bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lymphadenectomy in patients with transitional cell carcinoma of the urinary bladder; significance for staging and prognosis
Authors: Leissner J. , Hohenfellner R. , Thüroff J.W. , Wolf H.K. 
Published: March 2003

Objective  To determine the need to standardize the number and location of lymph nodes to be removed during radical cystectomy in patients with invasive bladder carcinoma. Patients and methods  The pelvic lymph nodes from 447 patients (mean age 62.8 years) who underwent radical cystectomy between 1986 and 1997 were evaluated. The number of lymph nodes was correlated with the depth of invasion of the primary tumour (pT), occurrence of nodal metastases, clinical outcome, the operating surgeons and the pathologists dissecting the nodes. Results
The clinical follow‐up was available for 302 patients (mean follow‐up 38.7 months). The mean (range) number of lymph nodes removed was 14.7 (1–46). The number of lymph nodes removed varied significantly among different surgeons but not among pathologists. In pT3 and pT4 tumours, a more extended lymphadenectomy ( 16 lymph nodes) correlated with a higher percentage of patients with documented nodal metastases. There was a significant correlation between the number of lymph nodes removed and the tumour‐free 5‐year survival in patients with pT1, pT2 or pT3 tumours, and in patients with 1–5 positive lymph nodes (P < 0.01). Conclusion  Extensive lymphadenectomy significantly improves the prognosis of patients with invasive bladder cancer and represents a potentially curative procedure in patients with nodal metastases, including micrometastases that may escape detection during routine histopathological evaluation. The results indicate the need for a standardized lymph node dissection.
Monitoring of renal function in patients with spinal cord injury
Authors: Macdiarmid S.A. , McIntyre W.J. , Anthony A. , Bailey R.R. , Turner J.G. , Arnold E.P. 
Published: March 2003

Objective To assess the sensitivity of serum creatinine level in detecting clinically important and early deterioration of renal function in patients with spinal cord injury (SCI), and to evaluate the optimal method of determining creatinine clearance in these patients.Patients and methods The serum creatinine level of 36 patients (25 paraplegics and 11 quadriplegics) was evaluated and compared with the corresponding measured creatinine clearance rate. Correlations were also assessed between the creatinine clearance measured by 24‐h endogenous clearance, single‐shot 99mTc‐labelled diethylenetriamine pentaacetic acid (99mTc‐DTPA) clearance technique, and the Cockcroft–Gault formula, to test their validity.Results Of the 36 patients 11 (31%) had a measured creatinine clearance of < 100 mL/min (mean 84.8) and a corresponding normal serum creatinine level. Creatinine clearance calculated by the Cockcroft–Gault formula did not correlate well with that measured by the 24‐h endogenous clearance (r = 0.426) and 99mTc‐DTPA clearance (r = 0.366), overestimating creatinine clearance in all but three patients. The mean (sd) difference between the creatinine clearance measured by the 24‐h and DTPA clearance technique was 17.7 (16.5)% and the correlation between these techniques was good (r = 0.71).Conclusion Serum creatinine level is not sensitive in detecting early deterioration of renal function in patients with SCI. The Cockcroft–Gault formula generally significantly overestimates the true creatinine clearance and is not recommended. The 24‐h endogenous creatinine clearance measured on appropriately collected urine samples is an acceptable accurate and practical method of determining glomerular filtration rate in patients with SCI.
Prognostic significance of p27Kip1 and Ki‐67 expression in carcinoma of the renal pelvis and ureter
Authors: Kamai T. , Takagi K. , Asami H. , Ito Y. , Arai K. , Yoshida K.‐I. 
Published: March 2003

Objective To determine the significance of p27Kip1 (p27) for tumour behaviour and prognosis of patients with transitional cell carcinoma (TCC) of the renal pelvis and ureter. Patients and methods Using immunohistochemical staining, the relationship was evaluated between p27 protein level (low  < 50%, high > 50%) and the Ki‐67 labelling index (low  < 30%, high > 30%) and clinicopathological features of 37 consecutive Japanese patients with TCC of the renal pelvis and ureter. Results Low levels of p27 correlated with higher tumour stage (P < 0.05) and positive lymph node metastases (P < 0.05). There was no significant association between p27 staining and the grade and tumour proliferation as assessed by the Ki‐67 index. A high Ki‐67 index correlated with higher grade and stage (P < 0.05). Kaplan‐Meier plots of survival rate in patients with low or high p27 staining showed that low levels correlated with a shorter disease‐free and overall survival (P < 0.001 and P < 0.01, respectively). Similarly, patients with a high Ki‐67 index had lower disease‐free and overall survival than those with a low Ki‐67 index (P < 0.01 and P < 0.05, respectively). The Cox proportional hazards model showed that a low level of p27 was an independent predictor of a shorter disease‐free (P < 0.01) and overall survival (P < 0.05) on univariate analysis, but not of overall survival on multivariate analysis. A high Ki‐67 index was an independent prognostic marker for shorter disease‐free survival on univariate and multivariate analysis (P < 0.01) and for overall survival on multivariate analysis (P < 0.05). In those with a high Ki‐67 index, increased p27 staining was associated with a better prognosis than decreased staining for disease‐free and overall survival (log‐rank test, P < 0.01 and P < 0.05, respectively). Conclusions The finding that a low level of p27 is associated with tumour invasion and unfavourable prognosis indicates that p27 may be a useful prognostic marker for survival in upper urinary tract cancer.
Couch or crouch? Examining the prostate: a randomized study comparing the knee‐elbow and the left‐lateral position
Authors: Frank J. , Thomas K. , Oliver S. , Andrews S. , Choong S. , Taylor R. , Emberton M. 
Published: March 2003

Objective To compare two methods of examining the prostate, the knee‐elbow (KE) and left‐lateral (LL) positions, to establish which allows a more complete examination, and to determine if there is any difference in patients' perception of pain or embarrassment for either method. Patients and methods All men attending two urology clinics who required a prostate examination were eligible for the study. Both the KE and LL methods were used for each participant, by the same clinician. The order in which the examinations were conducted was randomized using the last digit of the patient's hospital number. Results Five clinicians examined 117 men; three patients refused to participate and the examination data were incomplete for two. Irrespective of the order in which the examinations were conducted (P = 0.6), the KE position permitted a greater proportion of the prostate to be palpated (Wilcoxon signed‐ranks test, z = − 4.7, P < 0.001) in 35% of patients, but there was no difference in 60%. Most patients found the examinations equally painful and embarrassing. However, for those who expressed a difference, the KE was 1.9 times more comfortable than the LL position and twice as embarrassing. Conclusion The two methods of prostate examination were equal for completeness of examination, pain and embarrassment in most patients. However, the KE offers an alternative to the LL position for those patients in whom the prostate is difficult to palpate or who find the examination painful.
Diuretic renography in infants with prenatal unilateral hydronephrosis: an explanation for the controversy about poor drainage
Authors: Gordon I. 
Published: March 2003

Objective To present an explanation for impaired drainage on diuretic renography in infants with a prenatal diagnosis of unilateral renal pelvic dilatation (RPD) who are stable both in terms of renal function and dilatation on follow‐up investigations, despite undergoing no surgical intervention, and who undergo diuretic renography postnatally; this should provide some insight into whether impaired drainage is a sign of obstruction in these asymptomatic infants.Materials and methods Using a combination of published studies on the technique of diuretic renography and an analysis of such studies, a theoretical model of the infant kidney was developed to assess the possibility of prolonged drainage.Results The results from the model showed prolonged drainage in many different situations, thus offering an explanation of expected impaired drainage even if there was no obstruction.Conclusion Understanding the pathophysiology of prenatally diagnosed RPD allows different interpretations of the diuretic renogram and may affect the treatment of these children.
The effects of physiotherapy for female urinary incontinence: individual compared with group treatment
Authors: Janssen C.C.M. , Lagro‐Janssen A.L.M. , Felling A.J.A. 
Published: March 2003

Objectives To compare, in a randomized trial, the effects of individual and group physiotherapy for urinary incontinence in women referred by their general practitioner (GP). Patients and methods The study included women of all ages (mean 47.8 years) with stress, urge or mixed incontinence; 126 received individual and 404 group treatment. Both groups undertook the same pelvic floor exercises and bladder training, and received the same information. The effects were measured soon after treatment and again 9 months later. The main outcome measures were objective changes in the severity of incontinence, frequency of urine loss and frequency of nocturnal urine loss. The trial was nationwide; 25 physiotherapists and 337 GPs participated. Results There were no significant differences in effect between the groups; after individual treatment the severity of incontinence improved in 60% of the patients and the mean (95% confidence interval, CI) frequency of urine loss decreased, by −8.7 (− 6.4 to −11.1) times/week. After group therapy continence improved in 57% and the frequency of urine loss decreased, by – 8.4 ( − 6.8 to − 10.0) times/week. For women who had nocturnal urine loss (at baseline), the frequency decreased after individual treatment by −11.2 (4 to − 26.4) and after group therapy by −14 (− 9.1 to −18.9) times/month. All improvements persisted in full for up to 9 months. Conclusion Individual and group physiotherapy are equally effective for at least 9 months in improving incontinence in women. Factors should be sought that can predict the effectiveness of therapy, and thus better select those patients most likely to benefit from therapy.
The interaction of nitric oxide and prostaglandins in the control of corporal smooth muscle tone: evidence for production of a cyclooxygenase‐derived endothelium‐contracting factor
Authors: Minhas S. , Cartledge J.J. , Eardley I. , Joyce A.D. , Morrison J.F.B. 
Published: March 2003

Objective To investigate the interaction of endothelium‐derived nitric oxide (NO) and prostaglandins (PGs) in regulating corporal smooth muscle tone in vitro. Materials and methods Strips of rabbit corpus cavernosum were mounted in organ chambers for the measurement of isometric tension. Strips were submaximally contracted with noradrenaline and concentration‐response curves (CRCs) to acetylcholine (ACh) were constructed before and after treatment with 5 µmol/L atropine, 20 µmol of the cyclooxygenase inhibitor indomethacin and 10 µmol of the PGH2/thromboxane A2 receptor antagonist SQ29548. The NO synthase (NOS) inhibitors L‐NG‐monomethyl arginine (L‐NMMA) and L‐NG‐nitroarginine (L‐NOARG) were added to strips at tonic tension in the presence and absence of indomethacin, and after this CRCs to ACh were constructed. Results The addition of ACh to strips produced a concentration‐dependent relaxation which was inhibited by atropine. Indomethacin, but not SQ29548, significantly increased relaxation to ACh. Relaxation to ACh was impaired by L‐NMMA, but adding ACh to strips treated with L‐NOARG resulted in contractile responses, whilst both effects were reversed by indomethacin. L‐NMMA and L‐NOARG led to increases in tonic tone which were unaffected by indomethacin. Conclusions In rabbit corpus cavernosum there is a tonic release of NO which does not appear to be inhibited by a vasoconstrictor prostanoid. Endothelium‐dependent relaxation to ACh results in the dual production of NO and a cyclooxygenase‐derived endothelium contracting factor which acts in opposition to NO; this factor is unlikely to act on PGH2/TXA2 receptors.
Inducible nitric oxide synthase expression in benign prostatic hyperplasia, low‐ and high‐grade prostatic intraepithelial neoplasia and prostatic carcinoma
Authors: Baltaci S. , Orhan D. , Gögüs Ç. , Türkölmez K. , Tulunay Ö. , Gögüs O. 
Published: March 2003

Objective To elucidate the incidence of inducible nitric oxide synthase (iNOS) expression in benign prostatic hyperplasia (BPH), low‐ and high‐grade prostatic intraepithelial neoplasia (PIN) and prostatic carcinoma lesions, and to explore the role of iNOS in prostate tumorigenesis. Materials and methods Immunoreactivity for iNOS was examined in 20 samples each of BPH, high‐grade PIN, low‐grade PIN and prostatic carcinoma. Results Positive iNOS immunostaining was detected in all samples from all patients; iNOS was detected in both basal epithelial cells and secretory cells of the glandular epithelium. High‐grade PIN and prostatic carcinoma samples had more intense iNOS immunostaining than low‐grade PIN and BPH samples. In all samples, smooth muscle cells showed weak or moderate iNOS immunoreactivity and endothelial cells showed moderate immunostaining. Conclusions Nitric oxide generated by iNOS may be involved in prostate tumorigenesis and further studies with immunohistochemical and molecular biology are needed to determine the exact role of iNOS in the pathogenesis of prostatic carcinoma.
Colour Doppler ultrasonography of female urethral vascularization in normal young volunteers: a preliminary report
Authors: Siracusano S. , Bertolotto M. , D'Aloia G. , Silvestre G. , Stener S. 
Published: March 2003

Objective To assess urethral vascularization in healthy young women, using colour Doppler ultrasonography. Subjects and methods Eleven healthy young women volunteers (mean age 33.6 years, range 24–46) with no pelvic floor disorders and no history of incontinence were assessed. The subjects underwent colour Doppler ultrasonography using a 4–7 MHz convex broadband transducer. Translabial sagittal scans of the urethra were taken when the subjects had a full bladder, both during the oestrogenic and progestogenic phases. The colour Doppler ultrasonography parameters were optimized to detect slow flows in the anterior and posterior distal, middle and proximal urethra. A rank‐sum nonparametric test was used to assess differences between the resistive indices. Results The statistical evaluation showed a significant difference in the resistive index only in the anterior urethra, between the distal and middle plus proximal urethra, in both the progestogenic (P = 0.002) and oestrogenic (P = 0.0127) phases. Conclusions This study confirmed that the vascularization of the urethra plays an important role in the ‘seal’ effect, which is considered one of the most important factors in urethral closure. There was a significantly greater resistive index in the anterior proximal urethra than in the middle and distal urethra. These findings suggest that the seal effect is related to the existence of a rich venous urethral vascularization, involved in the mechanism of urethral closure. Colour Doppler ultrasonography of the urethra seems to be feasible and useful for understanding the mechanism of the vascular component in female continence.
Acetyl‐l‐carnitine vs tamoxifen in the oral therapy of Peyronie's disease: a preliminary report
Authors: Biagiotti G. , Cavallini G. 
Published: March 2003

Objective To detect whether oral acetyl‐l‐carnitine might be useful in the acute and early chronic phases of Peyronie's disease, compared with tamoxifen, a drug currently in use. Patients and methods The study included 48 patients with Peyronie's disease (15 acute and 33 initial chronic), randomized equally into two groups. The first group used tamoxifen 20 mg twice daily for 3 months and the second acetyl‐l‐carnitine 1 g twice daily for 3 months. The disease and stages were diagnosed and identified using a history, objective examination, pharmacologically induced erection, autophotography during erection, and basic and dynamic colour Doppler ultrasonography. Penile curvature, plaque size, pain and disease progression were assessed. The differences between the groups or between the variables before and after therapy were compared using analysis of variance or the chi‐squared test. Results Acetyl‐l‐carnitine was significantly more effective than tamoxifen in reducing pain and in inhibiting disease progression. Acetyl‐l‐carnitine reduced penile curvature significantly, while tamoxifen did not; both drugs significantly reduced plaque size. Tamoxifen induced significantly more side‐effects than acetyl‐l‐carnitine. Conclusions These results suggest that acetyl‐l‐carnitine is significantly more effective and safe than tamoxifen in the therapy of acute and early chronic Peyronie's disease.
Cystometric evaluation of reconstructed classical bladder exstrophy
Authors: Dave S. , Grover V.P. , Agarwala S. , Mitra D.K. , Bhatnagar V. 
Published: March 2003

Objective To evaluate the association of urodynamic variables with continence and upper tract status after reconstruction in patients with classical bladder exstrophy. Patients and methods Thirty‐one patients with bladder exstrophy were assessed 1 year after a modified bladder neck reconstruction. The evaluation included a detailed history, radioisotope renography, voiding cysto‐urethrography, ultrasonography and artificial slow‐filling cystometry. Results Fifteen of the 31 patients were satisfactorily continent; their maximum cystometric capacity was higher than that of the incontinent patients. The compliance, assessed as the maximum bladder capacity at a detrusor pressure of < 20 cmH2O, was significantly higher in the continent patients. There was a 45% incidence of unstable contractions in the 31 patients. Persistent sphincteric activity was detected on electromyography in 10 patients during voiding. Twenty‐one patients could initiate a detrusor contraction during voiding. The residual volume was significant in nine of the 21 patients who attempted to void. Patients with a high end‐fill pressure (> 40 cmH2O) had a significantly higher incidence of unobstructive hydronephrosis than had patients who had an end‐fill pressure of < 40 cmH2O. Conclusions Bladder abnormalities are common after reconstruction of bladder exstrophy, with poor compliance, small capacity and unstable contractions. These factors hinder any increase in capacity and cause persistent incontinence. Hypocompliance and high end‐fill pressure can lead to upper tract damage even in continent patients. Detailed urodynamic evaluation is vital to assess the results and to plan subsequent treatment.
Amplification of the androgen receptor may not explain the development of androgen‐independent prostate cancer
Authors: Edwards J. , Krishna N.S. , Mukherjee R. , Watters A.D. , Underwood M.A. , Bartlett J.M.S. 
Published: March 2003

Objective To examine the role of androgen receptor (AR) gene amplification and aneusomy of the X chromosome in the development of antiandrogen‐resistant prostate cancer. Patients and methods Twenty patients with prostate cancer resistant to androgen‐deprivation therapy were selected for study. The records of patients with tumours before and after antiandrogen therapy, and with a full clinical follow‐up, were retrieved. AR gene amplification and X chromosome copy number were assessed by fluorescence in situ hybridization using a labelled probe at locus Xq11–13 for the AR gene and a labelled α‐satellite probe for the X chromosome. At least 20 nuclei were scored over three tumour areas by two independent observers. Results Aneusomy of the X chromosome was reported respectively in seven (35%) and 11 (55%) tumours before and after hormone relapse, the AR gene copy number was increased in seven (35%) and 13 (65%), respectively, and AR gene amplification was detected in one (5%) and three (15%), respectively. Neither increased AR copy number nor AR amplification in primary tumours precluded a biological response to androgen‐deprivation therapy. Conclusion The rate of AR gene amplification is too low to be solely responsible for the development of antiandrogen‐resistant prostate cancer. Also, the presence of amplified AR and cells aneusomic for the X chromosome in primary tumours that respond to androgen‐deprivation therapy suggests that an increase in AR gene copy number does not prevent a tumour from responding to this therapy. Therefore other mechanisms which could cause hormone‐refractory prostate cancer must be investigated before it is understood why so many patients relapse with this disease.
The value of endotoxin concentrations in expressed prostatic secretions for the diagnosis and classification of chronic prostatitis
Authors: Li L.J. , Shen Z.J. , Lu Y.L. , Fu S.Z. 
Published: March 2003

Objective To clarify the value of endotoxin concentrations in expressed prostatic secretions (EPS) in the diagnosis and classification of chronic prostatitis. Patients, subjects and methods The study included 88 consecutive patients with chronic prostatitis and 15 controls with no urological disease. The diagnosis and classification were based on a history, symptoms, a digital rectal examination of the prostate, and a white blood cell count in the EPS. Endotoxin concentrations in the EPS or urine were measured using a colorimetric assay and standard microbiological methods used to identify bacterial growth. Results In men with chronic prostatitis caused by Gram‐negative or combined Gram‐negative and ‐positive bacteria, the endotoxin levels in urine collected immediately after prostatic massage were significantly greater (P < 0.01) than in a midstream urine sample, and the concentration in the EPS was significantly higher (P < 0.05) than that in the control group. The same was true of patients with chronic prostatitis and Gram‐positive bacteria isolated from the EPS or urine after massage. In patients with chronic pelvic pain syndrome (grade IIIA) the endotoxin level in the urine after massage was also significantly higher (P < 0.05) than that of the midstream sample, but there was no significant difference between the concentration in these samples in patients with grade IIIB, and no significant difference between the endotoxin concentration of the EPS in patients with grade IIIB and that in controls. Conclusion Endotoxin concentrations are increased in the EPS or urine (after prostatic massage) of men with bacterial chronic prostatitis or chronic pelvic pain syndrome grade IIIA. The current routine examinations (including bacterial culture and routine examination of EPS or urine) before diagnosis and classification of chronic prostatitis are insufficient to describe the cause and pathogenesis of this condition. The endotoxin concentration of the EPS or urine after massage may provide a supplementary tool to identify the cause of chronic prostatitis.