bluuebunny/crossref_metadata_2025_split huggingface dataset:
The value of multiple core biopsies for predicting the Gleason score of prostate cancer
Authors: Egevad L. , Norlén B.J. , Norberg M. 
Published: March 2003

Objective To evaluate the accuracy of Gleason grading of prostate cancer in multiple core biopsies, compared with the final Gleason score of total prostatectomy specimens, and to investigate whether the prediction of the correct Gleason score is improved by increasing the number of biopsies. Patients and methods Before total prostatectomy, 121 men had a mean (range) of 10.0 (8–14) transrectal ultrasonography (TRUS)‐guided core biopsies taken from the apex, mid‐medial, mid‐lateral and basal regions, from the transition zone and from lesions detected on TRUS. The biopsies and prostatectomy specimens were reviewed and the Gleason scores assessed. Results The preoperative biopsies predicted the prostatectomy Gleason score exactly in 45.5% of the patients and within one Gleason score in 93.4%. The biopsies under‐graded the prostate cancer in 38.8% and over‐graded it in 15.7%. The weighted kappa value for exact agreement was 0.502. If one biopsy was positive for cancer, the prostatectomy Gleason score was predicted correctly in 43.8% and within one score in 93.8%, compared with 53.8% and 92.3%, respectively, if cancer was found in at least seven biopsies. If the mid‐lateral and transition zone biopsies had been excluded from the biopsy protocol, 5% of the cancers would have been undetected. Among the remaining 115 cancers, grading accuracy only improved from 43.5% to 45.2% by adding biopsies to the sextant protocol. Conclusion Despite a statistically significant agreement between biopsy and prostatectomy Gleason score, under‐grading remains a major problem. The prediction of the prostatectomy Gleason score is only marginally improved by increasing the number of biopsies.
α‐catenin expression pattern and DNA image‐analysis cytometry have no additional value over primary histology in clinical stage I nonseminomatous testicular cancer
Authors: Spermon J.R. , De Wilde P.C. , Hanselaar A.G.J.M. , Schaafsma H.E. , Ruijter T.E.G. , Witjes J.A. , Van Moorselaar R.J.A. 
Published: March 2003

Objective To determine whether the α‐catenin expression pattern and DNA content have additional value over primary tumour histology, including information on vascular invasion and tunica albuginea invasion, in detecting occult metastasis in patients with clinical stage I nonseminomatous germ cell tumours of the testis (NSGCT). Patients and methods Fifty consecutive patients with clinical stage I NSGCT underwent retroperitoneal lymphadenectomy (RPLND) between 1986 and 1992. The orchidectomy specimens were histopathologically reviewed and immunohistochemically stained with mouse monoclonal anti‐α‐catenin antibody. The presence of an aberrant or negative staining in >10% of the malignant cells was defined as abnormal; in all other cases tumours were classified as normal. Furthermore, intact nuclei were isolated from 50 µm thick paraffin sections of the primary tumour, Feulgen stained, and analysed with an image‐analysis system. Results Of the 50 patients, 14 had positive retroperitoneal nodes (stage IIa, 28%), one pathologically staged I patient developed a lung metastasis (stage IV) within 3 months of RPLND. Univariate analysis showed that the presence of embryonal cell carcinoma, vascular invasion and tunica albuginea invasion were predictive for occult metastases. In multivariate logistic regression analysis only vascular and tunica albuginea invasion were significant. All 11 patients with no embryonal cell carcinoma in the primary tumour were classified as having pathological stage I disease. Also, the tumours which were DNA‐diploid (three) or DNA‐polyploid (two) were pathologically stage I. In screening for occult metastases the DNA content and the α‐catenin expression pattern had no additional value. Conclusion Vascular and tunica albuginea invasion have prognostic value in identifying patients with clinical stage I NSGCT at high risk for occult retroperitoneal disease. In contrast, the absence of embryonal cell carcinoma could predict all patients at low risk for metastasis. The DNA‐ploidy also identified patients at low risk. Other DNA‐analyses and the α‐catenin expression pattern provided no additional information. Further studies are recommended to identify patients who are at low or high risk for metastasis.
Histological and ultrastructural alterations in an animal model of Peyronie’s disease
Authors: El‐Sakka  , Hassan  , Nunes  , Bhatnagar  , Yen  , Lue  
Published: March 2003

Objective To determine the role of transforming growth factor beta (TGF‐β), one of the cytokines known to induce tissue fibrosis, in the induction of a Peyronie’s‐like condition, and to produce an animal model for the further study of Peyronie’s disease.Materials and methods Twenty‐four adult male Sprague‐Dawley rats were divided into two groups: in group 1, different concentrations of cytomodulin, a synthetic heptapeptide with TGF‐β‐like activity, were injected into the tunica of each of 18 rats and six rats group 2 received saline injections as a control. The tunical tissues were taken after 3 days, 2 and 6 weeks and were examined histologically using Hart and trichrome stains. Electron microscopy was used to examine the ultrastructural changes in the same tissue samples.Results There were histological and ultrastructural alterations in 15 of 18 rats in group 1 (cytomodulin‐injected), especially in tissue examined after 6 weeks. The most prominent histological changes were chronic inflammatory cellular infiltration, focal and diffuse elastosis, thickening, disorganization and clumping of the collagen bundles. The ultrastructural changes were in the form of densely packed collagen, fragmented and scarce elastic fibres, separation of neuronal fibres by interposing clumps of packed collagen, and perivascular collagen deposition as a part of the reorganization of the interstitial matrix.Conclusion Cytomodulin can induce a Peyronie’s‐like condition in the rat penis, which may explain the role of TGF‐β in the pathogenesis of Peyronie’s disease. With further refinement, such rats may be used as an experimental model for studies of Peyronie’s disease.
Prophylaxis for transrectal prostatic biopsies: a randomized controlled study of intravenous co‐amoxiclav given as a single dose compared with an intravenous dose followed by oral co‐amoxiclav for 24 h
Authors: Bates  , Porter  , Gingell  
Published: March 2003

Objective To compare in a randomized prospective study the infective complication rates of a single intravenous dose of co‐amoxiclav given alone before transrectal prostatic biopsy with an intravenous dose followed by oral co‐amoxiclav for 24 h.Patients and methods Eighty‐three patients undergoing prostatic biopsy were randomized to receive 1.2 g co‐amoxiclav intravenously and then either three further doses of oral co‐amoxiclav (Group 1) or no further antibiotics (Group 2). The evaluation included analysis of a mid‐stream urine (MSU) sample before and 72 h after biopsy, and the recording of oral temperatures and symptoms in the first 44 patients. Patients with symptomatic urinary tract infections (UTIs), prostatitis, indwelling catheters, diabetes and those receiving steroid therapy were excluded.Results Eight patients, four from each treatment arm, were found to have asymptomatic UTIs from their MSU before biopsy. Excluding these patients, four patients (11%) from Group 1 and six from Group 2 (16%) had positive MSUs at 72 h; two patients from Group 2 and one from Group l required admission to hospital. Of the patients returning symptom and temperature charts, a further six (14%; three from each group) reported signs and symptoms suggestive of infection despite negative urine cultures.Conclusions There was no statistically significant difference in the rate of positive MSUs between the groups. The incidence of infections was considerably higher than in previously published series where other antibiotics were used, suggesting that co‐amoxiclav is not the drug of choice for transrectal prostatic biopsy.
Tissue damage and regeneration of ureteric smooth muscle in rats with obstructive uropathy
Authors: Chuang  , Chuang  , Liu  , Chen  , Huang  
Published: March 2003

Objective To investigate regeneration in obstructed ureters and to elucidate the role of hyperplasia in the thickening of the smooth muscle layer in the late stages of complete ureteric obstruction.Materials and methods The expression of Ki‐67 antigen, c‐Fos, c‐Jun and c‐Myc in the smooth muscle layer of obstructed ureters was determined using immunohistochemistry in 40 Sprague‐Dawley rats. After unilateral ligation of the ureter, five rats each were killed for examination at 1, 3, 7, 10, 14, 21, 28 and 42 days after ligation; five rats that underwent a sham operation were also examined as controls.Results The severity of hydroureter and thickening of the smooth muscle layer progressed consistently in the ligated ureters, but no mitosis was detected in myocytes within 14 days of ligation. Fibrosis in the smooth muscle layer appeared 21 days after ligation and progressed. There was no expression of Ki‐67 antigen and oncoproteins until 14 days after ligation. The expression of Ki‐67 and c‐Myc increased gradually to a peak after 28 days, then declined. However, the expression of c‐Fos and c‐Jun was low and transient.Conclusion Cell regeneration is impaired in the damaged muscle layer of obstructed ureters. Only hypertrophy and not hyperplasia of the smooth muscle layer developed during the course of complete ureteric obstruction in this rat model of obstructive uropathy.
MN/CA9 gene expression as a potential biomarker in renal cell carcinoma
Authors: Murakami  , Kanda  , Tsuji  , Kanayama  , Kagawa  
Published: March 2003

ObjectiveTo compare the levels of MN/CA9 expression with clinicopathological variables in renal cell carcinoma (RCC), and thus evaluate MN/CA9 expression as a possible biomarker for RCC.Materials and methodsThe level of expression of MN/CA9 was evaluated in 76 surgically obtained tissue samples (49 from RCC, 22 from normal kidney and five from oncocytoma) using semiquantitative reverse transcription‐polymerase chain reaction (RT‐PCR) analysis. In RCC, MN/CA9 expression was compared with stage, grade and cell type.Results MN/CA9 was expressed in 42 of 49 (86%) RCC samples, but in only two of 22 (9%) normal kidney and none of five oncocytoma samples. Levels of MN/CA9 expression were significantly higher in tumours consisting only of clear cells than in those containing other cell types (P=0.0189), and MN/CA9 was expressed in 34 of 37 (92%) RCC samples consisting only of clear cells. Tumours of low clinical stage showed a striking increase in MN/CA9 expression, and high MN/CA9 expression was associated with a good patient outcome.ConclusionThese results suggest that MN/CA9 expression is a potential diagnostic biomarker of RCC, especially the clear‐cell type, and can be targeted using molecular biological techniques.
Changing practice in anterior urethroplasty
Authors: Greenwell  , Venn  , Mundy  
Published: March 2003

ObjectiveTo describe our experience of penile urethral repair and reconstruction, cataloguing the change in practice from one‐stage flap to two‐stage free graft procedures for anterior urethroplasty.Patients and methodsBetween January 1992 and December 1996, 79 patients underwent anterior urethroplasty. Of the 45 one‐stage bulbar patch urethroplasties, 37 (76%) used buccal mucosal free grafts rather than flaps. Of the 34 penile urethroplasties, 26 (82%) (including all of the circumferential reconstructions) were two‐stage procedures.ResultsBuccal mucosal free grafts were at least as good as local skin flaps for patch urethroplasty and two‐stage repairs gave much better results than one‐stage repairs for total circumferential reconstruction of the penile urethra.ConclusionsFor a patch urethroplasty of an uncomplicated stricture in the bulbar urethra, buccal mucosal free grafts are now the material of choice. For a patch urethroplasty of an uncomplicated stricture in the penile urethra the Orandi procedure remains the ‘gold standard’. For a circumferential repair of the urethra, particularly the penile urethra, a two‐stage repair using a free graft gives better results than a one‐stage repair using a flap.
Noradrenaline and nitrite‐nitrate concentrations in the contralateral testes during ipsilateral spermatic cord torsion in the presence or absence of a testis and epididymis
Authors: Tanyel  , Aydin  , Banoglu  , Isimer  , Büyükpamukçu  
Published: March 2003

ObjectiveTo determine the changes occurring during ipsilateral spermatic cord torsion either in the presence or absence of the ipsilateral testis and epididymis, by evaluating noradrenaline and nitrite‐nitrate concentrations in the contralateral testes.Materials and methodsForty male albino rats were allocated randomly to one of four equal groups undergoing: group 1, a sham operation; group 2, ipsilateral spermatic cord torsion; group 3, epididymo‐orchidectomy only; and group 4, spermatic cord torsion after epididymo‐orchidectomy. The contralateral testes were harvested after 24 h and the noradrenaline and nitrite‐nitrate contents determined. The levels in each group were compared using the Kruskal‐Wallis and Mann–Whitney U‐tests.ResultsThe noradrenaline content of testes from group 2 was significantly lower than in those of groups 1 and 3, but there were no significant differences in content between groups 1 and 3, 1 and 4, and 2 and 4. The content in group 4 was significantly less than that in group 3. There were no significant differences in nitrite‐nitrate contents among any of the groups.ConclusionSpermatic cord torsion for 24 h, either in the presence or absence of a testis and epididymis, significantly decreased the noradrenaline content in the contralateral testis. This finding supports the suggestion that the sympathetic system is activated by exposure to noradrenaline in the contralateral testis during ipsilateral spermatic cord torsion, with no dependency on the presence of a testis and epididymis. As the nitrite‐nitrate concentrations were unaffected, nitric oxide seems to have no role in contralateral testicular deterioration.
Renal abnormalities in patients with Kallmann syndrome
Authors: Zenteno  , Méndez  , Maya‐Núñez  , Ulloa‐Aguirre  , Kofman‐Alfaro  
Published: March 2003

ObjectiveTo report experience in patients with Kallmann syndrome (KS) in whom urography was used to establish the type and frequency of renal anomalies associated with the disorder.Patients and methodsOf 19 patients with KS, 15 had the X‐linked recessive form of the disease, whereas the remaining four were sporadic. Each patient underwent intravenous pyelography (IVP) using a non‐ionic, low osmolarity contrast medium.ResultsOf the 19 patients with KS, 10 had kidney abnormalities; four presented with unilateral renal agenesis and six had less severe forms of renal abnormality (renal malrotation in four and bilateral dilatation of the calyces and pelves in two). One of the patients with unilateral renal agenesis carried a deletion in KAL, the gene responsible for the X‐linked type of KS. Three of the four patients with renal malrotation had a confirmed X‐linked recessive form and one carried a point mutation in KAL.ConclusionThese results suggest that kidney abnormalities are more frequent and diverse in patients with KS than previously reported. They also indicate that defects in the KAL gene may contribute to abnormal renal development. However, a review of the literature revealed no close correlation between KAL mutations and kidney anomalies in the X‐linked type of disease. Taken together, these data suggest that KAL mutations are not invariably associated with failure of renal development and that additional factors (epigenetic or local) may compensate for defects in the KAL protein.
Suprapubic catheterization: a suitable procedure for clinical nurse specialists in selected patients
Authors: Gujral  , Kirkwood  , Hinchliffe  
Published: March 2003

ObjectiveTo assess the feasibility and advantages of urology clinical nurse specialists (NSs) extending their professional role to include inserting initial suprapubic catheters in selected patients in the hospital and community setting.Patients and methodsA urology NS, who is also the district continence adviser, was formally taught by a consultant urologist how to insert suprapubic catheters using the ‘Add‐a‐Cath’ introducer technique (Femcare, UK). Once deemed competent, the NS was indemnified by the Trust to carry out the procedure in carefully selected patients using a safe and unequivocal protocol.ResultsOver a period of 40 months, the NS undertook the procedure in 164 patients, with 64 being catheterized in the community. There were no serious complications in the series and during the period studied, only 17 patients were referred back to the urologists for catheterization under formal theatre conditions.ConclusionInitial suprapubic catheterization can be carried out safely by trained NSs in selected patients. This extended professional role has helped to improve the continuity and quality of care for patients who require long‐term catheterization. The NS was also a valuable source of training for junior medical staff who have limited experience with suprapubic catheterization.
Preoperative nested reverse transcription‐polymerase chain reaction for prostate specific membrane antigen predicts biochemical recurrence after radical prostatectomy
Authors: Okegawa  , Nutahara  , Higashihara  
Published: March 2003

ObjectiveTo assess the utility of the nested reverse transcription‐polymerase chain reaction (RT‐PCR) method for measuring prostate specific membrane antigen (PSM) and prostate specific antigen (PSA) in predicting serum PSA recurrence after radical prostatectomy.Patients and methodsNested RT‐PCRs for PSM and PSA were used in 40 patients who subsequently underwent radical prostatectomy. The accuracy of the RT‐PCR assays in predicting PSA failure was compared with those for the preoperative serum PSA level, Gleason score and final pathological staging. The patients were monitored using a PSA assay (Tandem‐R, Hybritech, San Diego, CA) at 3 weeks after radical prostatectomy and every 2 months thereafter. Biochemical recurrence was defined as a serum PSA level of ≥0.4 ng/mL.ResultsStatistical analysis indicated that the nested RT‐PCR assay for PSM was the most accurate preoperative predictor of potential surgical failure (PCR‐PSM, P<0.001; PCR‐PSA, P=0.018; serum PSA level, P=0.149; Gleason score P=0.388, by Fisher’s exact probability test). Biochemical recurrence was evaluated in relation to these methods during a mean (range) follow‐up of 16.7 (6–35) months. Of the 40 patients, eight (20%, one with organ‐confined cancer and seven with extraprostatic extension of cancer) developed biochemical recurrence. The Kaplan–Meier recurrence‐free actuarial probability curves differed significantly between patients with positive and those with negative results for the preoperative nested RT‐PCR for PSM (P<0.01, generalized Wilcoxon’s test). The nested RT‐PCR for PSA, preoperative serum PSA value and Gleason score were not significant predictors of biochemical recurrence (P=0.16, 0.12 and 0.24, respectively).ConclusionsThe nested RT‐PCR for PSM was the best preoperative predictor of biochemical recurrence among the factors examined.
The long‐term outcome in patients with superficial transitional cell carcinoma of the bladder: a single‐institutional experience
Authors: Haukaas  , Dæhlin  , Maartmann‐Moe  , Ulvik  
Published: March 2003

ObjectiveTo determine the natural history of transitional cell carcinoma (TCC) of the bladder, and to identify factors which place patients at lifelong risk of developing progression and dying from bladder carcinoma.Patients and methodsThe long‐term outcome was evaluated retrospectively in 231 patients with superficial bladder TCC, assessed for the first time within a 6‐year period from 1981 to 1986, with a median follow‐up of 108 months. Of 231 patients, 217 (94%) were initially treated by transurethral or segmental resection.ResultsRecurrence developed in 141 of 217 (65%) patients; the duration of the interval free of recurrence was significantly less for patients with initial G3 tumours than that for those with G1 (P<0.01) and for pT1 compared with pTa disease (P<0.01). The disease progressed in 42 of 231 (18%) patients. Differences in the progression‐free interval between patients with G1 and G3 tumours, and with pTa and pT1 disease, were statistically significant (P<0.005 and P<0.001, respectively). In 27 of 231 patients (12%), TCC of the bladder was the cause of death, whilst 118 (51%) died from unrelated causes. There were no deaths among patients with initial pTaG1 tumours, compared with 10 of 26 (38%) deaths in those with pT1G3 disease at presentation.ConclusionThe long‐term prognosis is good for patients with pTaG1 tumours, whilst pT1G3 is a potentially aggressive disease. Lifelong endoscopic surveillance is mandatory in patients in whom new tumours are very active, at least in those of younger age. Routine cystoscopy can possibly be discontinued in patients with low‐grade, low‐stage disease in whom a low liability of recurrence has been shown during follow‐up.
Bleeding and activation of coagulation during and after transurethral prostatectomy: importance of the acute‐phase response and prostate specific antigen?
Authors: Nielsen  , Gram  , Holm‐Nielsen  , Jespersen  
Published: March 2003

ObjectiveTo evaluate the importance of coagulation activation in patients with benign prostatic hyperplasia, undergoing transurethral prostatic resection (TURP) and to examine whether changes in activity are related to blood loss, the circulatory entry of prostate specific antigen (PSA), operative trauma (resected tissue weight) and the inflammatory response, as assessed by C‐reactive protein (CRP).Patients and methodsTURP was performed in 24 men and the weight of resected tissue and blood loss determined. The activation of coagulation was followed using new sensitive and specific assays, and the changes related to blood loss, the release of PSA, operative trauma and the acute‐phase response. The area under the curve (AUC) for the measured quantities was used in correlation analysis.ResultsTURP was followed by a marked activation in coagulation. There was no correlation between the markers of coagulation and the operative blood loss, but the latter correlated with the weight of resected tissue (P=0.001). Postoperatively, the blood loss correlated with prothrombin fragment (F1+2 ; P=0.010), with thrombin‐antithrombin complexes (TAT; P=0.024), and with the PSA concentrations (P=0.016) but not with fibrinogen. Serum concentrations of PSA increased significantly and the AUC in the operative period correlated with F1+2 (P=0.003) and TAT (P<0.005), but postoperatively only with F1+2 (P=0.013). The weight of resected tissue correlated operatively with PSA (P=0.012) but not with the concentrations of F1+2 or TAT. Postoperatively, there was a correlation with the acute‐phase proteins, CRP (P=0.005), fibrinogen (P=0.012) and with PSA (P=0.020).ConclusionThe operative blood loss is caused by surgical factors and the observed postoperative hypercoagulable state can be explained as a physiological response to bleeding, i.e. to secure haemostasis. The activity of coagulation was unrelated to operative trauma, but the acute‐phase proteins were. The release of PSA into the circulation probably has an effect on blood coagulation.