ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.00104.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.00085.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To review published reports of surgically treated adrenal myelolipomas and report experience with a further eight cases.Patients and methods Eight patients (three men and five women, mean age 50.7 years) with adrenal myelolipoma were treated surgically because of the tumour size, symptomatology and/or associated renal pathology. Associated medical problems included hypertension in three patients and diabetes mellitus in one but none of the tumours was endocrinologically active.Results Five patients were diagnosed definitively by abdominal ultrasonography, computed tomography and angiography while the other three were incidentally diagnosed during surgical intervention for ipsilateral renal cell carcinoma in one patient, hydronephrotic kidney in another and multiple renal stones in the third. On pathological examination, the masses removed were surrounded by a thin fibrous capsule and compressed cortical tissue. A cut section was bright yellow with foci of red‐brown discoloration. Microscopically, the tumour consisted mainly of mature adipose tissue with scattered islands of haemopoietic cells. There was no operative mortality and no gross morbidity.Conclusion The management of adrenal myelolipoma should be appropriate to each individual case. Operative intervention should be reserved for symptomatic patients or those with large ‘silent’ tumours that may produce life‐threatening shock secondary to spontaneous haemorrhage. Small asymptomatic tumours with definite radiological findings can be follo

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.00081.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objectives To compare treatment outcomes in symptomatic and incidental renal cell carcinoma (RCC) with specific interest in the role of radical nephrectomy.Patients and methods The records of 189 patients with a clinical diagnosis of RCC were reviewed. The mode of presentation, tumour size, grade and stage at presentation were correlated with final outcome, as measured by the disease‐free and overall survival of the patients.Results The rate of incidental detection was 15%; incidental tumours were of a lower stage and patients with incidentally detected tumours had a significantly longer disease‐free and overall survival than had those with symptomatic tumours (P<0.05).Conclusions The increased detection of incidental tumours should further improve survival in RCC. We continue to advocate radical nephrectomy for incidentally detected tumours, as it offers the best outcome and simplifies th

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.00140.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To report eight cases of limited Wegener's granulomatosis (WG) affecting the urogenital tract (testis, ureter, bladder, urethra and penis) and to emphasize the importance of the anti‐neutrophil cytoplasm antibody (ANCA) test in establishing the diagnosis.Patients and methods Eight patients (six men and two women, aged 41–77 years) were diagnosed with WG, based on their previous medical history, the ANCA test and by biopsy.Results In each case, there were difficulties and delay in establishing the diagnosis of WG and starting appropriate treatment. The ANCA test was positive in seven cases and helped in establishing the diagnosis, in conjunction with the confirmation of vasculitis and granulomata by biopsy.Conclusion We advocate ANCA testing in patients presenting with limited urogenital disease in association with a past or present relevant history of arthritis, skin vasculitis and/or biopsies showing necrosis or non‐specific

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.00166.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To characterize the multidrug resistance (MDR) phenotype in human urothelial cancers, the expression levels of four MDR‐related genes (multidrug resistance,mdrl; multidrug resistance‐associated protein,MRP; glutathione S‐transferase‐π,GST‐π; and DNA topoisomerase II,topo II) were analysed in urothelial cancers.Materials and methods Fifty‐two tumour tissue and three normal urothelial mucosa samples were obtained from 44 patients with urothelial cancers. The expression of each gene was analysed with a reverse‐transcription polymerase chain reaction (RT‐PCR) method using β2‐microglobulin (b2m) mRNA as an endogenous control. Levels of expression were expressed as the ratio of the specific products of the target gene to those specific tob2m.Results In primary urothelial cancer tissues, the mean (sd) expression ofmdrl,MRP,GST‐πandtopo IIrelative tob2mexpression were 0.067 (0.061), 0.27 (0.23), 0.35 (0.31) and 0.12 (0.05), respectively. The mean expressions ofMRPandGST‐πwere higher than those ofmdrlandtopo II. The mean ratios ofmdrl/b2m,MRP/b2m,GST‐π/b2mandtopo II/b2min normal urothelial mucosa were 0.06 (0.03), 0.12 (0.09), 0.30 (0.32) and 0.14 (0.01), respectively. There was no significant association of the expression of each gene with either the grade or extent of the primary tumour. The level ofMRPexpression in each sample was correlated significantly with the expression ofmdrlandGST‐πin the urothelial cancers (r=0.637 and 0.537, respectively). Chemotherapy did not markedly influence the induction of expression of the MDR‐related genes, except for one case in whichmdrlexpression was 15 times greater than before chemotherapy. The expression ofGST‐πin the patients not receiving chemotherapy was significantly higher than in those that did.Conclusions These results suggest that the activation ofMRPandGST‐πexpression occurs during the tumorigenesis of urothelial cancers and that it may conferde novoand acquired drug resistance on urothelial cancers. These results should provide further insight into the complex role postulated for MDR‐related genes in c

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.00099.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To determine the impact of post‐operative education about bladder cancer and topical immunotherapy on the physical, psychological and social well‐being of patients with superficial bladder cancer.Patients and methods Eighty‐five patients (mean age 59 years, range 26–85, 64 men and 21 women) receiving topical immunotherapy were questioned during the initial cycle of treatment and during maintenance therapy with bacille Calmette‐Guérin (BCG). Patients completed a questionnaire on their quality of life when they commenced treatment and twice more during maintenance therapy.Results Psychological distress and physical symptoms were intense when the diagnosis of bladder cancer was revealed to the patients, despite the knowledge that this cancer is usually curable. The overall quality of life, condition of health and sexual activity were mostly only moderate, were poor during initial therapy and better during 3‐monthly maintenance therapy.Conclusion In general, the quality of life of these patients is characterized by the disruption of their lifestyle and marked by change in their circumstances. It is the responsibility of the urologist to take the necessary time to educate, comfort and motivate such patients with superf

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.00134.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objectives To determine the current management of superficial bladder cancer in the United Kingdom.Methods An interactive seminar with a series of questions about management and hypothetical clinical scenarios was conducted at the 1995 conference of the British Association of Urological Surgeons. The responses of the audience were recorded electronically and analysed.Results The results showed that there is a wide variation in practice and some confusion over the place of intravesical treatment using cytotoxic drugs and bacille Calmette‐Guérin.Conclusions The management of superficial bladder cancer could be improved by a more widespread use of intravesical therapy, along with the introduction of local protocols and national

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.00135.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To examine the safety of finasteride as used in general medical practice to treat benign prostatic hypertrophy (BPH).Patients and methods Information was collected on 14 772 patients who were included in an observational cohort study conducted using Prescription‐Event Monitoring.Results Finasteride was reported to have been effective in 60% of the patients in whom an opinion on efficacy was recorded. Impotence or ejaculatory failure was reported in 2.1% of the patients, decreased libido in 1% and gynaecomastia and related conditions in 0.4%. Impotence was the most frequent reason for stopping treatment with finasteride and was the most commonly reported adverse reaction to the drug. Of the patients included in the elderly cohort involved in this study, 819 (5.5%) died; none of these deaths was attributed to finasteride.Conclusion Impotence or ejaculatory failure, decreased libido and gynaecomastia in a small proportion of patients were associated with the use of finasteride. The results of this study strongly suggest that this drug is acceptably safe when used in accordance with the current prescribing in

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.00091.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objectives To compare the results obtained using a portable home‐based uroflowmeter with the results of traditional flowmetry performed in the out‐patient department (OPD).Patients and methods Sixty‐seven patients (mean age 61 years, range 38–79) with lower urinary tract symptoms and/or benign prostatic enlargement used a home‐based uroflowmeter comprising a datalogger and specially designed fluid sensors incorporated into disposable beakers. The results of these measurements were compared with those from uroflowmetry in the OPD and with other clinical variables.Results There was a good correlation between the uroflow results obtained when voiding at home and at the OPD. The highest measured maximum flow and voided volume were obtained with the home‐based uroflowmeter system. However, the mean of all consecutive home‐based maximum flow and voided volume measurements were lower than those obtained by single‐void uroflowmetry in the OPD.Conclusions Home‐based uroflowmetry provides reliable voiding results which are comparable with

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.00115.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY