficial bladder cancer (P = 0.001). There was a positive correlation between TS expression and each proliferation marker of p53 (r = 0.686, P < 0.01), Ki‐67 (r = 0.715, P < 0.0001) or PCNA expressions (r = 0.670, P < 0.0001) in these patients. Patients with high TS levels (TS ≥ 2.63, the median value) had significantly higher rates of vascular invasion and distant metastasis. Kaplan–Meier analysis demonstrated that patients with high TS levels (TS ≥ 2.63) had unfavorable prognosis compared to patients with low TS levels (TS < 2.63; P = 0.034). Furthermore, patients with high TS staining had a significantly poorer prognosis than those with low staining (P = 0.012).Conclusion : Determination of level of TS expression may help in the selection of an appropriate treatment for bladder cancer because TS expression influences the biological characteristic of bladder tumor.
Surgical management of urinary incontinence in children with anatomical bladder‐outlet anomalies
Authors: SHIMADA KENJI , MATSUMOTO FUMI , TOHDA AKIRA , HARADA YASUNORI , NAITOH YASUYUKI 
Published: March 2003

AbstractBackground: Pediatric urinary incontinence secondary to anatomical anomalies of the bladder outlet is relatively rare, and there is no consensus on its surgical treatment. We reviewed the clinical courses and surgical management of children with this pathology.Methods: From 1991 to 2001, we performed bladder neck reconstruction on seven children (three boys and four girls). The mean age at the first intervention was 7 years (range 5–12 years). The underlying diagnosis was bladder exstrophy in two children, pseudoureterocele‐type ectopic ureter in three, bladder neck incompetence from unknown etiology in one boy with hypospadias, and bilateral single ectopic ureter associated with cloacal malformations in one child. Lower urinary tract was evaluated through various imagings, endoscopy, and urodynamic studies.Results: The methods used to reconstruct the bladder neck was the Young‐Dees‐Leadbetter procedure (performed on four children); the Kropp procedure (two children); and the Pippi‐Salle procedure (one child). Bladder augmentation with intestinal segment was performed on four children; Mitrofanoff continent stoma was created in all patients. Urethral catheterization could not be routinely used in all patients, because of pain, stricture, or complicated urethral anatomy. All patients achieved urinary continence.Conclusion: The treatment of pediatric urinary incontinence from anatomical anomalies is technically challenging. Depending on the underlying disorders and anatomy, one needs to decide which method of reconstruction to perform. It would be safer to employ simultaneous augmentation and to create catheterizable continent stoma.
Extensive bilateral renal pelvis, ureter and bladder leukoplakia
Authors: Gumus Eyup , Yilmaz Banu , Miroglu Cengiz 
Published: March 2003

AbstractWe are presenting a case of leukoplakia spread to the bilateral renal pelvis, ureter and bladder in a 52‐year‐old woman. We believe this case is important because it involves leukoplakia that is more extensive than in any cases previously cited in the literature. No other possible etiologic cause except a heavy smoking habit was defined. Conservative follow‐up was preferred to aggressive surgery.
Urinary oxalic acid excretion differs after oral loading of rats with various oxalate salts
Authors: HOSSAIN RAYHAN ZUBAIR , OGAWA YOSHIHIDE , MOROZUMI MAKOTO , SUGAYA KIMIO , HATANO TADASHI 
Published: March 2003

AbstractBackground: To compare urinary oxalate excretion after the oral administration of oxalic acid, disodium oxalate, or calcium oxalate in rats.Methods: Male Wistar rats were divided into four groups of six rats each and were intravenously hydrated with normal saline, and then were administered normal saline (control group), 10 mg of oxalic acid, equimolar disodium oxalate, or equimolar calcium oxalate via a gastrostomy. Urine specimens were collected just before administration and at hourly intervals up to 5 h afterwards. The urinary oxalate, calcium, magnesium and phosphorus levels were measured.Results: Urinary oxalate excretion peaked at 1–2 h after administration of oxalic acid or equimolar disodium oxalate, while administration of calcium oxalate only caused a small increase of urinary oxalate excretion. Cumulative urinary oxalate excretion during 5 h was 1.69 ± 0.10 mg (mean ± SD; 17%), 1.43 ± 0.13 mg (13%), and 0.22 ± 0.03 mg (2%) after the administration of oxalic acid, disodium oxalate, and calcium oxalate, respectively. Urinary calcium excretion showed a decrease in the oxalic acid and disodium oxalate groups, while urinary magnesium or phosphorus excretion did not change significantly.Conclusion: The upper gastrointestinal tract seems to be the major site of oxalic acid absorption and only free oxalate is absorbed irrespective of whether it is the sodium salt or not. After binding to calcium in the gut, oxalic acid absorption seems to be inhibited in the presence of calcium and this means that calcium oxalate is poorly absorbed (at least in the upper gastrointestinal tract).
Early rheumatoid arthritis: can we predict its outcome?
Authors: Williamson A. A. , McColl G. J. 
Published: March 2003

Abstract The continuing trend towards more aggressive treatment of rheumatoid arthritis (RA) has seen an increasing interest in the early phase of this chronic inflammatory disease. Optimal benefit from present and emerging therapies is limited by our prognostic abilities during this period. The present review attempts to outline first the many methodological issues encountered in studies of early RA, and second the extent to which each major outcome measure can be explained, both by readily available clinical variables and by HLA‐DR genotyping. The evidence supporting the clinical usefulness of genotyping is discussed separately. Based on this information, a clinically appropriate approach to the management of early RA and the identification of patients suitable for experimental therapies is suggested. (Intern Med J 2001; 31: 168–180)
Underuse of beta‐blockers following myocardial infarction: a tale of two cities
Authors: Nicholls S. J. , McElduff P. , Dobson A. J. , Jamrozik K. D. , Hobbs M. S. T. , Leitch J. W. 
Published: March 2003

Abstract Aims: To measure factors associated with underuse of beta‐blocker therapy after myocardial infarction (MI). Methods: The Newcastle and Perth collaborating centres of the World Health Organization (WHO) MONICA project (to MONItor trends and determinants of Cardiovascular disease) systematically evaluated all patients admitted to hospital in their respective regions with possible MI. A total of 1766 patients in Newcastle and 4503 patients in Perth, discharged from hospital after confirmed MI from 1985 to 1993, were studied. Rates of beta‐blocker use before and after hospital discharge were evaluated and correlates of beta‐blocker use determined. Results: Beta‐blocker use was similar in Newcastle and Perth before MI (21% of patients in each centre). During hospital admission, beta‐blocker therapy was initiated nearly twice as frequently in Perth compared with Newcastle (66 vs 36%, respectively) and more patients were discharged from hospital on beta‐blockers in Perth (68%) than in Newcastle (45%). The main factors associated with underuse of beta‐blockers in multivariate analysis were geographical centre (odds ratio (OR) for Newcastle compared with Perth 0.3; 95% confidence interval (CI) 0.3–0.3), a history of previous MI (OR 0.6, 95% CI 0.5–0.7), admission to hospital in earlier years (OR 0.4, 95% CI 0.3–0.4 for years 1985–87 compared with years 1991–93), diabetes (OR 0.6, 95% CI 0.5–0.8) and the concomitant use of diuretics (OR 0.5, 95% CI 0.4–0.6) and calcium antagonists (OR 0.6, 95% CI 0.5–0.8). Conclusions: Underuse of beta‐blockers after MI was strongly related to hospital prescribing patterns and not to community use of beta‐blockers. Underuse occurred in patients with diabetes and in patients with left ventricular dysfunction, patients who stand to benefit most from beta‐blocker use following MI. (Intern Med J 2001; 31: 391–396)
Feasibility study of the early detection and treatment of renal disease by mass screening
Authors: Craig J. C. , Barratt A. , Cumming R. , Irwig L. , Salkeld G. 
Published: March 2003

AbstractAim: To determine whether mass screening for proteinuria may be worthwhile in the detection of early renal disease in Australians.Methods: A feasibility study was conducted using systematic review, meta‐analysis and cost‐effectiveness methods.Results: End‐stage renal disease (ESRD) develops in about 1500 Australians each year. Of these, about 1000 are over 50 years of age (an incidence of about 200 per million, per year). Proteinuria, which is present in about 5% of the general population, confers an approximately 15‐fold increased risk for ESRD. Twelve randomized trials of angiotensin‐converting enzyme inhibitors (ACEi), in 1943 patients with varying degrees of renal impairment, hypertension and proteinuria, showed that the risk of developing ESRD can be reduced by about 30% over a 2‐ to 3‐year period. In a general‐practice‐based screening model involving: (i) an opportunistic single dipstick test for protein, (ii) a confirming 24‐h urine test for protein and (iii) commencement of ACEi in appropriate individuals, 20 000 people over 50 years of age would need to be screened to prevent one case of ESRD. To achieve this, approximately 100 people would need to be treated with ACEi for 2 to 3 years, and 1000 would need to have a 24‐h urine protein test (and of these, 700 would be false positives). Such a strategy may save health dollars but some critical research questions are still unanswered. What is an individual’s risk of developing ESRD, given values for proteinuria, blood pressure and renal function? What is the benefit of ACEi in screen‐detected cases, which are at low risk of ESRD? What psychological and physical harm is caused by screening, including the specific renal investigations and treatments that follow on from proteinuria detection?Conclusions: Given available data, screening middle‐aged and older Australians for proteinuria and treating some with ACEi is, at best, a promising primary prevention strategy for preventing ESRD. However, a large population‐based cohort study, with nested trial of ACEi, is still required to evaluate whether this model of screening for renal disease does more harm than good.(Intern Med J 2002; 32: 6–14)