bluuebunny/crossref_metadata_2025_split huggingface dataset:
Malignant fibrous histiocytoma of the spermatic cord: A case report
Authors: Uchida Kohsuke , Oda Toshiro , Adachi Hideki , Wakabayashi Junichi , Hisasue Shinichi , Takagi Yoshio 
Published: March 2003

AbstractWe present a case of malignant fibrous histiocytoma of the spermatic cord. An 86‐year‐old man was admitted to the hospital with a right painless scrotal mass. Under the diagnosis of a testicular tumor, right radical orchiectomy was performed. Grossly, the tumor firmly adhered to the spermatic cord. The right testis and epididymis were normal. The histologic diagnosis was malignant fibrous histiocytoma. There was local recurrence 2 months after surgery. The recurrent tumor was resected with the surrounding soft tissue, but the patient died 5 months after the initial operation.
A comparative study of endoscopic trigonoplasty for vesicoureteral reflux in children and in adults
Authors: Okamura Kikuo , Kato Norio , Tsuji Yoshikazu , Ono Yoshinari , Ohshima Shinichi 
Published: March 2003

Background
: Endoscopic trigonoplasty is an experimental therapy for vesicoureteral reflux. We investigated differences in surgical results between children and adults.
Methods
: Endoscopic trigonoplasty was performed on 51 patients and 15 pediatric and 21 adult patients were included in this study. The children accounted for 27 cases of refluxing ureter (grade II, 8; III, 14; IV, 4; V, 1) and the adults for 28 cases (I, 4; II, 18; III, 4; IV, 2). There was a greater proportion of bilateral disease and a higher average degree of reflux in the children’s group.
Results
: We found no significant differences in operative time, complications, analgesics usage, the duration of the indwelling catheter and hospital stay. Our follow up at 3 months showed that the reflux had ceased in 19 of 27 cases (70%) in the children’s group and in 27 of 28 cases (96%) in the adults’ group. The next follow up at 12 months showed that there was no reflux in 16 of 27 cases (59%) in 15 children and in 17 of 23 adult cases (74%). Trigonal splitting caused recurrence of reflux greater than grade II, in two children (13%) affecting four ureters and in three adults (14%) affecting four ureters.
Conclusions
: Endoscopic trigonoplasty has proved to be equally less invasive in children and in adults, but vesicoureteral reflux was less often resolved in children. This suggests that the greater original distance between the ureteral orifices and the greater thickness of the detrusor muscle favor the adult patient. For children, a new surgical concept is needed to increase cessation rate of vesicoureteral reflux.
Conservative treatment of childhood phimosis with topical conjugated equine estrogen ointment
Authors: Yanagisawa Naoko , Baba Katsuyuki , Yamagoe Masanari , Iwamoto Teruaki 
Published: March 2003

Abstract
Purpose
: To assess the application of topical conjugated equine estrogen for the treatment of boys with phimosis.
Methods
: Fifteen boys with phimosis were included in the study. Conjugated equine estrogen (Premarin®) 0.1% ointment was applied on the prepuce once daily. The treatment was continued until the prepuce was fully retractable. The patient was examined each second week up to a maximum treatment of 8 weeks. Retractability and the appearance of the foreskin were graded before and after treatment.
Results
: Thirteen of 15 boys (87%) referred with phimosis were successfully treated with conjugated equine estrogen ointment. An adverse effect of gynecomastia was seen in one boy (7%). Conclusion: Conjugated equine estrogen ointment application for phimosis may be an alternative to surgery.
Calcium supplement necessary to correct hypocalcemia after total parathyroidectomy for renal osteodystrophy
Authors: Nakagawa Masayuki , Emoto Akio , Nasu Nobuyoshi , Hirata Yuji , Sato Fuminori , Li Wenping , Imagawa Masaharu , Nomura Yoshio 
Published: March 2003

Abstract
Background
: Prediction of the extent of calcium supplement will facilitate safe and efficient management of hypocalcemia in the early postoperative stage of total parathyroidectomy with autotransplantation (PTXa) in patients with renal osteodystrophy.
Methods
: The correlation between the extent of calcium deficiency, estimated by the amount of calcium supplement over 48 h after PTXa and using various parameters such as carboxy terminal parathyroid hormone (c‐PTH), intact PTH (i‐PTH), alkaline phosphatase (ALP), serum calcium, serum phosphorus, duration of hemodialysis, total weight of resected parathyroid glands and degree of subperiosteal resorption of the middle phalanx was examined in 49 patients who underwent PTX with subcutaneous autotransplantation. Bone mineral density (BMD) was also determined before, 3 months and 1 year after PTXa with dual energy X‐ray absorptiometry (DEXA) in 13 patients.
Results
: There was a positive correlation between pre‐operative i‐PTH level (r = 0.56, P < 0.0005) or ALP level (r = 0.50, P < 0.0005) and the amount of calcium supplement over 48 h after PTXa in these patients. Furthermore, the degree of subperiosteal resorption, determined by Jensen’s classification, was significantly correlated with the amount of calcium supplement after PTX (P < 0.05). Bone mineral density 3 months after (P < 0.0005) and 1 year after PTXa (P < 0.001) significantly increased compared with BMD before PTXa in all patients examined.
Conclusion
: These findings suggest that the pre‐operative determination of i‐PTH, ALP levels and degree of subperiosteal resorption allow the management of hypocalcemia safely and efficiently in renal osteodystrophy patients after PTXa.
Microsurgical epididymovasostomy
Authors: Matsuda Tadashi 
Published: March 2003

AbstractEpididymal obstruction is found in about 30% of obstructive azoospermic patients. Half of these obstructions are due to unknown etiologies, followed by obstruction due to epididymitis. The development of a specific, mucosa‐to‐mucosa anastomosis of the epididymal tubule to the vasal mucosa using a surgical microscopy has greatly improved the outcome of epididymovasostomy. The patency and natural pregnancy rates in this study were 79% and 38%, respectively. Side‐to‐end anastomosis also decreases the technical difficulty in comparison to the end‐to‐end anastomosis procedure. An anastomosis at the epididymal caput generally results in a poorer outcome than at the corpus or cauda epididymis.
Oral estramustine phosphate and oral etoposide for the treatment of hormone‐refractory prostate cancer
Authors: Sumiyoshi Yoshiteru , Hashine Katsuyoshi , Nakatsuzi Hironori , Yamashita Yokihiko , Karashima Takashi 
Published: March 2003

Abstract
Background
: The purpose of the present study was to evaluate the antitumor activity and toxicity of oral estramustine phosphate (EMP) in combination with oral etoposide in patients with hormone‐refractory prostate cancer.
Methods
: Twenty patients with adenocarcinoma of the prostate that progressed after one or more regimens of androgen‐deprivation therapy were enrolled into this trial. Oral EMP was administered twice daily, for a total daily dose of 560 mg, and oral etoposide (50 mg/bodyweight per day) was given on days 1–21 and was stopped on days 22–35. Treatment was continued until evidence of disease progression appeared or two consecutive rises in the prostate‐specific antigen (PSA) value were observed.
Results
: Ten of 20 patients showed a decrease of 50% or greater in the PSA value from initially elevated PSA levels after therapy. The median progression‐free duration and 2 year cause‐specific survival rate of these 10 patients were 208 days (range 71–693 days) and 67.5%, respectively. There were no significant differences in age, pretreatment PSA value, duration from initial treatment to relapse, prior therapy or survival between patients who had a decrease of 50% or greater in PSA values after this combination therapy and those who did not. The main toxicities (≥ grade 2) were anemia, leukocytopenia, thrombocytopenia, gastrointestinal and hepatic disorders, which occurred in 40, 15, 10, 15 and 5% of patients, respectively.
Conclusions
: The combination of oral EMP and etoposide is considered to be a well‐tolerated outpatient treatment regimen for patients with hormone‐refractory prostate cancer and the therapy deserves further investigation.
Urological management of cloacal anomalies
Authors: Shimada Kenji , Hosokawa Syozo , Matsumoto Fumi , Johnin Kazuyosi , Naitoh Yasuyuki , Harada Yasunori 
Published: March 2003

AbstractBackground:A cloacal anomaly results from incomplete urorectal division and is frequently associated with genitourinary abnormalities. Experience of the urological reconstruction of this entity is reported.Methods:Nine girls with cloacal malformation have been treated at the Osaka Medical Center in the past 9 years. Seven patients were detected by prenatal ultrasonography as having: megacystis (two patients); hydronephrosis (two patients); or hydrometrocolpos (three patients). Two patients underwent prenatal shunt placement between the enlarged bladder and the amniotic space.Results:For neonatal urinary diversion, four patients received cystostomy. Six of seven patients with associated hydrocolpos required intermittent catheterization to decompress an enlarged vagina. Vesicoureteral reflux was detected in 12 ureters of seven patients. Antireflux surgery was indicated in four patients before definitive repair. Definitive reconstruction was performed on eight patients. The posterior sagittal approach was used in all patients. Vaginal reconstruction was done utilizing a perineal skin flap (one patient), a tubularized vaginal flap (three patients), distal rectum (three patients) and total urogenital mobilization (one patient). Postoperatively, urethrovaginal fistula was created in one patient and complete occlusion was seen in one patient.Conclusion:The anatomical variety of this entity determines the management options from in utero. It involves not only the creation of three perineal orifices, but also a continent, catheterizable urethra under the stabilization of renal function. Accomplishment of the definitive repair requires the combined expertise of experienced pediatric surgeons and pediatric urologists.
Chrono and clinical pharmacokinetic study of tacrolimus in continuous intravenous administration
Authors: Satoh Shigeru , Tada Hitoshi , Tachiki Yutaka , Tsuchiya Norihiko , Shimoda Naotake , Akao Toshiya , Sato Kazunari , Habuchi Tomonori , Suzuki Toshio , Kato Tetsuro 
Published: March 2003

Abstract Background: The circadian variation of clinical pharmacokinetics of tacrolimus in kidney transplant recipients receiving continuous intravenous administration has not been clarified. The aim of this study was to evaluate the circadian variation of this drug in continuous intravenous administration, with regard to the dosing scheme for conversion from intravenous to oral therapy.Methods: The blood concentration–time curve was studied in 10 living‐related kidney transplant recipients, aged 18–51 years (mean, 36.5 years), 1 day before operation for preoperative oral administration, the third postoperative day for continuous intravenous administration and the sixth postoperative day at the conversion from intravenous to oral therapy.Results: Although the total body clearance of daytime was slightly higher than that of night‐time, the intravenous tacrolimus infusion maintained an adequate therapeutic blood concentration for 24 h. There were significant differences between the preoperative and the postoperative state in the area under the curve, total body clearance and bioavailability for the oral administration. The mean absolute bioavailability was 17.7% in preoperative and 11.1% in postoperative state, respectively and a large interindividual variation was confirmed in this parameter, which was 7.0–27.2% for preoperative and 6.4–22.0% for postoperative area under the curve, respectively.Conclusion: This study proposes that intravenous administration is a safe and appropriate method to achieve the required blood concentration in patients with various tacrolimus metabolism in the early post‐transplant period. As the oral tacrolimus absorption was found to be variable between preoperative and postoperative states in identical patients, the conversion dosage cannot be calculated from preoperative oral or postoperative intravenous pharmacokinetics. Frequent blood concentration monitoring is needed to ensure safe treatment.
M1 prostate cancer with a serum level of prostate‐specific antigen less than 10 ng/mL
Authors: Yamamoto Shinya , Ito Takaaki , Akiyama Akihito , Aizawa Taku , Miki Makoto , Tachibana Masaaki 
Published: March 2003

Abstract Background: M1 prostate cancer, which is invasive, is usually associated with a serum level of prostate‐specific antigen (PSA) greater than 10 ng/mL, but cases are occurring where the serum PSA level is less than this. The present study investigated the clinical and pathologic characteristics of these cases of M1 prostate cancer.Methods:Between April 1989 and March 1998, 167 cases of M1 prostate cancer were diagnosed by transrectal needle biopsy and eight of these with a serum PSA level less than 10 ng/mL were investigated. The patients' ages ranged from 57 to 79 years (median, 73) and the serum PSA levels ranged from less than 4.0 to 9.8 ng/mL. In all cases except one, the distal metastasis was to bones only. All cases had received hormonal therapy as the initial therapy. Immunostaining of PSA, chromogranin A, neuron‐specific enolase, carcinoembryonic antigen and vimentin were performed in five of the eight cases.Results:Four cases were poorly differentiated, two were undifferentiated, one was a mixture of poorly differentiated and undifferentiated and one case was moderately differentiated. Of the five cases in the immunohistochemical study, three cases with an undifferentiated carcinoma component showed negative staining reactions for PSA and all cases were positive for carcinoembryonic antigen. Four of the patients died of prostate cancer. In two of these four cases, hormonal therapy was ineffective, but systemic chemotherapy and irradiation therapy had been moderately effective. The overall 3‐year survival rate was 33.3%.Conclusions:The cases of M1 prostate cancer with a serum PSA less than 10 ng/mL are almost always poorly differentiated or undifferentiated and have a poor prognosis compared with the usual M1 prostate cancer. Because hormonal therapy is ineffective in these cases, systemic chemotherapy and irradiation therapy should be chosen as the initial therapy.
New concept parameters of RigiScan in differentiation of vascular erectile dysfunction: Is it a useful test?
Authors: BASAR M MURAT , ATAN ALI , TEKDOGAN ÜMIT Y 
Published: March 2003

Abstract Background: The aim of this study is to investigate the value of new nocturnal penile tumescence recording parameters, such as tumescence activity unit and rigidity activity unit values, total erection number and erection times, in differentiating between psychogenic erectile dysfunction and organic erectile dysfunction. We also aimed to determine the role of these parameters in differentiating arterial erectile dysfunction from veno‐occlusive dysfunction.Methods: Eighty‐seven consecutive patients were allocated into three groups as psychogenic,
arterial and venous erectile dysfunction after investigations. Nocturnal penile tumescence
recording parameters between psychogenic and vascular erectile dysfunction and arterial
and veno‐occlusive dysfunction were compared. Mann–Whitney U‐test,
Pearson's χ2 test and correlation coefficient tests were used for statistical analysis.Results: Depending on intracavernous injection, penile Doppler ultrasonography and cavernosometry tests, 37 patients (43%) had psychogenic impotence while 50 (57%) had organic pathologies. Of the 50 patients diagnosed with vascular impotence, 29 (48%) had arterial failure and 21 (42%) had veno‐occlusive dysfunction.Nocturnal penile tumescence recording revealed psychogenic erectile dysfunction in 34 patients (39%) and vascular erectile dysfunction in 53 patients (61%). Nocturnal penile tumescence recording has been regarded as the gold standard and, in our series, it showed 90.6% sensitivity and 88.2% specificity in differentiating the cause of erectile dysfunction.Values of rigidity activity unit and tumescence activity unit were significantly higher in patients with psychogenic impotence (P < 0.001), when compared
with vascular impotence. In patients with a vascular cause, no difference was found
between arterial failure and veno‐occlusive dysfunction with regard to tip tumescence
activity unit, base tumescence activity unit, tip rigidity activity unit, base rigidity
activity unit and erection time (P > 0.001). However, patients with arterial
failure had less erection than patients with veno‐occlusive dysfunction (P < 0.001).Conclusion: New recording parameters of nocturnal penile tumescence can differentiate organic and psychogenic erectile dysfunction more precisely. However, these recording parameters cannot distinguish subgroups with a vascular cause of erectile dysfunction.
Clinical utility of ursodeoxycholic acid in preventing flutamide‐induced hepatopathy in patients with prostate cancer: A preliminary study
Authors: KOJIMA MUNEKADO , KAMOI KAZUMI , UKIMURA OSAMU , FUJITO AKIRA , NAKAO MASAHIRO , TANAKA SHIGEKI , MIYASHITA HIROAKI , IWAMOTO NORIYUKI , OHE HIROSHI , KITAMORI TOMOHITO , DATE SEIKI , KITAMURA KOJI , ARAKI HIROTAKA , AOKI TADASHI , IMADA NAOKI , TAKADA HITOSHI , IMAIDE YOICHIROH , MIKAMI KAZUYA , UCHIDA MUTSUMI , SAITOH MASAHITO , MIKI TSUNEHARU 
Published: March 2003

AbstractBackground:The present study was designed to ascertain retrospectively the validity of ursodeoxycholic acid (UDCA) in the treatment of prostate cancer in terms of prophylactic effects on the occurrence of flutamide‐induced hepatopathy in a large number of patients surveyed in a multi‐center cooperative study.Methods:One hundred and eighty‐one patients (74.1 ± 4.9 years) with prostate cancer treated with flutamide with (n = 70) or without (n = 111) UDCA were retrospectively evaluated and the occurrence of hepatopathy was compared between these two patient groups.Results:Between patients treated with UDCA and those without it, no significant differences were noted in age, clinical stage, grade, duration of flutamide administration and serum prostate‐specific antigen (PSA) levels before treatment. However, there were significant differences in the presence or absence of previous treatments and treatments used together with flutamide. The incidence of hepatopathy was 11.4% (8/70) in patients with UDCA and 32.4% (36/111) in those without it, showing a statistically significant difference (P < 0.05). The hepatopathy‐free rate obtained by

the Kaplan–Meier method was also significantly higher in patients with UDCA

(88.4% 1 year following flutamide administration) than that in those without

it (59.6%) (P < 0.005).Conclusion:These results suggest that UDCA has a prophylactic effect against flutamide‐induced hepatopathy in patients with prostate cancer.
Fate of tetraplegic patients managed by ileal conduit for urinary control: Long‐term follow‐up
Authors: Kato Haruaki , Hosaka Kyoko , Kobayashi Shinya , Igawa Yasuhiko , Nishizawa Osamu 
Published: March 2003

Abstract
Background:
A study was conducted to evaluate our experience of ileal‐conduit formation in tetraplegic patients with special reference to late complications due to upper urinary tract stones and pyocystis.
Methods:
Ileal‐conduit formation was performed in 16 patients with tetraplegia to improve urinary management. The mean age at operation was 46 years (range 19–70) and the mean follow‐up period was 8.7 years (range 2–17). We evaluated the results retrospectively from patients’ medical records.
Results:
Two patients died 2 years after the procedure and one patient died 8 years after the ileal‐conduit formation. Five patients suffered from repeated renal or ureteral stone. In three of these cases, serious urinary tract infections developed whenever the stone caused an obstruction. Three patients received a cystectomy at the time of the ileal‐conduit formation. Eight patients suffered from empyema of the bladder and in two of these cases a subsequent cystectomy was required.
Conclusions:
Ileal‐conduit formation should be cautiously considered as an option in the urinary management of tetraplegic patients, particularly when more conservative management strategies have proved unsuccessful. However, an antirefluxing mechanism for the ileal conduit may be necessary, and a simultaneous cystectomy may improve the results.
Increased transforming growth factor‐β1 and tubulointerstitial fibrosis in rats with congenital hydronephrosis
Authors: ZHOU YUN , TAKAHASHI GO , SHINAGAWA TOSHIHITO , OKUHARA TOSHINI , YONAMINE KYOKO , AIDA YOSHIO , TADOKORO MAMORU 
Published: March 2003

Abstract Objectives: Most of our knowledge concerning renal obstruction has been derived from experimental animal models, and it is not yet well defined in spontaneous hydronephrosis. The aim of our study is to evaluate the roles of transforming growth factor‐β1 (TGF‐β1) and apoptosis in congenital hydronephrotic kidneys in comparison with experimental models.Methods: We made histological studies on kidneys from 6‐week‐old Wistar‐Imamichi rats with congenital unilateral hydronephrosis as well as surgical models of complete or partial unilateral ureteral obstruction. The severity of hydronephrotic kidneys was evaluated on routine hematoxylin and eosin (H&E) stained sections, and the tubulointerstitial fibrosis analyzed morphometrically on Masson's trichrome stained sections. Renal tubular atrophy was assessed on periodic acid Schiff (PAS) stained sections, and tubular cell apoptosis assessed with TUNEL technique. The renal TGF‐β1 level was determined by a sandwich enzyme‐linked immunosorbent assay (ELISA).Results: We observed a significant loss of kidney weight with profound compensatory growth of the contralateral kidney in rats with congenital hydronephrosis. Most of the hydronephrotic kidneys were markedly enlarged with dilatation of the collecting system, renal parenchymal thinning, tubular atrophy, interstitial infiltration and fibrosis. The renal TGF‐β1 level was markedly elevated in hydronephrotic kidneys as compared with normal controls (326.01 ± 30.64 pg/mg protein vs 227.81 ± 11.07 pg/mg protein, P < 0.01). The tubular apoptotic score in hydronephrotic kidneys was also significantly higher than normal controls (2.17 ± 0.50/HPF [high power field]vs 0.14 ± 0.04/HPF, P < 0.01). The increased TGF‐β1 and apoptotic status paralleled the histological changes of tubulointerstitial fibrosis and tubular atrophy. Similar findings were also obtained in experimental obstructive models.Conclusion: In comparison with surgical models of partial and complete ureteral obstruction, our data provide solid morphological and molecular evidences of renal obstruction in rats with congenital hydronephrosis.