bluuebunny/crossref_metadata_2025_split huggingface dataset:
The implementation of clinical paths for six common urological procedures, and an analysis of variances
Authors: Chang  , Wang  , Huang  , Hsieh  , Tsui  , Lai  
Published: March 2003

Objective To evaluate the outcomes of treatment after implementing clinical paths for six common urological procedures, and analyse the variances from these paths.Patients and methods The study comprised 1006 consecutive patients treated according to the recommendations of the clinical path for six common urological procedures; the results of treatment were compared with those from 1006 patients treated by the same physicians before implementing the clinical paths. Total admission charges were divided into five categories, i.e. operation and anaesthesia, laboratory, radiology, pharmacy and other. The differences in these five categories before and after implementation were determined; the variance data were also tracked and analysed. Five quality indicators were monitored during implementation and compared with the data before implementation.Results The mean length of hospital stay (LOS) and admission charges were significantly lower (P=0.03 and P<0.01) after implementation. The charges for laboratory, radiology, pharmacy and other were significantly decreased after the use of clinical paths. The common variations from the clinical paths were patient‐related variance (33%) and discharge variance (26%). Variances affecting the LOS only or the admission charge only were more common than those affecting neither the LOS nor admission charges (both P<0.01), or both (both P<0.01). After implementation, the results of the five quality indicators were significantly improved and the number of patients with surgical complications was significantly reduced (P<0.01), but the mortality and readmission rate did not increase.Conclusions The implementation of clinical paths for six common urological procedures decreased the LOS, admission charges and surgical complications, and improved the quality of care. During implementation, variances can affect the LOS and/or admission charges.
Primary in situ extracorporeal shock wave lithotripsy in the management of ureteric calculi: results with a third‐generation lithotripter
Authors: Gnanapragasam  , Ramsden  , Murthy  , Thomas  
Published: March 2003

Objective To review the results of primary in situ extracorporeal shock wave lithotripsy (ESWL) for the treatment of ureteric stones using a third‐generation lithotripter, the Dornier MFL 5000 (Dornier Medizentechnic, Germany).Patients and methods The study comprised a retrospective review of treatment outcome in 180 patients with 196 stones who were treated with primary in situ ESWL, assessing the success of this approach and establishing reasons for failure.Results At the 3‐month follow‐up, 88% of patients were stone‐free; 21 patients failed ESWL and were treated by ureteroscopic stone extraction with no complications. Stone‐free rates were 90% for upper ureteric, 89% for middle‐third and 86% for lower‐third calculi. Twenty‐one patients required auxiliary procedures in the form of JJ stenting or nephrostomy. Failure of ESWL was associated with stone size (>1.3 cm) but not location or inadequate treatment.Conclusion Where prompt access to ESWL is available, primary in situ ESWL remains an effective form of treatment for all ureteric calculi, although stone‐free rates are lower for larger stones.
Late results of surveillance of clinical stage I nonseminoma germ cell testicular tumours: 17 years’ experience in a national study in New Zealand
Authors: Colls B.M. , Harvey V.J. , Skelton L. , Frampton C.M.A. , Thompson P.I. , Bennett M. , Perez D.J. , Dady P.J. , Forgeson G.V. , Kennedy I.C.S. 
Published: March 2003

ObjectiveTo re‐evaluate a national prospective study in New Zealand after 17 years to define whether orchidectomy alone and surveillance for nonseminoma germ cell testicular tumour (NSGCTT) is a sound policy and matches the results achieved by other treatment protocols.Patients and methodsBetween 1980 and 1997, 248 men with stage I NSGCTT, from six New Zealand centres, were managed by orchidectomy alone and surveillance, with treatment of relapses using combination chemotherapy.ResultsSeventy of the 248 patients (28%) relapsed; 42 of 92 (46%) with vascular and/or lymphatic invasion (VLI) in the primary tumour relapsed, whereas only 26 of 151 (17%) without this feature relapsed (P<0.001). VLI was the only identifiable risk factor for relapse in this series. Only one relapse occurred >28 months after orchidectomy. Despite poor compliance in some patients (12%) their survival was not prejudiced. Three patients died from disease despite chemotherapy at relapse. At 17 years and a median follow‐up of 53 months, 242 of the 248 men are disease‐free and the disease‐specific survival rate is 98%.ConclusionsThis study shows that orchidectomy alone and treatment of relapses produces excellent long‐term results without the adverse effects associated with retroperitoneal node dissection or elective chemotherapy for high‐risk cases.
Corporal reactivity to adenosine and prostaglandin E1in alloxan‐induced diabetic rabbit corpus cavernosum, and the effect of insulin therapy
Authors: Ayan S. , Yildirim S. , Uçar C. , Sarioglu Y. , Gültekin Y. , Bütüner C. 
Published: March 2003

ObjectiveTo investigate the changes in corporal reactivity to adenosine and prostaglandin E1(PGE1 ) in corpus cavernosal strips from alloxan‐induced diabetic rabbits and to determine the effects of insulin therapy.Materials and methodsTwenty‐four New Zealand white rabbits were studied in three equal groups: group 1, control; group 2, diabetes induced by the administration of alloxan hydrochloride intravenously; group 3, as group 2 but with insulin administered after the induction of diabetes. At the end of 8 weeks, the reactivity of corpus cavernosal strips from the animals was assessed in organ chambers.ResultsThe relaxation responses of corpus cavernosal strips to adenosine were similar in all groups, but the response to PGE1was impaired in groups 2 and 3 compared with that in controls.ConclusionIf vasoactive drugs are to be used for the diagnosis or treatment of diabetic erectile impotence, direct‐acting vasodilators, e.g. adenosine, must be used. In alloxan‐induced diabetes, the corporal reactivity to PGE1was impaired and insulin therapy did not restore the relaxation responses.
Helical computed tomography angiography in the evaluation of Chinese living renal donors
Authors: Tang  , Chan  , Tso  , Ho  , Chan  , Lai  
Published: March 2003

ObjectiveTo determine the suitability of helical computed tomography angiography (CTA), recently used in the anatomical evaluation of potential living renal donors (LRDs) in the Caucasian population, for Chinese LRDs.Subjects and methodsEighteen consecutive potential LRD candidates underwent both CTA and conventional renal angiography (CRA). Results from each were interpreted while unaware of the results from the other. Renal function was monitored after each radiological procedure.ResultsBoth procedures were able to identify all four accessory renal arteries present. One prehilar branch of <1 mm in diameter was not recognized on CTA. Renal artery ostial stenosis in one subject with normal blood pressure was identified on CTA, but not on CRA. CTA better delineated the renal venous and parenchymal anatomy and cost 60% less than CRA. There was no change in renal function after either procedure.ConclusionDespite there being few subjects, CTA has potential value as an alternative to CRA for the anatomical assessment of potential LRDs in Hong Kong. Advantages include a short examination time, non‐invasiveness and lower cost. CTA may provide an opportunity to living‐related and unrelated renal donor transplantation in this conservative Chinese culture.
Frequency and causes of fluid absorption: a comparison of three techniques for resection of the prostate under continuous pressure monitoring
Authors: Heidler  
Published: March 2003

ObjectiveTo compare in a prospective study three techniques for draining irrigation fluid during transurethral resection of the prostate (TURP) and to assess which method minimizes the risk of increased intravesical pressure and decreased plasma sodium level, as a sign of fluid absorption.Patients and methodsThe study included 90 patients with benign prostatic hyperplasia (BPH), randomized into three equal groups, who underwent TURP using different techniques for draining the irrigation fluid. Group 1 had suprapubic drainage via the Freka® CystTUR Standard device (Fresenius, Germany); group 2 underwent TURP with an Iglesias continuous‐flow resectoscope; and group 3 had suprapubic drainage using the Korth ‘flow controller’ (Olympus, Germany). The intravesical pressure was monitored continuously during surgery; an ‘increased’ pressure was defined as being >20 cmH2O. As fluid absorption decreases the plasma sodium level during surgery, the latter was also determined and the difference before and after surgery calculated.ResultsThe intravesical pressure was increased in 10% of those in group 1, 90% in group 2 and none of group 3. The differences between group 1 and 2 and between group 2 and 3 were significant (P<0.001). The differences in the decrease of plasma sodium levels in groups 1–3 were not significant, but there was a significant correlation (P=0.0075) between increased intravesical pressure and minimum levels of plasma sodium.ConclusionsThe three techniques for draining irrigation fluid produced significant differences in ‘increased’ intravesical pressure. In general, the levels of plasma sodium were not significantly different among the three techniques but patients with lower plasma sodium levels tended to have an increased intravesical pressure. In these cases, fluid absorption seems to be avoidable by an appropriate drainage technique. Nevertheless, considerable fluid absorption can occur at pressures of <20 cmH2O.
The impact of transurethral resection of bladder tumour on serum levels of soluble E‐cadherin
Authors: Durkan  , Brotherick  , Mellon  
Published: March 2003

ObjectiveTo evaluate soluble E‐cadherin (sE‐cadherin) as a potential tumour marker in patients with transitional cell carcinoma (TCC) of the bladder (previously shown to correlate with tumour grade, number of Ta/T1 tumours at presentation and a positive 3‐month check cystoscopy) by assessing its serum concentration in relation to transurethral resection of bladder tumour (TURBT).Patients and methodsSamples of venous blood were obtained from 25 patients with bladder cancer: (i) before cystoscopy/TURBT; (ii) intraoperatively, during tumour resection; and (iii) on the first day after surgery. Levels of sE‐cadherin were measured using an enzyme‐linked immunosorbent assay.ResultsSixty‐three serum samples from patients with TCC of the bladder were available for analysis (23 before, 21 during and 19 after surgery). Patients with G2/3 tumours had significantly higher median preoperative levels of sE‐cadherin (16.37 and 13.03 μg/mL, respectively) than those with G1 tumours (9.493 μg/mL; P=0.0164). There was no correlation between tumour stage and preoperative sE‐cadherin concentration. The median concentrations of sE‐cadherin were not significantly different before, during and after TURBT.ConclusionsThis study confirmed the previous finding that higher levels of serum sE‐cadherin correlate with increasing tumour grade but not with clinicopathological stage. Serum sE‐cadherin levels are not significantly altered by TURBT in the immediate perioperative period.
Transitional cell carcinoma expresses high levels of Fas ligand in vivo
Authors: Lee  , Lee  , Park  , Kim  , Jang  , Yoo  
Published: March 2003

ObjectiveTo characterize the Fas‐Fas ligand system, a main apoptotic pathway, in transitional cell carcinoma (TCC) of the urinary bladder, by analysing the expression of Fas and Fas ligand (FasL) in TCC samples.Materials and methodsArchival paraffin‐embedded tissues from 37 patients with TCC were analysed by immunohistochemistry to determine Fas and FasL expression.ResultsFas and FasL were detected on the cell surface and cytoplasm of respectively 34 (92%) and all cases analysed. The expression of Fas and FasL did not differ with the cytological grade of TCC.ConclusionThe high expression of FasL in TCC, reported for the first time in the present study, suggests that FasL may contribute to the immune escape of TCC through killing Fas‐bearing lymphocytes. Co‐expression of Fas with FasL also suggests that TCC may have pathways resistant to Fas‐mediated autocrine cell suicide.
Comparative physiology and biochemistry of rat and rabbit urinary bladder
Authors: Damaser M.S. , Whitbeck C. , Barreto M. , Horan P. , Benno H. , O’Connor L.J. , Levin R.M. 
Published: March 2003

Objective To compare directly the biochemistry and contractile responses of rat and rabbit bladder to different stimuli.Materials and methods Sexually mature male New Zealand White rabbits and Sprague Dawley rats were compared. Each bladder was excised while the animal was anaesthetized; longitudinal bladder strips were cut and then mounted in an organ bath. Tension (2 g) was placed on all strips and each underwent field stimulation (FS) for a total of 20 s at 1–32 Hz, 1 ms and 80 V and was exposed to carbachol (100 μmol/L), ATP (2 mmol/L) and KCl (120 mmol/L). The tension was monitored continually using a polygraph and data stored digitally in a computer. The responses to each stimulus were determined as the maximum tension generated, oaximum rate of tension generation and duration to a maximum response. The Ca2+‐ ATPase activity of the rat and rabbit bladder was determined. Bladder pressures were then predicted from the strip data using Laplace’s law and compared with published values.Results Contractile responses (per unit tissue mass) of rat bladder strips were significantly greater than those of rabbit bladder strips at all frequencies of FS and to carbachol, KCl and ATP. The rate of contractile force generated by rat bladder strips in response to all stimuli were significantly greater than that generated by rabbit strips. Rabbit bladder strips took significantly longer to generate maximum tension than did rat bladder strips in response to pharmacological stimuli. In response to FS, rat strips took significantly longer than rabbit strips to generate maximum tension. Although the predicted rat bladder pressures were significantly greater than those for rabbit, the predicted pressures for both the rat and rabbit were significantly lower than the pressure responses of the isolated whole bladder model. The contractile data correlated well with the Ca2+‐ATPase activity data; rat bladder had seven times the enzyme activity of rabbit bladder.Conclusion Per unit mass, rat bladder is capable of generating more than five times the tension of rabbit bladder. Similarly, the rate of tension generation by rat bladder is three to five times greater than that by rabbit bladder. The duration to maximum tension generated in response to FS compared with pharmacological stimuli was affected by the inherent difference in the rate of contractile response to electrical activation compared with agents which diffuse through tissue, and by the difference in size between rat and rabbit bladder smooth muscle cells.
Gastrinaemia and G‐cell density in the antral gastrocystoplasty: an experimental study in rats
Authors: Ortiz V. , Goldenberg S. 
Published: March 2003

Objective To evaluate gastrinaemia and G‐cell density in the antrum incorporated into the bladder of rats after antrocystoplasty.Materials and methods Thirty‐two adult, female Wistar EPM‐1 rats (body weight 200–220 g) were divided into four equal groups that underwent; group 1, no treatment (controls); group 2, a sham operation; group 3, antrectomy; and group 4, antrocystoplasty. The rats were assessed 2 months after treatment, and gastrinaemia and the G‐cell density determined in the antrum mucosa incorporated into the bladder.Results Compared with group 1, serum gastrin was significantly lower in group 3 (P < 0.05) and the G‐cell density lower in group 4 (P < 0.05), although there was no decrease in gastrinaemia in group 4.Conclusion Antrocystoplasty in rats did not affect gastrinaemia but reduced the number of G cells in the antrum incorporated into the bladder.
The relationship between early biochemical failure and perineural invasion in pathological T2 prostate cancer
Authors: Endrizzi J. , Seay T. 
Published: March 2003

Objectives To evaluate, in patients with pathologically localized prostate cancer, the relationship between early biochemical failure, i.e. an increasing prostate‐specific antigen (PSA) level, and perineural invasion (PNI) on final pathology. Patients and methods The records were reviewed of 171 patients with prostate cancer who underwent prostatectomy at one institution between January 1992 and December 1995. Data on the histology, therapy and PSA level were collected and evaluated. Results Of the 171 patients with pathologically localized (pT2) prostate cancer, 131 were evaluable; 17 (13%) had a detectable PSA level in the first 5 years after surgery and 63 had PNI in the pathological specimen. Of those with PSA recurrence, 14 had PNI, one had no PNI and in two there was no comment on PNI. In comparison, only 10 of the 17 patients with recurrence had a Gleason sum of  7. Conclusion Perineural invasion seems to be an important predictor of early outcome in patients with organ‐confined prostate cancer treated by prostatectomy. In this series it was the most sensitive predictor of biochemical failure. A more detailed pathological evaluation of prostate cancer may allow the clinician to provide closer surveillance and better informed clinical decision‐making.
Transrectal power Doppler imaging in the detection of prostate cancer
Authors: Okihara K. , Kojima M. , Nakanouchi T. , Okada K. , Miki T. 
Published: March 2003

Objectives To evaluate the clinical utility of transrectal power Doppler imaging (PDI) of the prostate for detecting prostate cancer in patients with abnormally high serum levels of prostate specific antigen (PSA).Patients and methods Patients (107) with abnormally high serum PSA levels were assessed using a digital rectal examination (DRE), transrectal ultrasonography (TRUS) and PDI. Any hypervascular lesion on PDI was graded on a scale of 0–3, where grade 1–3 was considered positive and grade 0 negative. Patients were then diagnosed by prostatic needle biopsy and the results compared with the other detection methods.Results Needle biopsy confirmed prostate cancer in 41 (24%) of the 170 patients. PDI was positive in 68, of whom 40 (59%) had prostate cancer; all those but one having prostate cancer were positive on PDI. Thus, PDI had a high sensitivity of 98% (40/41) and a negative predictive value of 99% (101/102). PDI could have saved a significant number of patients from undergoing unnecessary biopsies, compared with DRE and TRUS (P < 0.001).Conclusion The use of PDI in detecting prostate cancer might reduce the number of unnecessary needle biopsies of the prostate in patients with abnormally high serum PSA levels.
A prospective evaluation of scrotal ultrasonography in clinical practice
Authors: Adeyoju A.B. , Collins G.N. , Pollard A.J. , Liaw J. , Brooman P.J. , O'Reilly P.H. 
Published: March 2003

Objectives To prospectively evaluate scrotal ultrasonography (SUS) in patients presenting with scrotal symptoms and to make recommendations about use of SUS in clinical practice. Patients and methods Forty‐eight men with scrotal symptoms were examined by a urologist and independently underwent SUS by one radiologist with no knowledge of the clinical diagnosis. The clinical and SUS diagnoses were compared and the effect on subsequent management recorded. Results The clinical and SUS diagnoses agreed in 35 men (73%) although SUS provided an additional diagnosis in half of these men. The SUS diagnosis differed in 13 men (27%) although the management was altered in only four patients. Conclusion The clinical diagnosis is correct in most men with scrotal symptoms; the routine use of SUS is inappropriate and should be reserved for specific indications.
The prognostic value of inducible nitric oxide synthase in local prostate cancer
Authors: Aaltomaa S.H. , Lipponen P.K. , Viitanen J. , Kankkunen J‐P. , Ala‐Opas M.Y. , Kosma V.‐M. 
Published: March 2003

Objective To compare the clinical and histological data from patients with prostate cancer with the results of the immunohistochemical analysis of inducible nitric oxide synthase (iNOS), and thus determine the prognostic value of iNOS. Patients and methods The study included 82 patients (mean age 64.6 years,
sd 6.1) with local prostate cancer treated by radical prostatectomy in two Finnish hospitals. Their mean (
sd) follow‐up was 3.3 (2.2) years. An immunohistochemical method was used to detect the expression of iNOS in these specimens, and the expression graded according to staining intensity as none, weak or strong. Results There was weak or strong expression of iNOS in 25 (31%) and 56 (68%) of the patients, respectively, and one specimen was negative for iNOS. Strong expression of iNOS was related to high a preoperative prostate specific antigen (PSA) level (P = 0.006) and high pT classification (P < 0.001), but not to nodal status, grade, seminal vesicle or capsular invasion, surgical margin status, perineural infiltration, tumour infiltrating lymphocytes or proliferation rate of cancer cells. A PSA failure was detected in 29 patients but was not predicted by iNOS expression. A Cox multivariate analysis showed that surgical margin positivity, seminal vesicle involvement and number of tumour infiltrating lymphocytes predicted the PSA failure. Conclusion A high expression of iNOS was related to a high pT classification and the preoperative PSA level but not to other established prognostic factors; iNOS expression was not a predictor of PSA failure in patients with local prostate cancer.
5‐Hydroxytryptamine‐induced potentiation of cholinergic responses to electrical field stimulation in pig detrusor muscle
Authors: Sellers D.J. , Chess‐Williams R. , Chapple C.R. 
Published: March 2003

Objective To determine whether detrusor muscle from the pig can be used as a model to study presynaptic 5‐hydroxytryptamine (HT)4‐receptor‐mediated effects on the electrical field stimulated (EFS) cholinergic responses previously identified in the human bladder. Materials and methods Strips of detrusor muscle were mounted in physiological Krebs' solution under 1 g tension and field stimulated (25 Hz, 0.01 ms duration, 60 V for 5 s) at 100‐s intervals and allowed to equilibrate. Concentration‐response curves to 5‐HT (1 nmol/L to 300 µmol/L) were constructed in the presence and absence of the 5‐HT4‐selective antagonists RS‐100235 and GR‐113808 (both at 0.3, 1 and 3 nmol/L). All experiments were conducted in the presence of methiothepin and ondansetron (both 1 µmol/L) to block 5‐HT1, ‐HT2 and ‐HT3 receptors. Results 5‐HT potentiated the cholinergic responses to EFS in pig bladder strips in a concentration‐dependent manner, with a maximum mean (
sem) potentiation of 48.3 (7.7)% of the resting tension (n = 25). BothRS‐100235 and GR‐113808 antagonized the effect of 5‐HT with high affinity, yielding apparent pKB values which were consistent with the responses being mediated via the 5‐HT4 receptor subtype. Conclusion These data indicate that 5‐HT can potentiate EFS responses in isolated pig bladder strips and that the 5‐HT4 receptor subtype mediates this response. Therefore, the pig may be used as an effective model to study presynaptic 5‐HT4 receptors previously reported in the human bladder.