bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preliminary results of the alternating administration of natural interferon‐α and recombinant interferon‐γ for metastatic renal cell carcinoma
Authors: Fujii  , Yui‐En  , Ono  , Yamamoto  , Gohji  , Takenaka  
Published: March 2003

ObjectiveTo evaluate the efficacy and toxicity of the alternating administration of natural (n) interferon (IFN)‐α and recombinant (r) IFN‐γ for metastatic RCC.Patients and methodsThe study comprised 24 patients (median age 60 years, range 42–77), 20 of whom were evaluable for response and all 24 evaluable for toxicity. Initially, nIFN‐α was administered subcutaneously on days 1 and 3, and rIFN‐γ on day 2, for 1–2 weeks in the evening or at night, both at doses of 3 MU. If this regimen was tolerated, nIFN‐α and rIFN‐γ were administered at the same doses on days 1, 3 and 5, and on days 2 and 4, respectively.ResultsThere were three complete remissions and two partial remissions, giving a total response rate of 25%. All responders (complete plus partial remission) had undergone nephrectomy. Multiple lung metastases completely disappeared from four responders. The median and maximum time to remission in the responders were 2 and 7 months, respectively. The survival time of the responders was significantly longer than that of those not responding (stable and progressive disease, P=0.0202). Toxicities were mostly limited to WHO grades 1 and 2, with grade 3 leucopenia and grade 4 hepatic dysfunction in only one patient each. These toxicities were transient and there were no treatment‐related deaths.ConclusionThe alternating administration of nIFN‐α and rIFN‐γ is an effective treatment for metastatic RCC. This treatment is particularly suitable for patients who have undergone nephrectomy and have lung metastases.
Interstitial laser coagulation in patients with lower urinary tract symptoms from benign prostatic obstruction: treatment under sedoanalgesia with pressure‐flow evaluation
Authors: Dæhlin  , Hedlund  
Published: March 2003

Objectives To evaluate the effects on lower urinary tract symptoms and pressure‐flow variables after interstitial laser coagulation (ILC) of the prostate using the Indigo™ diode laser system (Indigo, Palo Alto, USA).Patients and methods Forty‐nine men (median age 68 years, range 52–80) were assessed using symptom scores and voiding variables before and at 3 and 12 months after ILC. A subset of 26 men (median age 68 years, range 63–72) underwent pressure‐flow measurements before and at 6 months after ILC. All treatments were performed in the outpatient department using sedoanalgesia.Results The International Prostate Symptom Score decreased from 22 to 11 at 12 months after ILC. The peak urinary flow (Qmax ) was 8.6 mL/s at baseline and increased to 9.9 mL/s at 12 months. Residual urine volumes were unchanged. The median duration of urinary retention after ILC was 3 days. From pressure‐flow recordings, 17 patients were categorized as obstructed and seven as equivocally obstructed before ILC (using the International Continence Society definition). Their Qmax increased from 7.7 to 9.0 mL/s after 6 months, the detrusor pressure at Qmax decreased from 68 to 51 cmH2O and the Abrams–Griffiths number decreased from 54 to 29 (P<0.01). Patients with moderate to equivocal obstruction had a greater relief of symptoms than those who were clearly obstructed. Patients with prostate volumes of >40 mL had a greater decrease in the Abrams–Griffiths number than had patients with smaller prostates. Postoperative perineal pain was reported by 72% of patients; the pain subsided after 1–2 weeks. The re‐treatment rate was 15% within the first year.Conclusion Treatment with ILC produced substantial effects on symptoms and moderate to small changes in urodynamic variables. Patients with moderate or equivocal bladder outlet obstruction or large prostates seem to be the best candidates for this treatment. However, treatment was followed by perineal pain for 1–2 weeks in most cases. A long‐term follow‐up is necessary to determine the role of ILC.
Influence of high‐grade prostatic intra‐epithelial neoplasia on total and percentage free serum prostatic specific antigen
Authors: Morote  , Encabo  , Lopez  , De Torres  
Published: March 2003

Objective To analyse the influence of high‐grade prostatic intra‐epithelial neoplasia (HGPIN) on total and percentage free serum prostatic specific antigen (PSA).Patients and methodsThe total and free serum PSA levels were measured (using a double‐monoclonal antibody immunoassay, Tandem and Tandem free PSA, Hybritech Inc, Liège, Belgium) in 570 consecutive patients undergoing sextant ultrasound‐guided prostatic biopsy because of an abnormal digital rectal examination or a serum PSA concentration of > 4.0 ng/mL. The main diagnosis was benign disease in 321 (56%) and prostate cancer in 249 (44%). HGPIN was detected in 85 (15%) of the patients; in 17 (20%) it was associated with benign tissue and in 68 (80%) with prostate cancer.ResultsPatients with benign disease had a median total serum PSA level of 7.2 with no HGPIN and 7.7 ng/mL when HGPIN was present (P>0.05); the corresponding values in patients with prostate cancer were 16.0 and 15.9 ng/mL (P>0.05). The median percentage free serum PSA was 15.8 in patients with HGPIN‐free benign disease and 14.1 when HGPIN was present (P>0.05); the corresponding values in patients with prostate cancer were 9.7 and 11.0 (P>0.05). In a multivariate analysis, prostate cancer was the major contributor to total and percentage free serum PSA levels.ConclusionThe presence of HGPIN does not contribute significantly to total and percentage free serum PSA levels.
Suture tracks after hypospadias repair
Authors: Snodgrass  
Published: March 2003

Objective To determine the incidence of suture tracks after hypospadias repair in which 6–0 chromic catgut was used to close the skin.Patients and methodsFrom an initial series of 72 boys undergoing tubularized, incised‐plate hypospadias repair, 23 (32%) were evaluated 1 year or more after surgery.ResultsOf the 23 boys, 10 (43%) were found to have suture tracks. In all cases tracks were located on the ventral shaft skin and did not involve the glans or dorsal aspect of the circumcision. These tracks had not been detected at an earlier follow‐up.ConclusionsTracks resulting from small absorbable sutures may not be apparent soon after surgery because the sinus is small. With time, the sinuses fill with keratin and thereby become obvious. The location of these tracks suggests that relative hypovascularity of ventral shaft skin may contribute to their development. The use of subcutaneous sutures may diminish the incidence of this minor complication of hypospadias surgery.
The neonatal management and surgical correction of urinary hydrometrocolpos caused by a persistent urogenital sinus
Authors: Arena F. , Romeo C. , Cruccetti A. , Antonuccio P. , Basile M. , Romeo G. 
Published: March 2003

Objective To define the neonatal management and ultimate surgical correction via the anterior sagittal transanorectal approach (ASTRA) in cases of neonatal urinary hydrometrocolpos associated with a persistent urogenital sinus (UGS). Patients and methods We report three patients with UGS (with no ambiguous genitalia) and urinary hydrometrocolpos in whom prenatal ultrasonography showed cystic dilatation of the pelvis. Two patients were temporarily treated with intermittent vaginal catheterization and antibiotic prophylaxis, and in one a cystostomy was necessary to temporarily drain the urine. At the age of 6–8 months the patients underwent reconstructive surgery of the UGS via the ASTRA, under a previous protective colostomy. Results The mean (range) age of the patients at the last follow‐up was 18.7 (8–32) months. A good cosmetic result was obtained in all patients. The vagina was dilated briefly with no anaesthesia in each patient. Patients had normal faecal control after the colostomy was closed and none had urinary incontinence. Conclusions When possible, intermittent vaginal catheterization permits sufficient temporary drainage of the urinary hydrometrocolpos associated with a persistent UGS. Subsequent ASTRA allows good exposure of the UGS, assuring the preservation of the anorectal innervation and of the sphincteric mechanism.
Short‐term morbidity and acceptability of 125iodine implantation for localized carcinoma of the prostate
Authors: Al‐Booz H. , Ash D. , Bottomley D.M. , Carey B.M. 
Published: March 2003

ObjectiveTo report the short‐term morbidity and acceptability of the first 50 patients treated with the percutaneous implantation of radioactive iodine seeds for localized carcinoma of the prostate at the Cookridge Hospital.Patients and methodsFifty patients were treated with transrectal ultrasonography‐guided percutaneous implants with radioactive (125I) iodine seeds for localized carcinoma of the prostate. The mean hospital stay was 36 h and most patients were able to return to work or normal activity within one week of implantation.ResultsAll patients developed urethritis which was most marked within the first 3 months of treatment; 8% of patients developed acute retention which resolved after temporary catheterization. At 3 months, 36% of patients still had moderate frequency and 18% moderate dysuria, but by 12 months these had resolved and only 5% of patients still complained of moderate nocturia. There were no cases of incontinence. The incidence of proctitis was very low, with only 2% still complaining of moderate symptoms at one year. Of those potent before implantation, 72% retained potency at one year.ConclusionsAlthough it is too early to comment either on late morbidity or on outcome, the results of this study show a side‐effect profile similar to that reported by other centres using the same technique.
Bladder augmentation with different forms of intestinal grafts: an experimental study in the pig
Authors: Clementson Kockum  , Willén  , Malmfors  
Published: March 2003

ObjectiveTo create an experimental animal model to examine changes in bladder volume and histology after bladder augmentation in growing individuals and from the model, evaluate a method using demucosalized intestinal grafts and short‐term bladder drainage.Materials and methodsThe study comprised 21 piglets: in group 1, seven underwent a sham operation; in group 2, seven piglets underwent bladder augmentation with full‐thickness caecum after a major bladder resection; in group 3 seven underwent the same procedure but with demucosalized caecum. The bladder volume and area of the intestinal segment were measured peroperatively and when the animals were killed 2 months later. Bladder specimens were taken for histological examination.ResultsThe mean preoperative bladder volumes were similar among the groups; in the control group, volumes increased from 58 to 165 mL and in group 2 from 63 to 255 mL, with an increase in area of the intestinal segment from 59 to 138 cm2 . In group 3 the volume was unchanged, from 63 to 71 mL, with a decrease in area from 58 to 5 cm2 . Control bladders showed normal urothelium with neutral mucins and sialomucins. In group 2, there was metaplasia in the border between urothelium and colonic epithelium, with enhancement of sialo‐ and sulphomucins. Demucosalization resulted in extensive fibrosis, with a monolayer of urothelial cells showing metaplasia.ConclusionsThe experimental model was successful; the observed changes in bladder volume correlated well with the fate of the intestinal implant, because the bladder resection was major. This is essential, as the bladder remnant has some growth potential. Full‐thickness grafts grew faster than the normal bladder. Mechanical demucosalization, including submucosa, results in shrinkage despite short‐term drainage. Glandular metaplasia, with production of sialomucins and sulphomucins, occurs at the junction between bladder and colon, irrespective of mucosal removal.
Results of the Gil Vernet procedure in preventing contralateral reflux in unilateral ureteric reflux
Authors: Liard  , Pfister  , Bachy  , Mitrofanoff  
Published: March 2003

ObjectiveTo evaluate whether contralateral meatal advancement based on the technique described by Gil Vernet decreases the risk of postoperative contralateral reflux, which may occur after a unilateral reimplantation.Patients and methodsFrom January 1986 to 1997, 321 reimplantations were performed for unilateral vesico‐ureteric reflux (VUR) using the Cohen procedure. In cases where the contralateral meatus was symmetrical or had a pathological appearance, preventive contralateral surgery with meatal advancement was performed.ResultsUreteric reimplantation was exclusively performed unilaterally in 254 patients and in 67 a contralateral meatal advancement was performed. There were 29 cases of contralateral reflux at the 4‐month follow‐up. In nine patients contralateral reimplantation was necessary for persistent symptomatic VUR, the reflux resolved spontaneously in 14 and a radiological examination was necessary in six. Reflux also appeared on the Gil Vernet side in only 6% of patients; there were no clinical symptoms and the outcome was favourable.ConclusionThe advancement of the meatus using the Gil Vernet procedure is simple, with no surgical complications. We suggest that this technique constitutes a useful surgical alternative in the prevention of contralateral reflux.
Intravesical bacille Calmette‐Guérin in the treatment of carcinoma in situ or high‐grade superficial bladder carcinoma after radiotherapy for bladder carcinoma
Authors: Palou  , Sánchez‐Martín  , Rosales  , Salvador  , Algaba  , Vicente  
Published: March 2003

ObjectiveTo evaluate the effectiveness and tolerance of endovesical bacille Calmette‐Guérin (BCG) after pelvic radiation therapy for bladder cancer in patients with recurrence as carcinoma in situ (CIS) and/or high‐grade superficial bladder cancer.Patients and methodsIn a prospective study, 13 patients were treated with weekly instillations of 81 mg BCG Connaught for 6 weeks, for CIS and/or high‐grade superficial bladder carcinoma. All had been treated previously with radical radiation therapy for bladder carcinoma.ResultsFive patients had no recurrences and six patients retained their bladders, within a median follow‐up of 74.5 months. Five patients progressed; two underwent radical surgery and are alive after 75 months of follow‐up, and three died from the disease (two were high‐risk surgical patients and one had metastatic disease). Another two patients died from intercurrent disease without bladder cancer. Eight patients were alive at a mean (sd, range) follow‐up of 85 (12, 65–97) months.ConclusionIntravesical BCG is useful for controlling CIS and/or high‐grade superficial bladder carcinoma in irradiated bladders and has an acceptable local tolerance; more than a third of patients were free of disease and preserved their bladders. This proportion is acceptable in patients currently scheduled for cystectomy.
Calculating the direct costs of urinary incontinence: a new test instrument
Authors: Dowell  , Bryant  , Moore  , Simons  
Published: March 2003

ObjectivesTo develop a universally applicable test instrument to measure the total direct costs of urinary incontinence, including personal costs and treatment costs, i.e. the Dowell‐Bryant Incontinence Cost Index (DBICI), and to study the construct validity and test‐retest reliability of the instrument.Patients and methodsIn a prospective observational study, 100 consecutive community‐dwelling ambulatory women who presented with stress, urge or mixed incontinence were asked to complete the DBICI questionnaire on two occasions, 7 days apart, before any treatment. The construct validity of the DBICI was ascertained by correlation with other standard measures of urinary incontinence severity; (i) a visual analogue scale (VAS) to assess the impact of leakage upon lifestyle; (ii) frequency‐volume charts (voids/24 h, leaks/week); (iii) urine loss during a standard 1 h pad test; and (iv) two disease‐specific quality of life questionnaires. The test‐retest reliability was measured by comparing the two test results and the construct validity of the individual subsets (personal and treatment) of the DBICI similarly assessed.ResultsNinety‐seven women completed the baseline assessment and 84 completed the re‐test. The median (interquartile range) total direct incontinence cost (in Au$) was 12.89 (5.26–22.67) per week, which comprised the median personal costs of 5.61 (1.68–10.36) and the median treatment costs of 4.96 (1.22–13.37). The total direct incontinence cost was significantly correlated with the severity of urinary leakage on a 1 h pad test (Kendall’s rank correlation, P=0.01), with the VAS impact score (P<0.001) and with the number of leaks/week (P=0.005). The correlation between the personal cost subset and other quantitative measures was also highly significant. Test‐retest analysis of the personal costs subset revealed that this subset was robust and satisfied the statistical criteria of repeatability.ConclusionsThe DBICI gives a detailed measure of the direct economic costs of urinary incontinence in ambulatory home‐dwelling women, with the construct validity confirmed by the significant correlation with other quantitative measures of incontinence. By substituting local prices into the test format, the index should be useful in other countries. In the current climate of economic rationalization, such an index should be a part of future urinary incontinence research.
Radiographic vs surgical size of renal tumours after partial nephrectomy
Authors: Herr H.W. 
Published: March 2003

Objective To compare the radiographic with the surgical size of renal tumours selected for partial nephrectomy. Patients and methods In 50 patients undergoing elective partial nephrectomy for renal carcinoma (31 men and 19 women, preoperative tumour size 1.5–5.2 cm) the maximum size of the renal tumour, as assessed from computed tomography (CT) before surgery, was compared with the tumour size at surgery. All patients had their renal artery temporarily occluded before surgery to shrink the kidney. Results After partial nephrectomy, the renal tumours were a mean of 0.63 cm smaller than the estimate from CT; tumours of  3.5 cm on CT were particularly reduced. Conclusion Incidentally discovered tumours on CT that are < 3.5 cm and favourably located are often selected for partial nephrectomy. If temporary vascular occlusion and surface hypothermia of the kidney causes shrinkage of most tumours of  3.5 cm, then surgeons might attempt partial nephrectomy in borderline cases, with a better chance of complete resection.
A comparison of the relative merits of radical perineal and radical retropubic prostatectomy
Authors: Sullivan L.D. , Weir M.J. , Kinahan J.F. , Taylor D.L. 
Published: March 2003

ObjectiveTo compare the outcome, advantages and disadvantages of retropubic and perineal approach to radical prostatectomy, as performed by one surgeon. Patients and methodsThis unrandomized study included 138 patients who underwent either radical retropubic (RRP) or radical perineal prostatectomy (RPP), based on the specific conditions or the patient’s choice; 79 patients (mean age 64.6 years) underwent RPP and 59 (mean age 61.7 years) RRP. Outcome measures included estimated blood loss, the incidence of blood transfusions, positive margins and complications, operative duration, analgesic use, days in hospital and quality of life. Results There was no difference in operative duration, and the incidence of positive margins or complications between the groups. The mean estimated blood loss in the RPP and RRP groups was 415 and 1138 mL, respectively. The RPP group stayed a mean of 2.2 days less in hospital and took 2.8 days less to regain a full diet than the RRP group; the RPP group needed 1.7 days before using oral analgesics and the RRP group 3.8 days. Of patients in both groups, 85% were pad‐free at one year and their overall quality of life was similar. ConclusionsThe results of RRP and RPP are comparable; the advantages of the perineal approach include minimal blood loss, low‐intensity postoperative nurs‐ing care, low analgesic use and earlier discharge from hospital.
Do experimentally induced ipsilateral testicular torsion, vas deferens obstruction, intra‐abdominal testis or venous obstruction damage the contralateral testis through a common mechanism?
Authors: Andiran F. , Okur D.H. , KiLiNç A. , Gedikog¯lu G. , KiLiNç K. , Tanyel F.C. 
Published: March 2003

Objective To evaluate if various conditions affecting the ipsilateral testis which also damage the contralateral testis share a common pathway for their effects. Materials and methods The study comprised five groups of 10 adult rats which underwent surgery to produce (on their left sides); group 1, a sham operation (control); group 2, testicular torsion; group 3, vas deferens obstruction; group 4, an intra‐abdominal testis; and group 5, venous obstruction. The ipsilateral and contralateral testes were harvested 4 weeks after surgery. The relative proportions of haploid cells, the mean seminiferous tubular diameter (MSTD), mean testicular biopsy scores (MTBS), and lactate and hypoxanthine levels were determined and compared. Results The proportions of haploid cells in the ipsilateral and the contralateral testes of groups 2–5 were significantly lower than those of the corresponding testes of the control group. The MSTD and MTBS of the ipsilateral testes in groups 2–5 were also significantly lower than the ipsilateral testes of controls and the contralateral testes within the same groups. While the MSTD and MTBS of the contralateral testes of groups 1 and 5 were not significantly different, those of the contralateral testes of groups 2–4 were significantly less than that of group 1. The lactic acid and hypoxanthine levels of the ipsilateral and contralateral testes were significantly increased in groups 2 and 3. While only the hypoxanthine level of group 5 increased significantly, both variables were not significantly different between the ipsilateral testes of groups 1 and 4. Conclusions These four treatments damaged both the ipsilateral and contralateral testes. As the lactic acid and hypoxanthine levels within the contralateral testis were greater than in the controls, testicular torsion and vas deferens obstruction seem to share a common pathway (which may be a reflex decrease in contralateral testicular blood flow) for their effects on the contralateral testis.
Congenital megaprepuce: an emerging condition – how to recognize and treat it
Authors: Summerton D.J. , Mcnally J. , Denny A.J. , Malone P.S.J. 
Published: March 2003

Objective To highlight the clinical presentation, pathological anatomy and surgical management of an emerging condition, the congenital megaprepuce (CM). Patients and methods All patients with CM treated at Southampton between 1994 and 1998 were reviewed retrospectively; 20 patients underwent surgery (mean age at operation 16 months, range 6–43). Surgical correction developed over this period and variations on a basic technique are now used, depending on the precise pathological anatomy. These techniques are described and illustrated. Cosmetic and functional success, and parental satisfaction, were assessed by a review of the case‐notes. Results After a follow‐up of  6 months, the cosmetic and functional outcome was very successful, with the parents of 19 of the 20 patients satisfied. Five patients underwent re‐operation, all requiring excision of redundant penile skin. Conclusions CM is a striking condition which cannot be easily missed or hidden; we propose that it is a newly emerging and distinct condition which should not be confused with a buried, concealed, webbed, trapped or micropenis. Early surgical correction is recommended and circumcision should be avoided.