bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of the local control in lymph‐node staged localized prostate cancer treated by external beam radiotherapy, assessed by digital rectal examination, serum prostate‐specific antigen and biopsy
Authors: BORGHEDE G. , ALDENBORG F. , WURZINGER E. , JOHANSSON K.‐A. , HEDELIN H. 
Published: November 2003

Objective To describe local disease control after radical external beam radiotherapy of prostatic carcinoma, as judged by digital rectal examination (DRE), transrectal ultrasonography (TRUS)‐guided biopsies and estimates of serum prostate‐specific antigen (PSA).Patients and methods The study comprised 175 patients (mean age 67.5 years, range 49–82; >90% aged ≥60 years) with localized prostatic carcinoma (T1‐T3C, N0, M0) who underwent external beam radiation therapy (70 Gy), and were then regularly followed with a DRE, measurements of serum PSA and TRUS‐guided biopsies to determine the outcome.Results The DRE revealed four patients with evidence of residual cancer in the prostate and biopsies showed no evidence of residual cancer in 131 (75%) of the patients. There was no correlation of residual cancer with tumour stage or grade but tumour size, as estimated by TRUS, correlated with the results of the biopsy. The nadir serum PSA level was ≤1.0 ng/mL in 116 (66%) of the patients, of whom 76 (43%) had a nadir serum PSA level of ≤0.5 ng/mL. The median time to the nadir level was 11 months. Serum PSA progression (>4.0 ng/mL) at the latest PSA measurement after reaching the nadir occurred in 13% of the patients with a nadir PSA of ≤0.5 ng/mL and in 25 of the 29 (86%) patients with a nadir serum PSA >2.0 ng/mL. Cox regression analysis showed that tumour size and rectal irradiation dose were the most important factors for local control.Conclusions Radiotherapy is effective in achieving local control in small prostate cancer tumours but less effective in large tumours. Tumour size and dorsal extension of the irradiated target, the rectal dose, were the two important factors for local control. A serum PSA level of ≤1.0 ng/mL was associated with a higher chance of prolonged disease control.
Immunohistochemical detection of sialosyl‐Tn antigen in carcinoma of the prostate
Authors: KUWABARA H. , UDA H. , TAKENAKA I. 
Published: November 2003

Objective To investigate the expression of sialosyl‐Tn antigen (STn) in human benign and malignant prostate.Materials and methods The expression of STn was investigated immunohistochemically in formalin‐fixed and paraffin‐embedded tissue specimens from 56 patients with primary prostatic adenocarcinoma (median age 74.3 years, range 47–89) and 20 patients with benign prostatic hyperplasia (median age 73.4 years, range 60–87).Results STn was expressed in only three (4%) of the 20 hyperplastic glands and the benign areas adjacent to the 54 carcinomas; by contrast, STn was expressed in 34 (61%) of the 56 carcinomas. The frequency of STn positivity was much higher in well‐differentiated carcinomas than in those poorly differentiated.Conclusion STn is expressed with malignant transformation of the prostatic epithelial cells and immunohistochemical methods using commercially available STn monoclonal antibody may be useful as an adjunct for distinguishing carcinoma from benign tissue.
The biodegradable self‐reinforced poly‐dl‐lactic acid spiral stent compared with a suprapubic catheter in the treatment of post‐operative urinary retention after visual laser ablation of the prostate
Authors: PÉTAS A. , TALJA M. , TAMMELA T.L.J. , TAARI K. , VÄLIMAA T. , TÖRMÄLÄ P. 
Published: November 2003

Objective To evaluate the efficacy and safety of a biodegradable self‐reinforced poly‐dl‐lactic acid (SR‐PLA) spiral stent compared with a suprapubic catheter after visual laser ablation of the prostate (VLAP) in a randomized study.Patients and methods The study comprised 45 patients (mean age 67.6 years, range 52–81) with bladder outlet obstruction caused by benign prostatic hyperplasia who received either a SR‐PLA stent (22 patients) and a suprapubic catheter, or a suprapubic catheter only (23 patients) after undergoing VLAP. The suprapubic catheter was removed when voiding started. The response to VLAP and the effect of the stent or catheter were assessed using symptom scores, peak flow rate (Qmax ), post‐void residual volume (PVR), stent degradation, infection and outcome.Results Voiding started on the first or second day after treatment in 18 (median one day) of 22 patients with a spiral stent and in eight (median 6 days) of 23 patients with only the suprapubic catheter. The mean degradation time of the SR‐PLA stent was 6 months; spiral fragments were found in the prostatic urethra or the urinary bladder in 20 of the patients on cystoscopy. Improvements in patient‐weighted symptom score, mean Qmax and PVR were significant in both groups at the 6 month follow‐up. The infection rate increased with the duration of suprapubic catheterization, from 25% (0–3 days) to 44% (>3 days). Stones were seen in two stented patients during the follow‐up.Conclusion The SR‐PLA spiral stent is safe and effective for the treatment of post‐operative urinary retention after laser therapy. The degradation time of the stent was unnecessarily long compared with the duration of prostatic swelling and tissue sloughing after laser therapy. The infection rate depends on the duration of suprapubic catheterization.
Comparison of polidocanol and tetracycline in the sclerotherapy of testicular hydrocele and epididymal cyst
Authors: DÆHLIN L. , TØNDER B. , KAPSTAD L. 
Published: November 2003

Objective To compare the effects and side‐effects of polidocanol and tetracycline when used as sclerosants for testicular hydrocele and epididymal cyst.Patients and methods Forty‐five men (median age 67 years, range 42–81) with 46 hydroceles or epididymal cysts were assessed. After puncture and aspiration, the empty sac was instilled with either polidocanol or tetracycline, assigned randomly. Patients recorded any treatment‐associated pain on a visual analogue scale.Results At 9 months of follow‐up, nine of 17 men were cured after sclerotherapy with polidocanol compared with 17 of 20 men treated with tetracycline (P<0.05). Tetracycline produced some pain for 3 days after treatment while polidocanol therapy was almost pain‐free. Re‐instillation should be considered for recurrences. At the follow‐up after 35 months, 16 of 18 men treated with polidocanol and 20 of 22 men treated with tetracycline were satisfied with the outcome.Conclusion Both polidocanol and tetracycline are useful sclerosants for treating testicular hydrocele and epididymal cyst. We prefer polidocanol as a first choice in older patients because there were few short‐term side‐effects.
Extraperitoneal laparoscopic dismembered fibrin‐glued pyeloplasty: medium‐term results
Authors: EDEN C.G. , SULTANA S.R. , MURRAY K.H.A. , CARRUTHERS R.K. 
Published: November 2003

Objective To assess the feasibility and results of performing retroperitoneoscopic dismembered fibrin‐glued pyeloplasty in a clinical series of patients with pelvi‐ureteric junction (PUJ) obstruction.Patients and methods A balloon‐dissecting four‐port extraperitoneal laparoscopic approach was used in each of nine patients (aged 21–60 years) to dismember the PUJ over a previously placed double‐pigtail stent, insert stay sutures to appose the urothelium and complete the pelvi‐ureteric anastomosis using fibrin glue. Anastomoses were assessed by diuresis renography 3 months after surgery and at yearly intervals thereafter.Results Eight of the nine attempted procedures were completed successfully in a median (range) operating time of 180 (150–230) min. The median (range) post‐operative parenteral opiate requirement was 0 (0–80) mg morphine sulphate and the post‐operative hospitalization was 2 (2–4) nights. A shortened fibrotic ureter prevented the laparoscopic completion of the second case, which was converted to an open procedure. Follow‐up imaging after 1–2 years showed satisfactory upper tract drainage in those cases completed successfully. One patient developed a renal pelvic calculus that was treated by extracorporeal shock wave lithotripsy.Conclusion This technique is associated with a significantly shorter operating time than historical laparoscopic controls, and with a significantly lower post‐operative opiate analgesic requirement and shorter post‐operative hospitalization than in a contemporaneous series of patients undergoing open pyeloplasty. However, longer term follow‐up is needed to fully assess the performance of these anastomoses.
Urinary continence after radical retropubic prostatectomy. Analysis and synthesis of contributing factors: a unified concept
Authors: KAYE K.W. , CREED K.E. , WILSON G.J. , D’ANTUONO M. , DAWKINS H.J.S. 
Published: November 2003

Objective To assess the effects of three types of apical dissection on urinary continence after radical retropubic prostatectomy and to evaluate possible contributing factors, e.g. preservation of the bladder neck and preprostatic sphincter, age, anastomotic strictures, previous transurethral resection and nerve‐sparing surgery.Patients and methods Having undergone one of three types of apical dissection, 280 patients were evaluated: in Group 1 (sphincter‐damaging) 134 patients underwent the original technique of ligating and transecting the venous complex; in Group 2 (sphincter‐repairing), 76 patients had the venous complex with part of striated sphincter incorporated within anastomotic suture(s); and in Group 3 (sphincter‐preserving), 70 patients had the venous complex alone ligated using the ‘bunching’ technique of Myers. The outcome was analysed for the number becoming continent and the time to continence.Results Continence was achieved in 93% overall, with 90%, 93% and 99% achieving continence in Groups 1, 2 and 3, respectively. The mean time to continence was 68 days overall, taking 100, 52 and 30 days for the respective groups. Twenty patients (7%) did not achieve full continence; 15 had minor incontinence and five severe, with none of the latter being in Group 3. The group (preservation of external sphincter), age and freedom from development of anastomotic strictures were the most important factors both in regaining continence and decreasing the time to continence.Conclusions Preservation of as much as possible of the normal anatomy of the sphincter mechanisms and their nerve supplies results in an excellent return to continence after radical retropubic prostatectomy.
Bone metabolism following bladder substitution with the ileal urethral Kock reservoir
Authors: Poulsen A.L. , Overgaard K. , Steven K. 
Published: November 2003

Objectives To assess bone metabolism following bladder substitution with the ileal Kock reservoir. Patients, subjects and methods The investigation comprised two separate studies, one with baseline measurements before and after surgery, and the second after surgery only, of bone mass, made using single‐photon absorptiometry and dual‐energy X‐ray absorptiometry, biochemical variables of bone turnover, plasma analyses and measurements of renal calcium and phosphate excretion. After inclusion, both groups of patients were observed longitudinally for 2 years. The post‐surgery study included 25 patients who had undergone bladder substitution (median age 67 years, range 44–75), with a median post‐operative follow‐up of 1.0 year (range 0.3–3.7), and 16 control subjects (either healthy or with other minor urological complaints; median age 62 years, range 34–80), and the pre‐surgery study comprised seven patients who had undergone bladder substitution (median age 57 years, range 42–68). Results Total body, forearm and spinal bone mineral contents were similar in patients with an ileal bladder substitute measured 1 year after surgery and in control subjects. There were equivalent significant changes in both the patients and control subjects during the 2‐year observation period, with a 2–3% decrease in total body and forearm bone mineral content. The values were similar in patients with and without a mild metabolic acidosis. Plasma calcium, phosphate, total alkaline phosphatase, intact parathyroid hormone, vitamin D and osteocalcin were normal in both patients and control subjects. Renal excretion of calcium and phosphate was also similar in patients and in control subjects. Conclusions Ileal urethral Kock bladder substitution does not lead to accelerated bone mineral loss in elderly men, despite a mild metabolic acidosis in half of the patients.
A dose‐ranging study of the efficacy and safety of tamsulosin, the first prostate‐selective &agr;1A‐adrenoceptor antagonist*, in patients with benign prostatic obstruction
Authors: ABRAMS P. , SPEAKMAN M. , STOTT M. , ARKELL D. , POCOCK R. 
Published: November 2003

Objective To evaluate the efficacy and safety in a dose‐ranging study of tamsulosin (once‐daily) as a modified‐release formulation compared with placebo in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic obstruction (BPO), and to establish the optimum dosage for phase III clinical studies.Patients and methods Of 169 patients with LUTS associated with BPO enrolled in a 3 week placebo run‐in period, 126 were subsequently randomized to receive placebo (28), or 0.2 mg (35), 0.4 mg (30), or 0.6 mg (33) of tamsulosin once daily for 4 weeks. Free‐flow and pressure‐flow measurements, and modified Boyarsky symptom scores were used to determine efficacy. Safety was evaluated by monitoring adverse events and vital signs (including 8 h after the first dose), and by laboratory determinations.Results Tamsulosin 0.4 mg and 0.6 mg produced significantly greater improvements in maximum urinary flow rate (Qmax ) (2.2 mL/s, 22.6%, and 1.8 mL/s, 20.2%, respectively) than did placebo (−0.1 mL/s, −0.9%). The results from the pressure‐flow studies confirmed the results for Qmax in the free flow studies, with optimum and significant effects for tamsulosin 0.4 mg. This also applied for detrusor pressure at maximum flow, which decreased by 26.6 cmH2O (−28.2%) on 0.4 mg tamsulosin whereas it increased by 4.9 cm H2O (5.7%) on placebo. The greatest reductions in total symptom score were obtained with tamsulosin 0.4 mg and 0.6 mg (4.1, −28.7%, and 4.4 points, −28.2%, respectively) compared with reductions of 3.4 (−20.1%) in the tamsulosin (0.2 mg) and 2.9 points (−17.7%) in the placebo groups. The difference in effects on total symptom score between treatment groups was not statistically significant, which can be attributed to the small sample size. Tamsulosin was well tolerated; at least one adverse event was reported by 29%, 23%, 27% and 36% of patients in the placebo and tamsulosin 0.2 mg, 0.4 mg and 0.6 mg groups, respectively. There were no apparent tamsulosin dose‐dependent changes in vital signs from baseline to the end of 4 weeks of randomized treatment. Tamsulosin caused no statistically significantly greater changes in blood pressure than placebo during the initial 8 h after the first dose. There were no clinically significant changes in laboratory variables.Conclusion Tamsulosin is well tolerated and effective in improving urinary flow and relieving LUTS associated with BPO. Optimal effects are achieved with tamsulosin 0.4 mg administered once daily.
Retrograde embolization and causes of failure in the primary treatment of varicocele
Authors: FENELEY M.R. , PAL M.K. , NOCKLER I.B. , HENDRY W.F. 
Published: November 2003

Objective To assess retrograde embolization for the treatment of varicocele and to examine the causes of surgical and radiological treatment failure.Patients and methods Of 154 patients with clinical varicocele associated with subfertility or symptoms who were treated, 100 underwent surgical high ligation, retrograde embolization under fluoroscopic control was attempted in 84 and 30 had both forms of treatment. Venographic findings were defined in those patients for whom embolization proved impossible and in those in whom prior high ligation had failed. Among subfertile patients, 64 had semen analyses before and at least 3 months after the procedure available for comparison. Those patients undergoing both radiological and surgical procedures were sent questionnaires to evaluate their experience.Results Retrograde embolization was technically successful in 68 (81%) of the 84 patients. Two early failures were associated with venous spasm provoked by technical inexperience, while difficulties in the remainder were caused by anomalous venous anatomy. In patients who had recurrent varicocele after previous ligation, venography showed incomplete ligation of collateral channels; 14 of 18 patients were successfully re‐treated by embolization. The sperm concentration improved significantly in 83% of patients undergoing embolization and in 63% of those surgically ligated. Patients who underwent both procedures expressed a strong preference for embolization.Conclusion In centres where there is a skilled interventional radiologist, embolization is an effective alternative to surgical ligation of varicocele. Carried out under local anaesthesia as an out‐patient procedure, it is cost‐effective, associated with minimal morbidity and most patients are able to return to normal daily activities immediately.
Flow cytometric analysis of tumour‐infiltrating lymphocytes in patients with renal cell carcinoma
Authors: KOWALCZYK D. , SKORUPSKI W. , KWIAS Z. , NOWAK J. 
Published: November 2003

Objective To determine the immunophenotype of tumour‐infiltrating lymphocytes (TIL) and peripheral blood lymphocytes (PBL) isolated from patients with renal cell carcinoma (RCC) and to analyse the correlations between the quantity of analysed cell subsets and the progression of the disease.Patients and methods PBL and TIL samples were obtained from 23 patients with RCC at different stages of disease. The immunophenotype of PBL and TIL was measured, and the TNM stage, tumour size, cellular type, histological grade, lymphocytic infiltration and performance status assessed.Results The predominant mononuclear cells infiltrating the tumour, in all patients, were T lymphocytes (CD3+ median 66.9%, CD8+ median 34.6%, CD4+ median 26.7%). The cells possessing gamma/delta type T cell receptor accounted for a small fraction of the T cells in PBL and TIL (median 5.6% and 3.7%). Tumour‐infiltrating T lymphocytes had a significantly higher percentage of cells expressing human leucocyte antigen (HLA) DR (median 30.9%) and CD25 (median 6.2%) antigens than the equivalent populations in peripheral blood from the same patient group (P<0.001). The degree of T cell activation appeared to negatively correlate with the tumour stage (K=–0.3, P=0.04). The percentage of natural killer (NK) cells among TIL (median 15.4%) did not reflect the value in PBL. The percentage of B cells in TIL was slightly lower than in PBL and accounted for 5.0% of cells. There was no relationship between the degree of lymphocytic infiltration and either tumour stage or grade but there appeared to be a positive correlation between the intensity of lymphocytic infiltration and the percentage of CD4+ cells in TIL (K=0.5, P=0.001). Moreover, the composition of TIL depended on tumour grade, which positively correlated with the percentage of CD8+ cells (K=0.4, P=0.005) and negatively with the percentage of NK cells (K=−0.5, P=0.005). There was an inverse correlation with the percentage of gamma/delta T cells in PBL and the TIL concentration (K=−0.3, P<0.05).Conclusions The TIL immunophenotype is different from PBL and is influenced by the histological grade of the tumour. The activation of TIL and its relationship with tumour progression suggests that they might be sensitized and activated by tumour cells.
Morphometric studies of intra‐prostatic volume relationships in localized prostatic cancer
Authors: HÄGGMAN M. , NORDIN B. , MATTSON S. , BUSCH C. 
Published: November 2003

Objectives To further characterize patterns of tumour growth and the distribution of markers for the aggressiveness of prostate cancer by assessing the relationships among the volume of the ‘index’ tumour and that of the remaining foci, with pathological (pT) stage, histological grade and DNA ploidy, and with the amount of low‐ and high‐grade prostatic intraepithelial neoplasia (PIN).Materials and methods Eighty‐eight step‐sectioned total prostatectomy specimens were analysed. The Gleason score, tumour stage and DNA ploidy (by flow cytometry) of multiple samples were determined. Tumour and PIN areas were outlined and their volumes estimated by computerized planimetry.Results The pT stage, Gleason sum and DNA non‐diploidy increased, and PIN volumes decreased, with increasing volume of the index tumour focus (P<0.01), but did not differ significantly between uni‐and multifocal tumours. However, PIN volumes were significantly larger in multifocal cases with an index tumour volume of >3 mL than in unifocal tumours >3 mL (P<0.05). Small volume, unifocal tumours had little PIN. The most malignant features of each case were always represented in the index tumour but not generally in the remaining foci.Conclusions The volume distribution, related to multicentricity and its concomitant PIN volumes, indicates that large index tumours, uni‐ or multifocal, of medium or high grade, are associated with low PIN volumes. However, multifocal medium‐ and high‐grade tumours with small index tumour volumes have higher PIN volumes. Small, single tumours are of low‐grade and may represent the slowly progressing cancers possibly resembling those found in autopsy studies.
A single‐centre observational study of surgery and late malignant events after chemotherapy for germ cell cancer
Authors: RAVI R. , OLIVER R.T.D. , ONG J. , BADENOCH D.F. , FOWLER C.G. , PARIS A.M.I. , HENDRY W.F. 
Published: November 2003

Objective To review the impact of surgical staging after treatment on the late malignant events in an unselected group of patients treated with chemotherapy for germ cell cancer of the testis over the last 16 years.Patients and methods The study comprised 256 patients treated between 1978 and 1994 who were reviewed for late relapse and development of second germ cell and non‐germ cell cancer.Results At diagnosis, 142 patients had clinical stage 2, 30 stage 3 and 84 stage 4 disease; 57 patients relapsed within 20 months of treatment, while late germ‐cell cancer relapses (≥24 months after treatment) occurred in six patients. Of patients relapsing early or late, 42% and 33%, respectively, received surgery after treatment. Only two of those relapsing late remain progression‐free with further treatment. Four patients developed germ cell cancer in the contralateral testis, while six developed second non‐germ cell cancers.Conclusion Late events occurred in 6.2% of 256 patients in this series, from 29 to 141 months after treatment. Given that the late relapse rate of six of 256 (2.3%) is less than the incidence of mature teratoma at routine retroperitoneal lymph node dissection, more patients may eventually relapse. These results suggest that there might be a case to evaluate the use of ultrasonographic surveillance of the retroperitoneum and testis at 5, 10 and 20 years, in addition to extending routine surveillance.