bluuebunny/crossref_metadata_2025 huggingface dataset:
VESICO‐URETERIC REFLUX FOLLOWING OPERATIONS ON THE URETERIC ORIFICE
Authors: Roper Brian A. , Smith Joe C.
Published: December 2008

The incidence of ureteric reflux in fifteen patients after operations on seventeen ureteric orifices has been assessed by micturating cystography and its significances discussed.

 Reflux can best be detected by micturating cystography and reports on a larger series would seem desirable. The cystoscopic appearance of the orifice is of little value in deciding whether reflux occurs.

 The relative importance of reflux and infection in the production of chronic pyelonephritis is discussed.

 Incision of ureteroceles with cystoscopic scissors seems to be preferable to their destruction by diathermy.

 Post‐operative micturating cystography is advised for patients who have had operations on the ureteric orifice.
DOUBLE CONTRAST CYSTOGRAPHY APPLIED TO THE DIAGNOSIS OF TUMOURS IN BLADDER DIVERTICULA
Authors: Shawdon Harry H. , Doyle Frank H. , Shackman Ralph
Published: December 2008

Four patients with tumours in bladder diverticula are described. Relevant diagnostic procedures and their limitations are briefly discussed. Attention is drawn to the value of double‐contrast cystography as a method for demonstrating tumours in bladder diverticula.
URETHRAL DIVERTICULA IN MALES: (With a Report of Eight Cases)
Authors: Maged Aly
Published: December 2008

Eight cases of urethral diverticula in the male are reported and the different causes in each case described. The aetiology, symptomatology and treatment of the condition are also discussed.
THE RENAL LYMPHATICS AND THERAPY OF PYELONEPHRITIS1
Authors: Cockett Abraham T. K. , Moore Raymond S. , Kado Ray T.
Published: December 2008

Urinary levels of Furadantin exceed the drug concentrations in the renal lymph and plasma.

 Renal lymph levels of Furadantin exceed plasma levels by two‐fold to three‐fold.

 Antimicrobial activity is demonstrated in the renal lymph against Esch. coli.

 Plasma concentrations of Chloromycetin exceed renal lymph levels by two‐fold.

 Antimicrobiological activity of renal lymph containing Chloromycetin is demonstrated against Shigella sonnei.

 Renal hilar lymph containing Furadantin was obtained from a patient. Renal hilar lymph concentrations exceeded plasma levels by five‐fold.

 All therapeutic agents alleged to be effective in treating pyelonephritis need to be reevaluated using the renal lymph‐plasma system.
SOME OBSERVATIONS ON THE VALUE OF EXCRETION UROGRAPHY IN THE DETECTION OF RENAL TUMOURS
Authors: Cope V. , Hackett M. , Raphael M. J.
Published: December 2008

The results of a post‐mortem study into the sensitivity of pyelography for the detection of renal tumours are reported.
URINARY INFECTIONS: RESULTS OF TREATMENT WITH COMPOSITE LONG‐ACTING SULPHONAMIDE (DOSULFIN)
Authors: Sutherland J. W.
Published: December 2008

The investigation surveys the progress of 210 patients treated for urinary tract infections which were sensitive to sulphonamide, with the composite long‐acting sulphonamide Dosulfin (Geigy).

 Three groups of clinical infection were recognised according to the chronicity of the infection and the presence or absence of any underlying urological condition. The numbers in the three groups were approximately equal.

 Clinical details studied included age, sex, length of symptoms, urological diagnosis, radiological, cystoscopic, and bacteriological findings. The diversity of conditions encountered made the test of the therapeutic agent employed a fairly stringent one, even although the infection was sensitive to it.

 Success was regarded as being the eradication of both the symptoms and the pus cells and organisms from the urine. This was achieved in over 60 per cent, of all cases treated with Dosulfin and in over 80 per cent, of Group I cases (early infections). Uncomplicated urinary infections responded therefore quite satisfactorily. Results were poorer in Groups II and III. Females seemed to respond slightly better than males.

 In a smaller group of 51 patients followed for longer periods, 70 per cent, did not relapse when observed over periods ranging from four to fifteen months.

 Previous investigations suggest that there is a natural cure rate, and to prove themselves of real value any new compounds must clearly produce better results than this rate.

 Long‐acting composite sulphonamide fulfils fairly well most of the conditions laid down for the perfect therapeutic agent for urinary infections apart from the possession of broad‐spectrum activity. This apart, the newer sulphonamides merit more attention than they are receiving and a return to their use on a wider scale is obviously overdue.

 Urinary infections are potentially dangerous as well as disturbing to patients. They are the commonest of all urological conditions and in many ways the least well understood. Nothing could be further from the truth than to say that the subject is simply a matter of determining sensitivities and carrying on mechanically from there.
EXTENDED PYELOLITHOTOMY FOR RENAL CALCULI
Authors: BLANDY J. P. , TRESIDDER G. C.
Published: December 2008

Extended pyelolithotomy offers a method for removing large or multiple renal stones with negligible bleeding or damage to the parenchyma. Experience based on 30 cases is described.
SURGICAL RECONSTRUCTION OF THE EXTERNAL GENITALIA IN FEMALE PSEUDOHERMAPHRODITES
Authors: STEFAN H.
Published: December 2008

The author analyses his experience of reconstruction of the external genitalia in ten females and one male pseudohermaphrodite who were operated on by labioplasty and clitoridoplasty in one session.

The submerged vaginal introitus is enlarged after cutting of a skin flap from the perineum. The corpora cavernosa of the hypertrophied clitoris are stitched and obliterated by mattress sutures, the glans being diminished by resection and overlapped by skin. The operation can be carried out before the age of 5 years. The advantages of this method over those previously described are discussed.
BLADDER–NECK OBSTRUCTION AND THE EHLERS–DANLOS SYNDROME
Authors: EADIE D. G. A. , WILKINS J. L.
Published: December 2008

A case is reported of the Ehlers–Danlos syndrome in which the well–known cutaneous and orthopædic manifestations were accompanied by bladder outlet obstruction and diverticulum of the bladder, which were successfully relieved by operation.

We should like to thank Mr John Blandy for his kind permission to publish this case, and Mr Ruddick, from the Department of Photography, The London Hospital.
CARCINOMA OF PENIS
Authors: FREW I. D. O. , JEFFERIES J. D. , SWINNEY JOHN
Published: December 2008

SUMMARY AND CONCLUSIONS

Forty–six cases of carcinoma of the penis treated primarily by surgery were reviewed. The following conclusions were reached:

Clinical staging as determined at the initial examination was of little value.

Pathological division into “solid” or “cord” pattern was of great importance in selecting cases with a good (solid) or poor prognosis (cord). The degree of differentiation was of much less prognostic value.

Urinary troubles were rare following a partial or radical amputation.

There was little point in preserving penile length except for psychological reasons, as few cases were having regular sexual intercourse when their disease was diagnosed.

We would like to thank Mr W. Keith Yeates of the Department of Urology, Newcastle General Hospital, for permission to include a number of his cases in this series.
FULMINATING RETROPERITONEAL FIBROSIS WITH PERICYSTITIS PLASTICA
Authors: WEBB JOHN , DAWSON–EDWARDS P.
Published: December 2008

A 36–year–old male diabetic developed a bizarre acute illness which was eventually revealed as severe retroperitoneal fibrosis and pericystitis plastica for which nephro–ureterectomy was performed. The co–existing prostato–vesiculitis and gross lymphadenopathy are discussed in relation to the ætiology of this mysterious pathological process. Cytological studies of the lymphadenopathy and retroperitoneal tissue are also presented, together with the pyelographic appearances.

The cytological studies (A. J. W.) are supported by grants from the Ernest and Minnie Dawson Cancer Trust, and the University of Birmingham Cancer Research Fund. Our thanks are due to Mr T. Dee for photographic help.
ADENOCARCINOMA OF THE FEMALE URETHRA
Authors: STEYN J. , HALL M. , LOGIE N. J.
Published: December 2008

An unusual case of adenocarcinoma of the female urethra presenting as retention of urine is described. A brief review of the literature is made. A plea is made for the use of radical surgery with the application of radium for any local recurrences.
FOREIGN BODIES AND DAMAGE TO THE FEMALE URETHRA AND BLADDER
Authors: JAMESON R. M.
Published: December 2008

The rarity of damage to the lower urinary tract in females following introduction of a foreign body is discussed and a case of injury to the urethra and bladder following insertion of a ball–point pen is described. Attention is drawn to the motives for self–introduction of foreign bodies and the methods of treatment are discussed

I am grateful to Mr J. Swinney for permission to publish details of the cases described.
CLINICAL EXPERIENCE WITH RENAL SCANNING USING Hg197CHLORMERODRIN1
Authors: GRAHAM A. G. , SCOTT J. S. , KENNEDY I. , MACK W. S.
Published: December 2008

The technique and results of performing renal scans in 148 patients, using Hg197chlormerodrin, are described. Information regarding renal function, rather than structure, has proved the more useful. The indications for carrying out renal scanning are discussed.

We should like to express our thanks to Mr Gabriel Donald and his Staff in the Department of Medical Illustration for providing the illustrations in this paper. We are also grateful to our medical colleagues in the Western Infirmary for permission to include their patients in this study.
URGENT MANAGEMENT OF ACUTE RETENTION OF URINE
Authors: TINCKLER LAURENCE F.
Published: December 2008

The subject of acute retention of urine is discussed with regard to urgent means of relieving the condition, and a pre–packaged, pre–sterilised appliance designed for suprapubic intubation drainage of the bladder is described.
CANCER OF THE BLADDER IN JAMAICA
Authors: ATKINSON D. W.
Published: December 2008

The pattern of carcinoma of the bladder in Jamaica is presented. The high incidence of squamous carcinoma in both sexes is discussed together with possible ætiological factors. The incidence of urethral stricture in association with carcinoma is given.
PART II PATHOLOGY
Authors: MATZ L. R. , CRAVEN J. D. , HODSON C. J.
Published: December 2008

Observations on the structural changes in experimental hydronephrosis due to complete obstruction of the lower ureter of pigs have suggested that the mechanism of renal substance loss is primarily due to a direct pressure effect on and within the papillae. As a consequence of extensive tubular rupture, disintegration or atrophy, there is a progressive loss of pyramid tissue.

Initial cortical changes are secondary to changes in the papillae because of interference with segments of individual nephron units, and consist predominantly of tubular atrophy, although tubulorrhexis also occurs. The distribution of the early cortical changes is related to an anatomical fact frequently overlooked—‐Henle loops are distributed within pyramids according to glomerular zones. Compression of the pelvic renal vein branches by the distending pelvis increases abnormal intra–renal pressure gradients as does focal thrombosis of peritubular capillaries and veins, and may be a contributory factor to furthering and maintaining tubular damage. There is no evidence of a major segmental ischasmic effect. Although compression of the interlobar arteries would be expected to produce general ischaemia in obstructed kidneys, the best preserved cortical areas are furthest from the blood supply, and in post–obstructed kidneys there is no evidence of a previous general ischaemic effect. During the fourth week the rate of cortical atrophy is increased, for with dilatation of the pelvis an increased effective compression force is exerted upon the lateral portions of renal lobules.

When ureteric obstruction is relieved and the kidneys are allowed to repair for six months, there is a progressive reduction in kidney size in proportion to the period of obstruction. One kidney became contracted with surface scars, but there is no evidence of chronic pyelonephritis. The histological appearances of these kidneys are of amazing reconstruction of the cortex with minimal fibrosis.

One incompletely obstructed kidney became larger than the contralateral kidney in the six–month post–obstructive period, although of reduced mass. Further studies on back pressure atrophy due to incomplete ureteric obstruction are required to resolve conflicting views on pathogenesis.
An Aggressive Approach to Stones in the Lower Ureter
Authors: WALSH ANTHONY
Published: December 2008

In cases of stone in the lower ureter, a conservative attitude should be adopted only if the patient is symptom free and there is no significant ureteral obstruction.

Properly used, the Dormia basket is a safe and effective instrument.

In a consecutive series of 126 cases of stone in the ureter where the Dormia basket was used, the stone was extracted immediately in 82 (65 %).

When the stone is stuck in the intramural ureter it should be removed by transurethral ureterolithotomy.
A Classification and Quantitative Histological Study of Abnormal Ureters in Children
Authors: EMERY JOHN L. , GILL GORDON W.
Published: December 2008

A gross and quantitative study of the muscle and connective tissue and elastic tissue has been carried out on a series of 78 abnormal ureters in children.

The ureters have been classified into 5 classes: (A) normal; (B) ureters with irregular dilatations; (C) slightly dilated ureters with muscular hypertrophy and hyperplasia; (D) elongated and dilated ureters with muscular hypertrophy and hyperplasia but probably decompensated; (E) grossly distended and elongated ureters having an increase in elastic tissue but with no comparable muscular hypertrophy or hyperplasia.

Ureters showing structural changes do so uniformly throughout their length and no local anatomical deformities were found to account for the irregularities in the ureters of Class B.

Structurally incompetent uretero‐vesical junctions are only associated with ureters of Classes D and E.

All abnormal ureters show varying degrees of muscular hypertrophy and hyperplasia. It is suggested that the form of the ureter is related to whether or not the muscular hypertrophy is adequate to compensate for the increased luminal diameter.
Nephrogenic Adenoma of the Urinary Bladder
Authors: TANEJA O. P. , AURORA A. L. , GROVER N. K. , GULATI S. M. , TAGORE N. K.
Published: December 2008

A case of nephrogenic adenoma of the urinary bladder has been reported. This tumour is essentially benign and probably arises as a result of metaplasia due to chronic urinary tract infection.

The disease affects young males and is characterised by haematuria.

Fulguration of the tumour is effective in controlling haematuria.

A close watch and follow‐up is essential to detect recurrence.
Total Replacement of Ureter by a ScurasilR Prosthesis in Pigs: Morphology and Renal Function: A Clinical Trial in Two Patients
Authors: DJURHUUS J. C. , GYRD‐HANSEN N. , NERSTR0M B. , SVENDSEN O.
Published: December 2008

Five pigs of the Danish Landrace breed had one ureter totally replaced with a Scurasiln prosthesis provided with RhodergonR cuffs and an anti‐reflux valve. The opposite kidney was removed simultaneously.

There were no postoperative complications. All pigs survived an observation period of 6 to 8 months. There were no signs of hydronephrosis or urine leakage and the kidney function remained normal. Postmortem examinations showed foreign body reaction adjacent to the prosthesis but this was without clinical significance.

As a consequence of these results, the prosthesis was used in 2 women with ureteric obstruction after radiotherapy for carcinoma of the cervix. The results may be described as satisfactory.
Intraperitoneal Rupture of the Bladder
Authors: CARSWELL J. WILSON
Published: December 2008

11 cases of intraperitoneal rupture of the bladder were seen in a 3–year period at Mulago Hospital, Uganda.

The presentation and management are described and possible reasons for the good prognosis are discussed.
A Double Blind Trial of a Polyene Macrolide‐ Nystatin‐in the Treatment of Benign Prostatic Hyperplasia in Man
Authors: BOURKE J. B. , GRIFFIN J. P. , THEODORIDES P.
Published: December 2008

Gordon and Schaffner (1968) showed that anti‐fungal drugs of the polyene macrolide group caused a reduction in volume of the hyperplastic prostate of aged dogs. It was, therefore, decided to investigate the effect of nystatin in patients with benign prostatic hyperplasia. In a double blind trial of 6 weeks' duration nystatin in doses of 500,000 units 8–hourly when taken orally was without effect when compared with a placebo.
Some Observations on the Medulla of the Kidney
Authors: FINE H. , KEEN E. N.
Published: December 2008

Terminology of the cortex of the kidney is discussed and some new terms are suggested.

Observations are described on 50 kidneys which have been injected and variously dissected. These include descriptions of the medulla, papillae and calyces.

Some developmental, radiological and surgical aspects are mentioned and suggestions for further study are made.
A Case of Behcet's Disease involving the Bladder
Authors: CARSWELL G. F.
Published: December 2008

A case of Behçet's disease involving the bladder has been described. It resembled a bladder carcinoma.

The pathology, aetiology and treatment have been briefly outlined.
Cryosurgery for Prostatic Obstruction using Liquid Nitrous Oxide
Authors: WRIGHT B. M.
Published: December 2008

The history of the use of liquid N2O for prostatic cryosurgery is briefly reviewed and an account given of a new simple instrument.

Details are given of the first 3 operations and of the results of another 82 performed at a number of different centres.

Relief of acute or chronic obstruction was obtained in about two‐thirds of the patients, all of whom were elderly and unfit for conventional operations.

There were no serious complications attributable to the operation and it was suggested that it would now be justifiable to offer it, as an alternative, to patients who are fit for conventional surgery.
Surgical Correction of Arterial Stenosis in Renal Allografts
Authors: OSBORN D. E. , CASTRO J. E. , SHACKMAN R.
Published: December 2008

The diagnosis, treatment and results of renal artery stenosis occurring in 9 out of 177 renal transplants are described.
Vaginal Ureterolithotomy
Authors: O'BOYLE P. J. , GIBBON N. O. K.
Published: December 2008

The vaginal approach to the low ureteric calculus may provide an easy, rapid and safe solution to a difficult surgical problem. It is important to select the case with care and, provided basic surgical principles are followed, the complications should be minimal.

3 recent successful cases are described and a further 2 in which the technique failed due to proximal displacement of the stone. The importance of adequately immobilising the calculus prior to ureterotomy is emphasised.
Amoebiasis of the Penis
Authors: THOMAS JOHN A. , ANTONY A. JOSEPH
Published: December 2008

The 9th patient in world literature with penile amoebiasis, is reported.

An extensive review of world literature suggests that the main diagnostic symptomatology in penile amoebiasis is pain with ulceration, in contrast to ulcerative carcinomas of the penis, which are painless.

The possible antecedent causes could be homosexuality, venereal contacts, phimosis with resultant inadequate sex hygiene.
Predictive Value of Pressure Flow Studies for the Functional Outcome of Reconstructive Surgery for Hydronephrosis
Authors: DJURHUUS J. C. , SØRENSEN S. S. , JØRGENSEN T. M. , TAAGEHØJ‐JENSEN F.
Published: December 2008

Summary— In 22 of 40 patients with unilateral hydronephrosis the pressure flow study was compared with the outcome of surgery. Seventeen of the 22 patients had impaired function before surgery as judged from the 2‐min uptake on the renogram. The pressure flow study as a measure of pre‐operative obstruction showed no relation to the functional outcome of surgery. Patients with obstructed pressure flow studies as well as those without signs of obstruction either remained stable or improved after surgery.

It was concluded that pressure flow studies are of no value in predicting the outcome of surgery for hydronephrosis.
Minocycline in Chronic Abacterial Prostatitis: a Double‐blind Prospective Trial
Authors: SIMMONS P. D. , THIN R. N.
Published: December 2008

Summary— In patients with chronic abacterial prostatitis, a double‐blind trial of 3 months of treatment with minocycline 100 mg twice daily compared with diazepam 5 mg twice daily was undertaken.

The percentage fall in polymorphonuclear leucocyte counts in the expressed prostatic secretions was much more marked after treatment with minocycline than with diazepam. Over a follow‐up period of at least 12 months, further treatment was necessary in more patients originally treated with diazepam than with minocycline.
Cystometry: Unstable Bladder and Urinary Tract Infection
Authors: BHATIA N. N. , BERGMAN A.
Published: December 2008

Summary— In order to study the effect of urinary infections upon the incidence of bladder instability during cystometric evaluation, 15 women underwent cystometry during the course of significant bacteriuria (105 organisms/ml) and again 2 weeks after treatment. The pre‐treatment incidence of bladder instability (53%) dropped by 50% following treatment of the infection but other cystometric measurements remained unchanged. Urinary tract infections must be treated adequately before treating bladder instability.
Long‐term Follow‐up of Detrusor Instability Following the Colposuspension Operation
Authors: STEEL SHIRLEY A. , COX C. , STANTON S. L.
Published: December 2008

Summary— Pre‐ and post‐operative clinical and urodynamic data have been reviewed in 24 women with detrusor instability following colposuspension. Follow‐up ranged from 3 to 5 years. Ten women remained asymptomatic throughout; of the remainder, four (28.6%) were improved by drug therapy. With one exception, patients who were symptomatic at the outset remained so at late follow‐up.
Is a Male Infertility Clinic of Any Use?
Authors: HARGREAVE T. B. , McGOWAN B. , HARVEY JENNIFER , McPARLAND MARY , ELTON R. A.
Published: December 2008

Summary— Two methods of statistical analysis were used to evaluate the results from an infertility clinic (the couple‐months method and Cox regression analysis). The results were in general agreement and validated the couple‐months method. The total trying time, sperm motility, sperm density and results of the wife's investigation were all shown to be highly significant prognostic factors. The age of either husband or wife, semen volume, sperm morphology, size of the testes, presence of a varicocele, serum LH and serum testosterone all failed to give significant additional prognostic information. High serum FSH and testis asymmetry both gave weak additional prognostic information.

The benefit of attendance at the infertility clinic was evaluated in two ways: firstly by testing whether the event of clinic attendance altered prognosis and secondly by examining the results of a broad range of treatments. The results showed that attendance at the clinic with subsequent treatment did not improve the chance of fertility. The main benefit from clinic attendance was that the couple could be given an accurate prognosis and supportive counselling.
Percutaneous Renal Surgery and Local Radiotherapy in the Management of Renal Pelvic Transitional Cell Carcinoma
Authors: WOODHOUSE C. R. J. , KELLETT M. J. , BLOOM H. J. G.
Published: December 2008

Summary— Six patients with a history of bladder carcinoma and a radiographic filling defect of the pelvicaliceal system have been investigated or treated percutaneously. In two cases of doubtful diagnosis, percutaneous pyeloscopy showed that no pelvicaliceal tumour was present. In four patients with multifocal or recurrent transitional cell carcinoma and difficult clinical problems, intrarenal tumours were cauterised or resected percutaneously. Radioactive iridium wire (192/Ir) was inserted into the surgical track to deliver prophylactic irradiation (4500 cGy) to prevent tumour seeding.

Follow‐up was from 7 to 36 months. One operated patient developed early wide‐spread multifocal disease throughout the urothelium, including the operated kidney, and died of uraemia. The other three patients have shown no recurrence in the operated kidney, though two have developed recurrences in the bladder or ureter. There have been no track recurrences.
Modified Nephroureterectomy: a Risk of Tumour Implantation
Authors: HETHERINGTON J. W. , EWING R. , PHILP N. H.
Published: December 2008

Summary— The standard surgical management of patients presenting with transitional cell carcinoma of the upper urinary tract is nephroureterectomy with excision of a cuff of bladder around the ureteric orifice. Recently a modified technique of resecting the lower ureter endoscopically and completing the nephroureterectomy through a single loin incision has been advocated as a safe and simple procedure. We consider that this technique may have a risk of tumour implantation at the site of the resected lower ureter.

We report our experience of this operation in five patients, two of whom developed invasive tumour at the site of the ureteric orifice after only a short follow‐up.
Conservative Surgery for Ureteric Tumours
Authors: SOUTHCOTT R. D. C.
Published: December 2008

Summary— Eleven patients with ureteric transitional cell tumours were reviewed and conservative management recommended.
The Effect of Age on the Autonomic Innervation of the Urinary Bladder
Authors: GILPIN S. A. , GILPIN C. J. , DIXON J. S. , GOSLING J. A. , KIRBY R. S.
Published: December 2008

Summary— Quantitative methods have been used to assess the amount of autonomic nerve in bladder biopsy samples from a group of “control” patients ranging in age from 20 to 79 years. Each patient included in the study was urodynamically normal and showed no subjective evidence of bladder trabeculation at cystoscopy. Using light microscopy, a significant linear reduction in the amount of acetylcholinesterase‐positive nerve was observed with increasing age. Counts of axon profiles and measurement of smooth muscle cell cross‐sectional areas in the electron microscope revealed a similar reduction in the amount of nerve per mm2 of detrusor muscle tissue. These findings thus confirm that a real reduction in the number of nerve axons occurs with age and the light microscope results are not due merely to a reduction in the amount of nerve‐associated acetylcholinesterase.

The present study provides baseline data for future comparisons of the density of autonomic innervation in bladders which are functionally impaired.
A Prospective Study of Bladder Function Following Aortic Surgery
Authors: KWOK K. Y. , BLACKLOCK A. R. E. , BULLEN B. R.
Published: December 2008

Summary— Twenty‐four patients undergoing aortic surgery for aneurysmal or occlusive aortic disease were studied prospectively to assess the effect on bladder function. Thirteen patients completed the study with post‐operative follow‐up at 3 months. Aortic surgery was found to be unlikely to cause damage to the parasympathetic nerves. There was no change in the detrusor stability/instability status in five of seven patients undergoing surgery for occlusive disease. Fifty‐seven per cent of patients undergoing surgery for aneurysmal disease and 83% of those undergoing surgery for occlusive disease noted improved urinary flow with decreased maximal urethral pressure following surgery, suggesting damage to the sympathetic nerve supply to the lower urinary tract. The improvement in urinary flow did not relate either to the assessed extent of damage to the sympathetic nerves at operation or to the type of operation or vascular anastomosis. It is concluded that aortic surgery damages the sympathetic rather than the parasympathetic nerves and that any effect on bladder function is of no serious significance.
Transurethral Ureteroscopy. Safety Guide Wire as an Aid to a More Aggressive Approach
Authors: EKMAN P. , HUSAIN I. , SHARMA N. D. , AL‐FAQIH S. R.
Published: December 2008

Summary— In an unselected, consecutive series of patients, ureteroscopy was carried out for removal or manipulation of stones in 48 patients and for evaluation of suspected ureteric tumours in two. A success rate of 92% was achieved. The use of an intra‐ureteric safety guide wire, indwelling throughout the procedure, facilitated ureteroscopic manipulation, minimised complications, reduced the need for subsequent open surgery and has been a prerequisite for our comparatively aggressive approach to ureteric disorders. The procedure may be time‐consuming but prolonged manipulation within the ureter seems to carry little morbidity.
Correction of Reflux with the Ureteric Crossover Method Clinical Experience in 50 Patients
Authors: KONDO A. , OTANI T.
Published: December 2008

Summary— We describe 50 consecutive patients who underwent anti‐reflux surgery with the ureteric crossover method; 32 had primary and 18 had secondary reflux. The surgical procedure was characterised by the fact that the ureters crossed and overlapped each other at their middle portion submucosally. The surgical success rate was 100% for primary reflux patients and 89% for those with secondary reflux. It was concluded that the ureteric crossover method was a safe and effective anti‐reflux procedure.
The Action of the Prostaglandins on Isolated Human Ureteric Smooth Muscle
Authors: COLE R. S. , FRY C. H. , SHUTTLEWORTH K. E. D.
Published: December 2008

Summary— A study has been carried out on the actions of the prostaglandins E2 and F2α and their synthesis inhibitors, indomethacin and diclofenac sodium, upon isolated human ureteric smooth muscle, using the technique of microsuperfusion designed to ensure good tissue viability.

Indomethacin and diclofenac sodium were shown to abolish almost completely the contractile response of ureteric muscle to electrical field stimulation. Contractile activity, in the presence of the inhibitors, could be restored by prostaglandin E2 or F2α or by increasing the external potassium concentration, [K+]o, of the superfusate.

Prostaglandin E2 or F2α alone were shown to increase dramatically both the phasic and tonic component of the electrically stimulated contractions, on occasions inducing spontaneous activity.

A possible mechanism of action was elucidated with an electrophysiological technique using intracellular microelectrodes. The mean membrane potential recorded was 54.7 mV (SD ± 10 mV, n=15). The depolarising action of raising [K+]o was demonstrated and prostaglandin F2α (3 times 10‐6M) was shown to produce a small depolarisation of the ureteric muscle cell membrane.
TRADING WITH THE WAITING‐LIST: THE JUSTICE OF LIVING DONOR LIST EXCHANGE
Authors: DEN HARTOGH GOVERT
Published: December 2008

In a Living Donor List Exchange program, the donor makes his kidney available for allocation to patients on the postmortal waiting‐list and receives in exchange a postmortal kidney, usually an O‐kidney, to be given to the recipient he favours. The program can be a solution for a candidate donor who is unable to donate directly or to participate in a paired kidney exchange because of blood group incompatibility or a positive cross‐match.

Each donation within an LDLE program makes an additional organ available for transplantation. But because most of the pairs making use of the program will be A/O incompatible, it will also tend to increase the waiting time for patients with blood group O, who already have the longest waiting time. It has therefore been objected that the program is materially unjust, because it further disadvantages the least advantaged. This objection appeals to John Rawls’ difference principle. However, the context for which Rawls proposed that difference principle, is significantly different from the present one. Applying the principle here amounts to a lop‐sided trade‐off between considerations of need and considerations of overall utility.

Considerations of formal justice, however, may lead to a stronger objection to LDLE programs. Such a program means that one O‐patient on the waiting list is exempted from the application of the general criteria used in constructing the list because he has a special bargaining advantage. This objection is spelled out and weighed against the obvious attraction of LDLE in a situation of (extreme) organ scarcity.
GENETIC ENGINEERING TO AVOID GENETIC NEGLECT: FROM CHANCE TO RESPONSIBILITY
Authors: HAMMOND JESSICA
Published: December 2008

Currently our assessment of whether someone is a good parent depends on the environmental inputs (or lack of such inputs) they give their children. But new genetic intervention technologies, to which we may soon have access, mean that how good a parent is will depend also on the genetic inputs they give their children. Each new piece of available technology threatens to open up another way that we can neglect our children. Our obligations to our children and our susceptibilities to corresponding legal and moral sanctions may be about to explosively increase.

In this paper I argue that we should treat conventional neglect and ‘genetic neglect’– failing to use genetic intervention technologies to prevent serious diseases and disabilities – morally consistently. I conclude that in a range of cases parents will have a moral obligation to use genetic treatments to prevent serious disabilities in their children. My particular focus is on prenatal interventions and their impact of the bodily integrity of expectant mothers. I conclude that although bodily integrity constrains moral obligations, it is outweighed in a range of cases.
MORAL STATUS REVISITED: THE CHALLENGE OF REVERSED POTENCY
Authors: BAERTSCHI BERNARD , MAURON ALEXANDRE
Published: December 2008

Moral status is a vexing topic. Linked for so long to the unending debates about ensoulment and the morality of abortion, it has recently resurfaced in the embryonic stem cell controversy. In this new context, it should benefit from new insights originating in recent scientific advances. We believe that the recently observed capability of somatic cells to return to a pluripotential state (a capability we propose to name ‘reversed potency’) in a controlled manner requires us to modify the traditional concept of moral status and to consider it as referring not only to intrinsic properties (like ‘to possess reason’ or ‘to be a person’), but also to extrinsic or relational ones.
COULD A ZYGOTE BE A HUMAN BEING?
Authors: BURGESS JOHN
Published: December 2008

This paper re‐examines the question of whether quirks of early human foetal development tell against the view (conceptionism) that we are human beings at conception. A zygote is capable of splitting to give rise to identical twins. Since the zygote cannot be identical with either human being it will become, it cannot already be a human being. Parallel concerns can be raised about chimeras in which two embryos fuse. I argue first that there are just two ways of dealing with cases of fission and fusion and both seem to be available to the conceptionist. One is the Replacement View according to which objects cease to exist when they fission or fuse. The other is the Multiple Occupancy View – both twins may be present already in the zygote and both persist in a chimera. So, is the conceptionist position tenable after all? I argue that it is not. A zygote gives rise not only to a human being but also to a placenta – it cannot already be both a human being and a placenta. Neither approach to fission and fusion can help the conceptionist with this problem. But worse is in store. Both fission and fusion can occur before and after the development of the inner cell mass of the blastocyst – the entity which becomes the embryo proper. The idea that we become human beings with the arrival of the inner cell mass leads to bizarre results however we choose to accommodate fission and fusion.
Inhibition of Ca2+‐dependent glutamate release from cerebral cortex synaptosomes of rats with experimental autoimmune encephalomyelitis
Authors: Vilcaes Aldo Alejandro , Furlan Gabriela , Roth German A.
Published: December 2008

Several pathological studies have revealed a prominent involvement of the cerebral cortex in patients with multiple sclerosis (MS). In order to better understand the events that lead to the progressive neuronal dysfunction in MS, herein we explore the contribution of the glutamatergic release in cerebral cortex synaptosomes isolated from rats with experimental autoimmune encephalomyelitis, an animal model reproducing many features of MS. We found that the Ca2+‐dependent but not the Ca2+‐independent glutamate release induced by KCl and 4‐aminopyridine was significantly decreased during the acute stage of the disease. This inhibited release coincides with the onset of the clinical signs and after 24 h tends to recover the level of the control animals. The results also showed an inhibition of the glutamate release stimulated by ionomycin. When the animals were totally recovered from clinical signs, the neurotransmitter release stimulated by the different inductors was similar to the controls. Examination of the cytosolic Ca2+ using fura‐2‐acetoxymethyl ester revealed that the inhibition of glutamate release could not be attributed to a reduction in voltage‐dependent Ca2+ influx. However, this inhibition was concomitant with a lower phosphorylation of synapsin I at P‐site1. Our results show that the inhibition observed on the Ca2+‐dependent neurotransmitter release from cerebral cortex synaptosomes in experimental autoimmune encephalomyelitis is specific and correlates with the beginning of the clinical disease. Moreover, they suggest an alteration in the metabolism of proteins involved in the vesicular glutamate release more than a deregulation in the influx of cytosolic Ca2+.
Phosphodiesterase 5 inhibitors prevent 3,4‐methylenedioxymethamphetamine‐induced 5‐HT deficits in the rat
Authors: Puerta Elena , Hervias Isabel , Goñi‐Allo Beatriz , Lasheras Berta , Jordan Joaquin , Aguirre Norberto
Published: December 2008

Phosphodiesterase 5 (PDE5) inhibitors are often used in combination with club drugs such as 3,4‐methylenedioxymethamphetamine (MDMA or ecstasy). We investigated the consequences of such combination in the serotonergic system of the rat. Oral administration of sildenafil citrate (1.5 or 8 mg/kg) increased brain cGMP levels and protected in a dose‐dependent manner against 5‐hydroxytryptamine depletions caused by MDMA (3 × 5 mg/kg, i.p., every 2 h) in the striatum, frontal cortex and hippocampus without altering the acute hyperthermic response to MDMA. Intrastriatal administration of the protein kinase G (PKG) inhibitor, KT5823 [(9S, 10R, 12R)‐2,3,9,10,11,12‐Hexahydro‐10‐methoxy‐2,9‐dimethyl‐1‐oxo‐9,12‐epoxy‐1H‐diindolo[1,2,3‐fg:3′,2′,1′‐kl]pyrrolo[3,4‐i][1,6]benzodiazocine‐10‐carboxylic acid, methyl ester)], suppressed sildenafil‐mediated protection. By contrast, the cell permeable cGMP analogue, 8‐bromoguanosine cyclic 3′,5′‐monophosphate, mimicked sildenafil effects further suggesting the involvement of the PKG pathway in mediating sildenafil protection. Because mitochondrial ATP‐sensitive K+channels are a target for PKG, we next administered the specific mitochondrial ATP‐sensitive K+channel blocker, 5‐hydroxydecanoic acid, 30 min before sildenafil. 5‐hydroxydecanoic acid completely reversed the protection afforded by sildenafil, thereby implicating the involvement of mitochondrial ATP‐sensitive K+channels. Sildenafil also increased Akt phosphorylation, and so the possible involvement of the Akt/endothelial nitric oxide synthase (eNOS)/sGC signalling pathway was analysed. Neither the phosphatidylinositol 3‐kinase inhibitor, wortmannin, nor the selective eNOS inhibitor,l‐N5‐(1‐iminoethyl)‐l‐ornithine dihydrochloride, reversed the protection afforded by sildenafil, suggesting that Akt/eNOS/sGC cascade does not participate in the protective mechanisms. Our data also show that the protective effect of sildenafil can be extended to vardenafil, another PDE5 inhibitor. In conclusion, sildenafil protects against MDMA‐induced long‐term reduction of indoles by a mechanism involving increased production of cGMP and subsequent activation of PKG and mitochondrial ATP‐sensitive K+channel opening.
Debate: Substitution of generic drugs in epilepsy: Is there cause for concern?
Authors: Gidal Barry E. , Tomson Torbjörn
Published: December 2008

The role of generic drugs in both the US and global marketplace has been steadily increasing over the last few years. Although generic drugs clearly represent an important economic alternative for many patients, there are reasons for concern in certain disease states. Recently, the substitution of antiepileptic drugs in patients with epilepsy has gained increased attention. Concerns over potential therapeutic inequivalence has prompted many clinicians to question current regulatory requirements for both establishing bioequivalence, as well as product substitution. The objective of this article is to present arguments both for and against the use of generic drugs and practice of generic substitution in patients with epilepsy. Regulatory requirements, pharmacokinetic methodology, and biopharmaceutical considerations are discussed.
Mechanistic and pharmacologic aspects of status epilepticus and its treatment with new antiepileptic drugs
Authors: Wasterlain Claude G. , Chen James W. Y.
Published: December 2008

We review recent advances in our understanding and treatment of status epilepticus (SE). Repeated seizures cause an internalization of γ‐aminobutyric acid (GABA)Areceptors, together with a movement ofN‐methyl‐d‐aspartate (NMDA) receptors to the synapse. As a result, the response of experimental SE to treatment with GABAergic drugs (but not with NMDA antagonists) fades with increasing seizure duration. Prehospital treatment, which acts before these changes are established, is finding increased acceptance, and solid evidence of its efficacy is available, particularly in children. Rational polypharmacy aims at multiple receptors or ion channels to increase inhibition and simultaneously reduce excitation. Combining GABAAagonists with NMDA antagonists and with agents acting at other sites is successful in treating experimental SE, and in reducing SE‐induced brain damage and epileptogenesis. The relevance of these experimental data to clinical SE is actively debated. Valproate and levetiracetam have recently become available for intravenous use, and the use of ketamine and of other agents (topiramate, felbamate, etc.) have seen renewed interest. A rapidly increasing but largely anecdotal body of literature reports success in seizure control at the price of relatively few complications with the clinical use of those agents in refractory SE.
The role of the newer antiepileptic drugs in the treatment of generalized convulsive status epilepticus
Authors: Wheless James W. , Treiman David M.
Published: December 2008

The emergency treatment of seizures is an important practical issue, especially the treatment of generalized convulsive status epilepticus (GCSE). Benzodiazepines or older standard antiepileptic drugs (phenobarbital, phenytoin) have typically been used as initial intravenous treatment of GCSE. As new parenteral antiepileptic drugs are developed, and more are on the horizon, questions are raised regarding their role in the treatment of status epilepticus (SE). This review discusses the evidence for the treatment of GCSE, including the newer agents (valproate, levetiracetam). We correlate the treatment of SE with our modern understanding of the underlying neurophysiology and seizure duration.
Feeding, growth and nutritional status of restocked salmon parr along the longitudinal gradient of a large European river: the Allier
Authors: Descroix A. , Desvilettes C. , Martin P. , Anneville O. , Bec A. , Bourdier G.
Published: December 2008

Abstract – The feeding, growth and nutritional status of salmon parr (0+) released at fry stage in different riffles were studied in a large temperate river (Allier, France) throughout the active feeding period. Significant differences were observed along the upstream–downstream gradient. Parr growth performance and energy storage were higher in downstream riffles and low in the most upstream one. These longitudinal growth variations are discussed in the context of diet and food availability differences, habitat variables and intra‐ and inter‐species competition. The most favourable site for optimum growth and nutritional status appeared to be the intermediary riffle located in the grayling zone.
A toll‐like receptor 4 variant is associated with fatal outcome in children with invasive meningococcal disease
Authors: Faber Joerg , Henninger Nicole , Finn Adam , Zenz Werner , Zepp Fred , Knuf Markus
Published: December 2008

Aims: Toll‐like receptor 4 (TLR4) is the major endotoxin signalling receptor of the innate immune system and is required for efficient recognition of bacterial infections. Here, we analysed a possible association between the TLR4 variant Asp299Gly and disease outcome in children with invasive meningococcal disease.

Methods: In total, 197 children with invasive meningococcal disease were analysed for the TLR4 Asp299Gly variant. Genotyping results were correlated with mortality, the frequency of ventilation support, application of inotropic substances, skin grafting, and limb loss.

Results: The overall Asp299Gly allele frequency was 9.4%. Detection of a heterozygous Asp299Gly TLR4 mutation was significantly associated with fatal outcome (non‐survivor group: 31.6% vs. survivor group: 12.1%; p = 0.021) and was even more pronounced in patients with disease onset less than 24 months of age (non‐survivor group: 42.8% vs. survivor group: 10.2%; p = 0.006). In this age group, ventilation support was also more frequent in patients with the Asp299Gly genotype (37.5% vs. 6.2%).

Conclusion: Our data suggest that the heterozygous TLR4 Asp299Gly genotype is associated with an increased mortality in children with invasive meningococcal disease.
Aristotle and Open Population Thinking
Authors: Kreager Philip
Published: December 2008

Aristotle's Politics contains the most extensive consideration of actual populations to survive from Antiquity. Population, for Aristotle, is a logistics of memberships. The size, fertility, and other properties of a state's population are determined by relationships among the several subpopulations that it comprises. This approach gives rise to a comprehensive logic that addresses many policy concerns of modern demography, yet within fundamentally different ideas of quantification and structure. Some of this logic fits easily with current demographic thinking. Relations among sub‐populations, for example, play a crucial role in population change because they are conduits of communication and reflect differences in education. Aristotle's method stands in contrast to modern demographic thinking, however, in treating migration, inequality, and the mutability of population memberships as primary processes of population change. Given that interest in this conjunction of issues is now central to the demography of globalization, there is added reason to consider Aristotle's insights as complementary to modern population studies. His principal case study, the constitution of Athens, illustrates the development of his thought.