bluuebunny/crossref_metadata_2025 huggingface dataset:
ULTRASTRUCTURE OF TETRASPOROGENESIS IN THE MARINE RED ALGA PTILOTA HYPNOIDES1
Authors: Scott J. L. , Dixon P. S.
Published: April 2006

Both tetrasporangia and dormant apical cells of short vegetative filaments of the marine red alga Ptilota hypnoides have been examined by electron microscopy. Various cytoplasmic inclusions readily distinguish the vegetative apical cells from the reproductive apical cells which become tetrasporangial mother cells. The transformation of tetrasporangial mother cells into mature tetrasporangia involves a series of cytoplasmic changes which can be correlated with specific changes in the investing wall layers. The extracellular changes provide the basic criteria for the division of tetrasporogenesis into 3 successive stages. The ultrastructure of each stage is described and discussed in relation to the current knowledge of red algal cytology. In addition, a possible mechanism for the liberation of spores and gametes of red algae is proposed.
GROWTH OF THE GREEN ALGA CODIUM FRAGILE IN A CONNECTICUT ESTUARY1
Authors: Malinowski K. C. , Ramus J.
Published: April 2006

An in situ comparison of environmental and physiological factors was undertaken in 1971–72 (15 months) in the Niantic River estuary to elucidate some of the important aspects, of the growth and development of the seaweed Codium fragile.

In general, Codium in the estuary has a growing season of from 6 to 9 months. Growth increments during this period are relatively constant. Temperature and salinity are the main limiting factors to growth, although low summer concentrations of inorganic nitrogen may also be involved. Reproduction by means of swarmers occurs only in late summer or autumn.

Codium appears highly adapted to the role of a colonizing species. It not only possesses the capability to occupy the harshest of environments, but also a system of reproductive alternatives which facilitates rapid colonization. The availability of substrate for attachment is the chief factor limiting its spread in this estuarine system.
Comparison of elicitation potential of chloroatranol and atranol – 2 allergens in oak moss absolute
Authors: Johansen Jeanne D. , Bernard Guillaume , Giménez‐Arnau Elena , Lepoittevin Jean‐Pierre , Bruze Magnus , Andersen Klaus E.
Published: April 2006

Chloroatranol and atranol are degradation products of chloroatranorin and atranorin, respectively, and have recently been identified as important contact allergens in the natural fragrance extract, oak moss absolute. Oak moss absolute is widely used in perfumery and is the cause of many cases of fragrance allergic contact dermatitis. Chloroatranol elicits reactions at very low levels of exposure. In oak moss absolute, chloroatranol and atranol are present together and both may contribute to the allergenicity and eliciting capacity of the natural extract. In this study, 10 eczema patients with known sensitization to chloroatranol and oak moss absolute were tested simultaneously to a serial dilution of chloroatranol and atranol in ethanol, in equimolar concentrations (0.0034–1072 µM). Dose–response curves were estimated and analysed by logistic regression. The estimated difference in elicitation potency of chloroatranol relative to atranol based on testing with equimolar concentrations was 217% (95% confidence interval 116–409%). Both substances elicited reactions at very low levels of exposure. It is concluded that the differences in elicitation capacity between the 2 substances are counterbalanced by exposure being greater to atranol than to chloroatranol and that both substances contribute to the clinical problems seen in oak moss absolute‐sensitized individuals.
Nurse‐related factors in the delivery of preoperative patient education
Authors: Fitzpatrick Elizabeth , Hyde Abbey
Published: April 2006

Aims and objectives.  This article aimed to explore the factors relating to nurses themselves that influence the delivery of preoperative patient education in everyday surgical clinical contexts at one large general adult teaching hospital in Ireland.

Background.  As landmark studies of preoperative education undertaken in the UK in the 1970s identified the superiority of structured programmes of patient education over and above ‘regular’ preoperative care, there have been many intervention/outcome experimental studies carried out in this area. However, there has been little interpretative work conducted that explores the regular, or ‘usual’ preoperative education given to patients in everyday surgical units.

Methods.  A sample of 12 experienced surgical nurses was selected and each participant was interviewed in depth. Data were analysed using a qualitative strategy resembling grounded theory.

Results.  Findings indicate that preoperative education was variously interpreted by participants, and participants’ accounts suggested that different understandings and practices by nurses resulted in patients receiving different levels of care. In addition, diverse levels of knowledge and experience of individual nurses resulted in unevenness in the type of preoperative education that patients received. A number of participants advocated a more formal method of preparation for nurses in the area of preoperative education. Finally, in some surgical areas, specialist nurses worked side‐by‐side with regular ward nurses and their input in preoperative education was largely seen by participants in a positive way, particularly in view of the structural constraints that ward nurses faced.

Conclusions.  We conclude that nurse‐related factors in preoperative education do not arise in a vaccum, but rather are related to the wider organizational practices and culture. The difficulties with preoperative education identified in data may be addressed through organizational investment in preoperative education.

Relevance to clinical practice.  This paper produces evidence for nurses and clinical nurse managers about how nurse‐related factors impede preoperative education, and may provide a starting point for how to begin to address obstacles to better preoperative care.
Effect of reclining and chin‐tuck position on the coordination between respiration and swallowing
Authors: AYUSE T. , AYUSE T. , ISHITOBI S. , KURATA S. , SAKAMOTO E. , OKAYASU I. , OI K.
Published: April 2006

summary  Chin‐tuck position and reclining posture have been used in dysphagia patients to prevent aspiration during swallowing. However, both behavioural treatments may affect respiratory function. This study was carried out to test the hypothesis that if chin‐tuck posture and body reclining affected respiratory function, this would be associated with altered coordination between respiration and swallowing. To investigate this hypothesis, respiratory parameters and manometry were used in each of four combinations of reclining posture and chin‐tuck position. In the 60 °reclining with 60 °chin‐tuck position, duration of swallowing apnea (0·89 s.d. 0·17 s) and submental electromyography burst (2·34 s.d. 0·84 s) were significantly longer when compared to both upright sitting and 30 °reclining positions. We conclude that 60 °reclining from vertical with 60 °chin‐tuck may affect oral processing stages which delay and reduce a variety of oropharyngeal movements. These in turn significantly influence the coordination between respiration and swallowing.
Supplementary ultraviolet‐B irradiation reveals differences in stress responses between Arabidopsis thaliana ecotypes*
Authors: KALBINA IRINA , STRID ÅKE
Published: April 2006

Irradiation of Arabidopsis thaliana ecotypes C24, Wassilewskija (Ws) and Columbia‐0 (Col‐0) with supplementary ultraviolet‐A+B (UV‐A+B) radiation revealed ecotype‐specific differences in expression of the gene for the pathogenesis‐related protein PR‐5. C24 showed an increased expression level of PR‐5 (5‐ and 20‐fold higher compared with Col‐0 and Ws, respectively). Expression of other molecular markers such as CHS (encoding chalcone synthase), MEB5.2[encoding a gene strongly up‐regulated by ultraviolet‐B (UV‐B)] and PYROA[encoding a pyridoxine (Vitamin B6) biosynthesis enzyme] only showed slight differences between ecotypes. Oxidative stress during UV‐A+B exposure was monitored by staining for H2O2. This analysis also revealed important ecotype‐specific differences. ‘H2O2 hot spots’ were found in C24, whereas an even distribution of H2O2 was found in Ws and Col‐0. Necrotic lesions also appeared on C24 leaves after prolonged UV‐B exposure. There was a reverse correlation between the H2O2 steady‐state concentration and the PR‐5 gene expression; Ws showed the highest level of H2O2 accumulation but the lowest expression level of the PR‐5 gene. Furthermore, application of paraquat on the rosettes led to similar PR‐5 expression and H2O2 accumulation patterns as were found after UV‐A+B irradiation. The observed ecotypic differences were also reflected in a statistically significant UV‐B‐dependent decrease in biomass, rosette size and leaf area for Ws, but not for C24 and Col‐0. Our results show that a significant ecotype‐specific genetic variability in general UV‐B responses in Arabidopsis exists. Moreover, the signal transduction or gene regulation pathway for PR‐5 differs from the other molecular markers used in this study.
Specialist Training at the Faculty of Odontology, Malmö University
Authors: Lindh C , Lindberg P , Rohlin M.
Published: April 2006

Aim  To describe the specialist training at the Faculty of Odontology in Malmö for eight specialities that are certified in Sweden and report the results of a questionnaire among former specialist trainees.

Material and Method  The objectives of the specialist training are set on three levels: the national level according to the Swedish National Board for Health and Welfare, the faculty level, the so called Malmö model, and finally the specialist subject level.

 The specialist training in Malmö is implemented in collaboration with the Public Dental Health Care in southern Sweden. The Postgraduate Education Board of the faculty scrutinizes and approves each trainee's individualized specialist training programme. The clinical part of the training is to be shared between the collaborating units and the theoretical part is the prime responsibility of the faculty. During the three‐year‐programme, seven core courses are held for all trainees irrespective of specialist subject parallel to the clinical training. Every semester there are two joint seminars: one seminar on a current odontological theme and one on the following subjects; epidemiology, ethics, migration and ethnic relations, environment, gender, leadership.

 A written and oral programme evaluation is performed yearly by the Chair of the Postgraduate Education Board together with a representative of the Public Dental Health Care. As part of the 2003 evaluation a questionnaire was sent to 31 specialist graduates trained between 2000 and 2003. Twenty‐four specialists responded, 13 graduates from Malmö and 11 from other Swedish specialist institutions.

Results and Conclusion  A majority of the 24 responding graduates express that the work as specialists suit them very well and that the education well serve the purpose to work as a specialist. A majority of the graduates from Malmö were positive to the joint courses during their training. Some thought that there should be more joint activities among trainees of different subject specialities.
Socio‐economic Factors Guiding the Number of Dental Specialists in Europe
Authors: Widstrom E
Published: April 2006

In the European Economic area, four countries have no recognised dental specialties and eight have five or more. Orthodontics is recognised in most countries and Oral Maxillofacial Surgery and/or Oral Surgery in over 60%. Other common specialties are Paedodontics, Periodontics and Prosthetics. Variation in the numbers of specialties and specialists between individual countries can partly be explained by oral healthcare systems. A further factor is that the population has become older, wealthier, less edentulous and demands more advanced treatment. Those who support an increase in dental specialties and in numbers of specialists, highlight professional development and better care for patients. Those against are afraid of restrictions in general practice and competition.

Most existing specialties seem to have emerged from professional interests. Only two, Orthodontics and Oral Surgery, have been formally recognised by the European Commission (EC).

A new EC Draft Directive proposes that specialties, which exist in 10 or more Member States will be recognised by the EU. This could lead to more dental specialties. The need for specialists should be assessed on the basis of treatment needs of the populations concerned. Key questions are how to ensure that, at present and in the future, specialties and specialists serve these needs and offer high quality and affordable services.
Developing Research in Graduate Programmes
Authors: Eliades G
Published: April 2006

The aim of this presentation was to provide an overview of the current status of research activities in the graduate programmes of European Dental Schools, their scope, structure, funding and assessment. The key issues explored included the aims, goals and perspectives of research activities in relation to the challenging and educational aspects of research, criteria for selection of research topics, development of skills for augmentation of basic and applied science, build up of creative thinking for data analysis and synthesis, the advisor's contribution, research assessment and feedback to the academic environment, aspects of research funding to support educational needs and ethical aspects of research.
The mapping of DFNB62, a new locus for autosomal recessive non‐syndromic hearing impairment, to chromosome 12p13.2‐p11.23
Authors: Ali G , Santos RLP , John P , Wambangco MAL , Lee K , Ahmad W , Leal SM
Published: April 2006

Autosomal recessive non‐syndromic hearing impairment (ARNSHI) is the most common form of prelingual inherited hearing impairment (HI). Here is described the mapping of a novel ARNSHI locus in a consanguineous Pakistani family with profound congenital HI. Two‐point and multipoint linkage analyses were performed for the genome scan and fine mapping markers. Haplotypes were constructed to determine the region of homozygosity. At θ = 0, the maximum two‐point LOD score of 4.0 was obtained at marker AAC040. A maximum multipoint LOD score of 5.3 was derived at marker D12S320, with the three‐unit support interval demarcated by D12S89 and D12S1042. The region of homozygosity is flanked by markers D12S358 and D12S1042, which corresponds to 22.4 cM according to the Rutgers combined linkage‐physical map of the human genome and spans 15.0 Mb on the sequence‐based physical map. A novel ARNSHI locus DFNB62 was mapped to chromosome 12p13.2‐p11.23. DFNB62 represents the second ARNSHI locus to map to chromosome 12.
Effects of streptozotocin‐induced diabetes on bladder and erectile (dys)function in the same rat in vivo
Authors: CHRIST GEORGE J. , HSIEH YI , ZHAO WEIXIN , SCHENK GREGORY , VENKATESWARLU KARICHETI , WANG HONG‐ZHAN , TAR MOSES T. , MELMAN ARNOLD
Published: April 2006

OBJECTIVE

To establish the methods, feasibility and utility of evaluating the impact of diabetes on bladder and erectile function in the same rat, as more than half of diabetic patients have bladder dysfunction, and half of diabetic men have erectile dysfunction, but the severity of coincident disease has not been rigorously assessed.

MATERIALS AND METHODS

In all, 16 F‐344 rats had diabetes induced by streptozotocin (STZ), and were divided into insulin‐treated (five) and untreated (11), and compared with age‐matched controls (10), all assessed in parallel. All STZ rats were diabetic for 8–11 weeks. Cystometric studies were conducted on all rats, with cavernosometric studies conducted on a subset of rats.

RESULTS

There were insulin‐reversible increases in the following cystometric variables; bladder weight, bladder capacity, micturition volume, residual volume, micturition pressure and spontaneous activity (P < 0.05, in all, one‐way analysis of variance, anova). Cavernosometry showed a diabetes‐related, insulin‐reversible decline in the cavernosal nerve‐stimulated intracavernosal pressure (ICP) response at all levels of current stimulation (P < 0.05, in all one‐way anova). Plotting erectile capacity (i.e. ICP) against bladder capacity showed no correlation between the extent of the decline in erectile capacity and the magnitude of the increase in bladder capacity.

CONCLUSIONS

These studies extend previous work to indicate that the extent of diabetes‐related bladder and erectile dysfunction can vary in the same rat. As such, these findings highlight the importance of evaluating the impact of diabetes on multiple organ systems in the lower urinary tract. Future studies using this model system should lead to a better understanding of the initiation, development, progression and coincidence of these common diabetic complications.
Fluid shear stress‐induced nitric oxide production in human cavernosal endothelial cells: inhibition by hyperglycaemia
Authors: WESSELLS HUNTER , TEAL THOMAS H. , ENGEL KAREN , SULLIVAN CHRISTOPHER J. , GALLIS BYRON , TRAN KHOA B. , CHITALEY KANCHAN
Published: April 2006

Associate Editor

Michael G. Wyllie

Editorial Board

Ian Eardley, UK

Jean Fourcroy, USA

Sidney Glina, Brazil

Julia Heiman, USA

Chris McMahon, Australia

Bob Millar, UK

Alvaro Morales, Canada

Michael Perelman, USA

Marcel Waldinger, Netherlands

OBJECTIVE

To investigate whether fluid shear stress (FSS) induces endothelial nitric oxide synthase (eNOS) activity and NO production in isolated human corpus cavernosal endothelial cells (HCCECs), and whether this response is altered during hyperglycaemia in vitro, as haemodynamic signalling during penile erection induces eNOS‐mediated NO production in vivo.

MATERIALS AND METHODS

ECs were cultured from HCC and characterized by the uptake of acetylated low‐density lipoprotein and the expression of von Willebrand factor, VE‐cadherin, CD31 and eNOS. HCCECs were exposed to FSS (1.2 Pa (12 dynes/cm2), 5 min) using a cone‐and‐plate viscometer in the presence or absence of high glucose (30 mm, 48 h). The phosphorylation of ser1177 on eNOS and total eNOS protein expression after FSS was examined by Western blot. NO in the conditioned media was assessed by measuring nitrate and nitrite levels.

RESULTS

Compared to static conditions, FSS induced a significant increase in the phosphorylation of eNOS on ser1177 in HCCECs, and the release of NO to the conditioned media. Treatment of HCCECs with high glucose levels did not alter the ratio FSS‐induced phosphorylated eNOS/total eNOS, but did result in the down‐regulation of total eNOS and significantly attenuated FSS‐induced NO release.

CONCLUSION

These in vitro data suggest that FSS contributes to eNOS activation and NO release in HCCECs, and supports in vivo reports suggesting a role for haemodynamic signalling in the erectile response. Treatment with high glucose levels prevented FSS‐induced NO release, suggesting a mechanism that may contribute to decreased erectile function associated with diabetes.
The influence of changes in extracellular and intracellular sodium concentration on detrusor contractility
Authors: BESARANI DLER , WU CHANGHAO , FRY CHRISTOPHER H.
Published: April 2006

OBJECTIVE

To determine the role of Na+‐Ca2+ exchange in the regulation of isolated detrusor smooth muscle contractility.

MATERIALS AND METHODS

Isolated guinea‐pig detrusor strips were used to record isometric tension generated by; (a) electrical‐field stimulation to elicit nerve‐mediated responses; and (b) adding carbachol or superfusing with a high‐K+ solution. The [Na+] gradient between extracellular and intracellular compartments was altered by: (i) reducing superfusate [Na+] in stages from 140.2 to 10.2 mm; (ii) addition of the cardiac glycoside strophanthidin (200 µm).

RESULTS

Reducing extracellular [Na+] reversibly reduced the magnitude of nerve‐mediated contractions but increased the resting tension and magnitude of carbachol‐induced contracture. The mean (sd) [Na+] required for a half‐maximum effect on attenuating contractions, at 85.9 (6.2) mm, and developing contracture, at 59.1 (14.3) mm, were significantly different. The time constants of changes to nerve‐mediated contractions and carbachol contracture were also significantly different, at 147 (5) vs 1207 (386) s, respectively. These differences suggest that separate mechanisms influence nerve‐mediated contraction and contracture in low‐Na+ solutions. Exposure to the cardiac glycoside strophanthidin produced a similar effect to low‐Na+ solutions for carbachol contracture. Low‐Na+ solutions had no significant effect on contractures induced by high extracellular [K+].

CONCLUSION

Reducing the transmembrane [Na+] difference increases intracellular [Ca2+]. This increase is largely accommodated in intracellular stores, that can be released by exogenous carbachol. The results are consistent with the presence of a functional Na+‐Ca2+ exchanger in the surface membrane. The lack of effect of low‐Na+ solutions on contractures evoked by membrane depolarization is consistent with this conclusion. The reduction of the nerve‐mediated contraction by low‐Na+ solution might result from blockade of the nerve action potential.
Predictive factors of resolution of primary vesico‐ureteric reflux: a multivariate analysis
Authors: SILVA JOSE MARIA P. , DINIZ JOSE SILVERIO S. , LIMA ELEONORA M. , VERGARA RENATA M. , OLIVEIRA EDUARDO A.
Published: April 2006

The two papers in this section evaluate different diseases in children, but the two subjects are of considerable importance: nocturnal enuresis and VUR.

OBJECTIVE

To identify independent factors predicting the resolution of primary vesico‐ureteric reflux (VUR) in a cohort of medically managed children.

PATIENTS AND METHODS

Between 1977 and 2003, 506 children were diagnosed with VUR and were conservatively managed and prospectively followed. All of the children were maintained on antibiotic prophylaxis. Follow‐up imaging consisted of voiding cysto‐urethrography (VCUG) or a direct isotope cystogram at intervals of 2–3 years. The predictive factors used are based on the patient data at the time of entry in the protocol. The dependent variable was VUR resolution. The criterion for resolution was based on a single negative VCUG or direct isotope cystogram. A survival analysis identified variables significantly associated with VUR resolution. Cox's regression model was applied to identify variables independently associated with the dependent variable.

RESULTS

After adjustment, four variables remained as independent predictors of VUR resolution: nonwhite race, relative risk (95% confidence interval) of 1.5 (1.1–1.9; P = 0.009); mild grade of VUR, 3.3 (2.1–5.3; P < 0.001); absence of renal damage, 3.3 (2.4–4.5; P < 0.001); and absence of dysfunctional voiding, 2.0 (1.4–3.1; P < 0.001). For mild VUR, three variables were significantly associated: male gender, 1.7 (1.1–2.6; P = 0.012); absence of renal damage, 3.4 (1.8–6.4; P < 0.001); and unilateral VUR, 1.6 (1.1–2.3; P = 0.004). For moderate/severe VUR, three variables were significantly associated: nonwhite race, 1.7 (1.1–2.6; P = 0.01); absence of renal damage, 3.0 (2.0–4.4; P < 0.001); and absence of dysfunctional voiding, 2.8 (1.4–5.5; P = 0.004).

CONCLUSION

Few factors are amenable to intervention to modify the natural history of VUR. According to our findings, there are only two possible interventions: avoiding renal scars and managing voiding dysfunction.
Efficacy and tolerability of tolterodine extended‐release in men with overactive bladder and urgency urinary incontinence
Authors: ROEHRBORN CLAUS G. , ABRAMS PAUL , ROVNER ERIC S. , KAPLAN STEVEN A. , HERSCHORN SENDER , GUAN ZHONGHONG
Published: April 2006

A group of authors from the USA evaluated the efficacy and tolerability of tolterodine extended‐release on objective and subjective endpoints in men with an overactive bladder. They found that it significantly reduced incontinent episodes and improved patient perception of treatment benefit in men with an overactive bladder

OBJECTIVE

To evaluate the efficacy and tolerability of tolterodine extended‐release (ER) on objective and subjective endpoints in men with overactive bladder (OAB) and urgency urinary incontinence (UI).

PATIENTS AND METHODS

This was a post hoc analysis of data collected from men with OAB enrolled in a 12‐week, double‐blind, placebo‐controlled trial of tolterodine ER (4 mg once daily; tolterodine ER registration trial) and included men with urinary frequency (≥8 micturitions/24 h) and urgency UI (≥5 episodes/week). UI episodes were assessed using 7‐day bladder diaries. Patient perception of treatment benefit was evaluated after 12 weeks. Adverse events (AEs) were recorded throughout the study.

RESULTS

In all, 163 men with OAB (placebo, 86; tolterodine ER, 77; mean age 65 years) were evaluated. Baseline demographics and clinical characteristics were similar for the two treatment groups. Compared with placebo, tolterodine ER significantly reduced weekly UI episodes (median % change, −71% vs − 40%, P < 0.05; mean numeric change, − 11.9 vs −5.9, P = 0.02). Men receiving tolterodine ER had fewer micturitions/24 h, but this was not a significant difference from placebo (median % change, −12% vs − 4%, P = 0.22). Significantly more men treated with tolterodine‐ER (63%) than placebo‐treated men (46%) reported a benefit of treatment after 12 weeks (P = 0.04). The most commonly reported AEs associated with tolterodine‐ER vs placebo were dry mouth (16% vs 7%), constipation (4% vs 9%), dyspepsia (4% vs 1%), dizziness (5% vs 1%), and somnolence (3% vs 1%). One of the men receiving tolterodine ER had symptoms suggestive of urinary retention that led to his withdrawal from the study. None of the men had acute urinary retention requiring catheterization.

CONCLUSION

In men with OAB and urgency UI, tolterodine ER was well tolerated and significantly reduced episodes of urgency UI, and improved patient perception of treatment benefit.
Diagnostic utility of a p63/α‐methyl coenzyme A racemase (p504s) cocktail in ambiguous lesions of the prostate upon needle biopsy
Authors: MOLINIÉ VINCENT , HERVÉ JEAN MARIE , LUGAGNE PIERRE MARIE , LEBRET THIERRY , BOTTO HENRY
Published: April 2006

OBJECTIVE

To investigate the potential utility of a new combined immunostaining technique for diagnosing prostate cancer from histological analysis of needle biopsy specimens.

MATERIALS AND METHODS

Tissue was immunostained with a combination of antibodies against a basal cell marker (p63), and an enzyme commonly overexpressed in prostate cancer (p504s), on 63 small prostate cancer foci (<1 mm) and 109 cases of ambiguous lesions observed in needle biopsies.

RESULTS

After p63/p504s immunostaining, 93% of the ambiguous lesions (102/109) were classified. The final diagnoses retained were: 92 prostate cancers, seven atypical small acinar proliferations suspected of being malignant but undiagnosed, 21 prostatic intraepithelial neoplasia, five atypical adenomatous hyperplasia, and 36 atrophic benign mimickers of cancer.

CONCLUSIONS

Combining p504s as a positive marker for prostate cancer and p63 as a negative marker might improve diagnostic performance, sensitivity and specificity, and lead to fewer false‐negative results. This simple immunostaining procedure should reduce the percentage of residual ambiguous lesions and the need for additional biopsies.
Flow meter urine testing: a practical proposition in patients attending for urodynamics?
Authors: HASHIM HASHIM , ABRAMS PAUL
Published: April 2006

OBJECTIVE

To find a practical way of detecting urinary tract infection (UTI) before invasive urodynamic testing, as UTIs after urodynamics are well documented, but there are no standard guidelines about when urine should be analysed before urodynamics.

PATIENTS AND METHODS

Before urodynamics all patients are asked to provide a free urine flow; the patient is then catheterized to obtain a catheter‐specimen of urine that is tested for infection by a urine dipstick. If the dipstick is found positive for nitrites and/or leukocytes, the test is abandoned and the sample sent for microscopy, culture and sensitivity. In the present study, patients were asked to provide a free urine flow into the flowmeter as usual. Between patients, the flowmeter was washed with soap and water and dried, so that there would be no cross‐contamination between patients’ urine results. Urine was collected as usual and tested using a dipstick, the patient was then catheterized and another dipstick test done on the catheter specimen of urine (CSU), to compare results.

RESULTS

Pairs of urine samples, when positive for nitrite were 100% consistent, and 89% of pairs positive for leukocytes were the same before and after catheterization. The remaining 11% (all women) of the positive leukocyte group had leukocytosis on testing the flowmeter urine but not on the CSU, possibly due to contamination from the vagina.

CONCLUSION

Testing urine by dipstick in the sample from the flowmeter is a feasible option, thus saving the patient an inappropriate catheterization, with the risk of bacteraemia during urodynamics, and allowing the flowrate to be measured.
Differences in characteristics of nocturnal enuresis between children and adolescents: a critical appraisal from a large epidemiological study
Authors: YEUNG CHUNG K. , SREEDHAR BIJI , SIHOE JENNIFER D.Y. , SIT FRANCES K.Y. , LAU JOSEPH
Published: April 2006

OBJECTIVE

To evaluate any differences in the characteristics of primary nocturnal enuresis (PNE) between younger enuretic children and adolescents.

SUBJECTS AND METHODS

In all, 21 000 questionnaires designed to determine the presence or absence of bed‐wetting, diurnal incontinence, frequency of wetting, systemic illness, and family history, were sent to children aged 5–19 years from 67 kindergartens, primary schools and secondary schools randomly selected by a computer from different areas in Hong Kong. In addition, questions were asked to evaluate when and how the parents became aware that bed‐wetting is a significant medical problem deserving attention in children after the age of 5 years.

RESULTS

Of the 21 000 questionnaires distributed, 16 512 (78.6%) were completed. Among the respondents, 512 children (302 boys, 210 girls) had PNE; of these, 106 (20.7%) also had daytime incontinence. There was a marked reduction in the overall prevalence of PNE with advancing age. At 5 years old, 16.1% of children had PNE (20.7% boys, 10.8% girls; at age 9 and 19 years, 3.14% and 2.2% of children had PNE, respectively. However, this reduction was significantly more apparent among those with mild enuretic symptoms (wet <3 nights/week) than in those with more frequent bed‐wetting. Furthermore, younger enuretic children behaved very differently from adolescents and older patients. As age increased there was a significant tendency towards more severe enuretic symptoms. At age 5 years, 14.3% of enuretic children wet 7 nights/week, compared with 48.3% at age 19 years (P < 0.001). In addition, significantly more adolescent boys aged >10 years had daytime urinary incontinence than had enuretic children aged ≤ 10 years (32% vs 14.6%, respectively, P < 0.001). Most (89%) parents only became aware that bed‐wetting was a significant medical problem deserving attention through material in the mass media over the past 3–4 years.

CONCLUSIONS

The present finding suggesting that PNE spontaneously resolves with increasing age probably applies only to those with mild enuretic symptoms. There are significant differences in characteristics between younger enuretic children and older subjects. As age increases there is an increasing proportion of enuretic patients with more severe bed‐wetting. Enuretic children aged >10 years and adolescents have significantly more daytime urinary symptoms and incontinence. The previously reported low prevalence of PNE in Hong Kong was probably due to parental indifference to the problem.
Laparoscopic radical prostatectomy: minimum 3‐year follow‐up of the first 100 patients in the UK
Authors: EDEN CHRISTOPHER G. , MOON DANIEL A.
Published: April 2006

OBJECTIVE

To present the results of the first 100 patients in the UK treated by laparoscopic radical prostatectomy (LRP) and with at least 3 years of follow‐up, as LRP continues to develop as a minimally invasive alternative to open radical prostatectomy.

PATIENTS AND METHODS

In all, 100 patients (mean age 62 years, range 52–72) had a transperitoneal LRP by one surgeon during a 25‐month period from 2000 to 2002. Most (78%) patients had a prostate‐specific antigen level of 4–10 ng/mL, clinical stage T1 disease (62%), and Gleason 6 on biopsy (50%). Sixty‐four patients had unilateral or bilateral nerve preservation and 14 had pelvic lymphadenectomy.

RESULTS

The mean operative duration was 245 min, with a 1% conversion rate. Three patients received a blood transfusion and three had major complications, including a rectal injury. The positive margin rate was 16% and correlated with pathological variables. At ≥ 3 years of follow‐up (mean 3.7) the overall survival rate was 99% and the biochemical progression‐free survival was 88% in all patients, at 90% for pT2 and 75% for pT3. Ninety patients used 0–1 pads/day (84% pad‐free) and 60 undergoing nerve preservation retained erectile function.

CONCLUSION

This series includes the first results for LRP with a ≥ 3‐year follow‐up reported from the UK, with oncological control and morbidity comparable to those in previously published open and laparoscopic series. The history of open radical prostatectomy suggests that as the technique of LRP develops and experience with it increases, these results are likely to improve.
What is the optimum dose of type A botulinum toxin for treating neurogenic bladder overactivity?
Authors: RUFFION ALAIN , CAPELLE OLIVIER , PAPAREL PHILIPPE , LERICHE BEATRICE , LERICHE ALBERT , GRISE PHILIPPE
Published: April 2006

OBJECTIVE

To assess the effects of two doses of botulinum toxin A (Dysport®, Ipsen‐Biotech, France; 500 and 1000 Speywood units, SU) injected into the bladder for treating incontinence due to a neurogenic overactive bladder.

PATIENTS AND METHODS

In an open‐label, prospective study between October 2002 and May 2004, in two centres, we analysed the effects of successive doses of 500 and 1000 SU of Dysport, endoscopically injected into the detrusor muscle. At each step, patients (26 women and 19 men) were re‐evaluated at 1 month (clinical evaluation and pressure‐flow study). If there was a ‘good’ clinical response (complete absence of urinary leakage) the patient was observed until incontinence recurred; otherwise a further injection was administered at a higher dose.

RESULTS

The mean (sd, range) follow‐up was 22 (0.75, 5–31) months; 11 of the 45 patients (24%) did not respond primarily at 1 month for both doses. The analysis of the two curves of survival with no re‐injection of Dysport showed a statistically longer action at 1000 SU (P = 0.016). However, in this group there was one patient with general muscle weakness and asthenia, which could have been related to the injection.

CONCLUSIONS

The optimum dose of Dysport for incontinence secondary to a neurogenic overactive bladder is not yet defined; 1000 SU probably has a more prolonged effect than 500 SU but exposes the patient to major complications. Further studies evaluating the clinical effect of 750 SU of Dysport are necessary.
Incidental renal tumours: the frequency of benign lesions and the role of preoperative core biopsy
Authors: VASUDEVAN ARVIND , DAVIES ROBERT J. , SHANNON BEVERLEY A. , COHEN RONALD J.
Published: April 2006

OBJECTIVE

To determine the incidence of benign renal lesions in incidentally discovered small renal tumours, increasingly detected by the widespread use of abdominal imaging, and to evaluate whether preoperative renal core biopsy is effective in identifying benign lesions.

MATERIALS AND METHODS

In a retrospective study, renal core biopsies for incidental tumours over a 5‐year period were analysed. The biopsies were correlated with the final pathology of the nephrectomy specimens, or with patient follow‐up if nephrectomy was avoided.

RESULTS

Of 70 diagnostic core biopsies, a third of cases were considered benign. The sensitivity and specificity for both benign and malignant lesions when compared to definitive pathology was 100% in all cases subjected to nephrectomy. Of the 30 non‐diagnostic biopsies, three were proved to be benign, and 18 likely to be benign. The only complication of renal biopsy was one case of bleeding after biopsy.

CONCLUSION

A higher than previously anticipated proportion of incidentally detected small renal masses are benign. Given the high sensitivity and specificity, there is value in taking a core biopsy of small incidental renal lesions, a procedure with a low complication rate (1%). When analysed by a pathologist familiar with renal biopsy, this might avoid radical nephrectomy in many patients.
Health‐related quality of life and satisfaction with care among older men treated for prostate cancer with either radical prostatectomy or external beam radiation therapy
Authors: JAYADEVAPPA RAVISHANKAR , CHHATRE SUMEDHA , WHITTINGTON RICHARD , BLOOM BERNARD S. , WEIN ALAN J. , MALKOWICZ S. BRUCE
Published: April 2006

OBJECTIVE

To analyse health‐related quality of life (HRQoL) and satisfaction with care across potential curative treatments for older patients newly diagnosed with prostate cancer.

PATIENTS AND METHODS

In a prospective cohort study we recruited 115 older patients (≥65 years) newly diagnosed with prostate cancer from the urology clinics of an urban academic and a Veterans’ Administration (VA) hospital. Patients completed generic (Short Form‐36), prostate‐specific (University of California Los Angeles Prostate Cancer Index) HRQoL, and Client Satisfaction with Care (CSQ‐8) surveys before treatment with either radical prostatectomy (RP) or external beam irradiation (EBRT) and at 3, 6 and 12 months afterward. Clinical and demographic data were obtained via medical chart review. A repeated‐measures analysis of variance was used to examine changes in generic and prostate cancer‐specific HRQoL between treatments. Log‐linear regression was used to analyse the factors associated with 12‐month HRQoL scores, and Kaplan–Meier survival curves were used to compare the return to baseline values for HRQoL.

RESULTS

The RP group had significantly higher income, education and better general health than the EBRT group. Age (odds ratio 0.5, 95% confidence interval 0.32–0.82), non‐VA hospital (28.8, 2–402) and prostate‐specific antigen level at diagnosis (2.8, 1.05–7.5) were associated with RP. The analysis results indicated that the RP group had higher scores for generic HRQoL subscales of physical function (P = 0.019), role emotional (P = 0.037), vitality (P = 0.033) and general health (P = 0.05) than the EBRT group. A log‐linear regression model for predicting the 12‐month scores showed that RP was associated with higher scores for most of the generic HRQoL and bowel function (odds ratio 1.12, P = 0.03), urinary bother (1.6, P = 0.014) and bowel bother (1.5, P = 0.013). Being older was associated with a lower score on bowel function (0.98, P = 0.05) and sexual function (0.92, P = 0.05). Satisfaction with care was comparable between treatment groups at baseline and at the follow‐up.

CONCLUSIONS

Older patients tolerate RP well from the HRQoL perspective and thus decisions for therapy in this age cohort should not be based primarily on age.
The effects of isolated posterior compartment defects on lower urinary tract symptoms and urodynamic findings
Authors: COLE EMILY E. , KAUFMAN MELISSA R. , SCARPERO HARRIETTE M. , DMOCHOWSKI ROGER R.
Published: April 2006

OBJECTIVES

To determine any significant patterns among subjective and/or objective storage or voiding variables in women with isolated rectoceles or posterior enteroceles.

PATIENTS AND METHODS

We retrospectively reviewed the charts of 23 women with isolated posterior compartment defects. Patient histories, physical examination findings, catheterized postvoid residual urine volume (PVR) after uroflowmetry, and urodynamic evaluations were reviewed. Lower urinary tract symptoms (LUTS) were classed as pure storage (urgency, frequency, nocturia, etc.), pure voiding (hesitancy, straining, positional voiding, etc.), or mixed.

RESULTS

The mean (range) age of the women was 67 (48–85) years. On physical examination, 15 women had a grade 3 defect, and eight a grade 2 defect. Thirteen women reported symptoms related to their prolapse (vaginal bulge, splinting with defecation): nine reported pure storage symptoms, one pure voiding symptoms, and 12 mixed symptoms; two women relied on catheterization for bladder emptying. Only one woman reported no LUTS. An elevated PVR (>100 mL) was found in 11 women (48%). Urodynamic studies were available for 17 women, and revealed detrusor overactivity in nine of them. There were low maximum urinary flow rates (Qmax ≤ 15 mL/s) in 12 of the 17 women, and high voiding pressures at Qmax (Pdet.Qmax ≥  20 cmH20) in 10. Both findings were present in seven of the 17 women. There was evidence of abdominal straining to void in nine of the 17 women.

CONCLUSIONS

The overwhelming majority of women with isolated posterior compartment defects reported bothersome LUTS and most had abnormal urodynamic variables. The findings suggest that significant posterior prolapse defects can cause bladder outlet obstruction.
Effects of magnetic stimulation in the treatment of pelvic floor dysfunction
Authors: VOORHAM–VAN DER ZALM PETRA J. , PELGER ROB C.M. , STIGGELBOUT ANNE M. , ELZEVIER HENK W. , LYCKLAMA À NIJEHOLT GUUS A.B.
Published: April 2006

OBJECTIVE

To correlate, in a pilot study, the clinical results of extracorporeal magnetic innervation therapy (ExMI) of the pelvic floor muscles with functional changes in the pelvic floor musculature, urodynamics and quality of life.

PATIENTS AND METHODS

In all, 74 patients (65 women and nine men) with urge incontinence, urgency/frequency, stress incontinence, mixed incontinence and defecation problems were included in a prospective study of ExMI using a ‘electromagnetic chair’. All patients were treated twice weekly for 8 weeks. Digital palpation and biofeedback with a vaginal or anal probe were used for registration of the pelvic floor musculature. A urodynamic evaluation, a voiding diary, a pad‐test, the King's Health Questionnaire (KHQ) and a visual analogue scale (VAS) were completed by the patient at baseline and at the end of the study.

RESULTS

In the group as a whole, there were no significant differences in the voiding diary, pad‐test, quality of life, VAS score, biofeedback registration and urodynamics before and after treatment. Additional stratification was applied to the total patient group, related to the pretreatment rest tone of the pelvic floor, the basal amplitude registered on electromyography, to age and to previous treatments. However, there were no significant differences in the data before and after treatment within all subgroups (stress incontinence, urge incontinence, urgency/frequency, defecation problems, overactive pelvic floor, age, previous treatments), except for the KHQ domain of ‘role limitations’, where there was a significant improvement in all groups.

CONCLUSION

ExMI did not change pelvic floor function in the present patients. The varying outcomes of several studies on ExMI stress the need for critical studies on the effect and the mode of action of electrostimulation and magnetic stimulation. In our opinion ‘the chair’ is suitable to train awareness of the location of the pelvic floor. However, active pelvic floor muscle exercises remain essential.
Incidental acute prostatic inflammation is associated with a lower percentage of free prostate‐specific antigen than other benign conditions of the prostate: a prospective screening study
Authors: ROWE EDWARD W.J. , LANIADO MARC E. , WALKER MARJORIE M. , ANUP PATEL
Published: April 2006

OBJECTIVE

To evaluate the performance of percentage free/total prostate‐specific antigen (f/tPSA) as a screening tool for prostate cancer, and to assess the impact of prostatic inflammation on f/tPSA.

PATIENTS AND METHODS

Men aged 50–65 years were invited for prostate cancer screening. Biopsies were taken from men with a tPSA of ≥ 4 ng/mL, together with those with a tPSA of 1.1–3.99 ng/mL and a f/tPSA of ≤ 20%. Histological evidence of prostate cancer, acute inflammation, chronic inflammation, and benign prostatic tissue were noted in biopsy cores, together with the associated f/tPSA values.

RESULTS

The cancer detection rate was 4.3% (33/773). Evidence of inflammation was found in about half (87/175) of those biopsied. Men with acute inflammation (27/175, 15%) had significantly lower serum f/tPSA values (mean 13.4%) than those with chronic inflammation (mean 16.6%, P = 0.002) and benign prostatic tissue (mean 15.7%, P = 0.034), but were similar to men with prostate cancer (mean 15.3%, P = 0.315).

CONCLUSIONS

In this prospectively screened cohort of men, there was a high incidence of asymptomatic inflammation on prostatic histology; f/tPSA values were significantly lower in men with acute inflammation. This might explain the variability of f/tPSA in improving specificity when used as a screening tool for prostate cancer, and might also reduce its effectiveness in differentiating tumours with more aggressive potential.
Metabolic abnormalities associated with calyceal diverticular stones
Authors: AUGE BRIAN K. , MALONEY MICHAELLA E. , MATHIAS BARBARA J. , PIETROW PAUL K. , PREMINGER GLENN M.
Published: April 2006

Stones in calyceal diverticula present an interesting problem, both surgical and metabolic. Authors from the USA used a comprehensive metabolic evaluation of patients with these stones, and found consistent abnormalities. They also found that these could be corrected with selective medical therapy, and this was associated with a high remission rate.

OBJECTIVE

To review the metabolic analyses of patients with calyceal diverticular stones who had surgical treatment of their calculi and to examine the effect of selective medical therapy on stone recurrence, as recent reports suggest that metabolic abnormalities contribute to stone development.

PATIENTS AND METHODS

In all, 37 patients who had endoscopic treatment of symptomatic calyceal diverticular calculi were retrospectively reviewed. Stone composition and initial 24‐h urine collections (24‐h urinary volumes, pH, calcium, sodium, uric acid, oxalate, citrate, and the number of abnormalities/patient per collection) were compared with 20 randomly selected stone‐forming patients (controls) with no known anatomical abnormalities. Stone formation rates before and after the start of medical therapy were calculated in the patients available for follow‐up.

RESULTS

Twelve of the diverticulum patients (five men and seven women) had complete 24‐h urine collections, all of whom had at least one metabolic abnormality. Seven patients had hypercalciuria, four had hyperuricosuria and three had mild hyperoxaluria. The most common abnormality was a low urine volume; 11 of the 12 patients had urine volumes of <2000 mL/day (range 350–1950). Ten patients had hypocitraturia in at least one of the two 24‐h urine samples; seven had low urinary citrate levels (172–553 mg/day) on both samples. The findings were similar in the control group. The diverticulum patients had 3.1 abnormalities/patient, and the controls had 2.9 abnormalities/patient (P > 0.05). No patients had gouty diathesis and none developed cystine stones. Stone analyses were similar in the two groups; both developed either calcium oxalate or mixed calcium oxalate/calcium phosphate stones. Six patients were followed for a mean of 23.1 months while on selective medical therapy; only one passed any additional stones, thought to be existing calculi, for a remission rate of five of six (83%).

CONCLUSIONS

All patients with symptomatic calyceal diverticular stones who had comprehensive metabolic evaluation had metabolic abnormalities. There were similar abnormalities in the control random stone‐formers. The abnormalities were corrected with selective medical therapy, as shown by the high remission rate. We recommend that, for patients with symptomatic calyceal diverticular calculi, a metabolic evaluation should be considered to determine stone forming risk factors.