bluuebunny/crossref_metadata_2025 huggingface dataset:
Posttraumatic Stress Disorder: Do Electrical Startle Responses and Thyroid Function Usefully Supplement Self-Report? A Study of Vietnam War Veterans
Authors: Wells J. Elisabeth , Williams Timothy H. , Macleod Alastair D. , Carroll Grant J.
Published: May 2003

Objective: To investigate the usefulness of electrical startle responses and thyroid function as supplements to self-report measures of posttraumatic stress disorder (PTSD).

Method: Invitations were sent to all New Zealand Vietnam War veterans known to be living in North Canterbury; 50 responded and the 35 living in or near Christchurch were included. Self-report measures of PTSD (the Davidson Trauma Scale (DTS) and the Symptom Check List (SCL-90-R)), an eye blink electrical startle response and thyroid function were measured. The DTS was re-administered one to two weeks later to assess short-term test–retest reliability. Six months later the DTS and the electrical startle response were measured again.

Results: The veterans reported a wide range of PTSD severity, with 15/35 reporting prior diagnosis of PTSD. The DTS showed high short-term test–retest reliability (r = 0.93) and a moderate correlation after 6 months (r = 0.73). It also showed sensitivity to change; in one to two weeks the scores increased by nearly half a standard deviation, possibly because of an imminent ‘homecoming’ march. The DTS and a PTSD scale from the SCL-90-R were highly correlated (r = 0.89). The total triiodothyronine (T3) to free thyroxine (T4) ratio measure of thyroid function correlated poorly with self-report (r ≤ 0.27). The electrical startle response also correlated poorly with self-report (r ≤ 0.26), showed low internal consistency between left and right sides (r = 0.43), and correlated 0.39 over six months. It was disliked by the veterans and had increased slightly at 6 month follow-up, perhaps because of sensitization.

Conclusions: The DTS was reliable and correlated highly with the SCL-90-R PTSD scale. Neither thyroid function nor eye blink electrical startle correlated with each other or with selfreport, and reliability was not good for electrical startle. These two measures do not appear to add anything useful to the assessment of PTSD.
Dysexecutive Syndrome and Social Adjustment in Schizophrenia
Authors: Simon Andor E. , Giacomini Véronique , Ferrero François , Mohr Sylvia
Published: May 2003

Objective: This paper reports on a study designed to (i) assess levels of executive functions among patients suffering from schizophrenia; (ii) investigate associations between measures of executive functions and psychosocial adjustment; and (iii) examine the influence of psychopathology on the relationship between executive functions and psychosocial adjustment. Clear knowledge of executive functions and of their impact on social adjustment in patients with schizophrenia may play a decisive role in preparing and structuring appropriate outpatient care.

Method: An extensive battery constituted of several tests developed for the assessment of executive functions was used in 38 inpatients with a DSM-IV diagnosis of schizophrenia. Psychosocial adjustment was assessed with a set of commonly used scales.

Results: Performance on measures of executive functions was heterogeneous among the patient population, with a subgroup performing within normal scores. A similar pattern was found on measures of psychosocial adjustment. Most of the executive measures were not dependent on demographic or clinical variables. A factorial analysis on measures of psychosocial adjustment yielded a one-factor model which showed inconsistent, and at most, weak to moderate correlations with executive functions. Regression analysis revealed that symptom levels accounted for two-thirds of the variance of psychosocial adjustment, and together with measures of executive functions for 91% of the variance. General and negative symptoms showed strong correlations with psychosocial adjustment.

Conclusions: Our study supports the view that executive function is a heterogeneous construct with several subdimensions. Additionally, it suggests that symptom level has an important role as ‘rate limiting factor’ on psychosocial adjustment and is partially mediated by executive dysfunction. Our results call for careful and detailed assessment in this patient population in order to establish appropriate treatment programmes such as cognitive remediation.
The Excess Cost of Depression in South Australia: A Population-Based Study
Authors: Hawthorne Graeme , Cheok Frida , Goldney Robert , Fisher Laura
Published: May 2003

Objective: To establish excess costs associated with depression in South Australia, based on the prevalence of depression (from the Primary Care Evaluation of Mental Disorders (PRIME-MD)) and associated excess burden of depression (BoD) costs.

Method: Using data from the 1988 South Australian (SA) Health Omnibus Survey, a properly weighted cross-sectional survey of SA adults, we calculated excess costs using two methods. First, we estimated the excess cost based on health service provision and loss of productivity. Second, we estimated it from loss of utility.

Results: We found symptoms of major depression in 7% of the SA population, and 11% for other depression. Those with major depression reported worse health status, took more time off work, reported more work performance limitations, made greater use of health services and reported poorer health-related quality-of-life. Using the service provision perspective excess BoD costs were AUD$1921 million per annum. Importantly, this excluded non-health service and other social costs (e.g. family breakdown, legal costs). With the utility approach, using the Assessment of Quality of Life (AQoL) instrument and a very modest life-value (AUD$50 000), the estimate was AUD$2800 million. This reflects a societal perspective of the value of illness, hence there is no particular reason the two different methods should agree as they provide different kinds of information. Both methods suggest estimating the excess BoD from the direct service provision perspective is too restrictive, and that indirect and societal costs ought be taken into account.

Conclusions: Despite the high ranking of depression as a major health problem, it is often unrecognized and undertreated. The findings mandate action to explore ways of reducing the BoD borne by individuals, those affected by their illness, the health system and society generally. Given the limited information on the cost-effectiveness of different treatments, it would seem important that resources be allocated to evaluating alternative depression treatments.
Collision, subduction and accretion events in the Philippines: A synthesis
Authors: Yumul Graciano P. , Dimalanta Carla B. , Tamayo Rodolfo A. , Maury Rene C.
Published: May 2003

Abstract  The Philippines preserves evidence of the superimposition of tectonic processes in ancient and present‐day collision and subduction zone complexes. The Baguio District in northern Luzon, the Palawan–Central Philippine region and the Mati–Pujada area in southeastern Mindanao resulted from events related to subduction polarity reversal leading to trench initiation, continent‐arc collision and autochthonous oceanic lithosphere emplacement, respectively. Geological data on the Baguio District in Northern Luzon reveal an Early Miocene trench initiation for the east‐dipping Manila Trench. This followed the Late Oligocene cessation of subduction along the west‐dipping proto‐East Luzon Trough. The Manila Trench initiation, which is modeled as a consequence of the counter‐clockwise rotation of Luzon, is attributed to the collision of the Palawan microcontinental block with the Philippine Mobile Belt. In the course of rotation, Luzon onramped the South China Sea crust, effectively converting the shear zone that bounded them into a subduction zone. Several collision‐related accretionary complexes (e.g. Romblon, Mindoro) are present in the Palawan–Central Philippine region. The easternmost collision zone boundary is located east of the Romblon group of islands. The Early Miocene southwestward shift of the collision boundary from Romblon to Mindoro started to end by the Pliocene. Continuous interaction between the Palawan microcontinental block and the Philippine Mobile Belt is presently taken up again along the collisional boundary east of the Romblon group of islands. The Mati–Pujada Peninsula area, on the other hand, is underlain by the Upper Cretaceous Pujada Ophiolite. This supra‐subduction zone ophiolite is capped by chert and pelagic limestones which suggests its derivation from a relatively deep marginal basin. The Pujada Ophiolite could be a part of a proto‐Molucca Sea plate. The re‐interpretation of the geology and tectonic settings of the three areas reaffirm the complex geodynamic evolution of the Philippine archipelago and addresses some of its perceived geological enigmas.
Early Cretaceous sinistral shearing and associated folding in the South Kitakami Belt, northeast Japan
Authors: Sasaki Migiwa
Published: May 2003

Abstract  Early Cretaceous structural development of the southern part of the South Kitakami Belt, northeast Japan, is discussed through precise structural mapping and the measurement of semiquantitative strain. The mapping and measurement revealed that wide north‐ to northeast‐trending sinistral shear zones occupied by the ‘slate’ with higher strain than the surrounding rocks run from the axial part to the western limb of major synclines, with the wavelength of 5–10 km. The major synclines with a U‐shaped rock distribution opening to the south are interpreted to be drag folds along the sinistral shear zones. These structures were modified by a second stage of Early Cretaceous sinistral shearing characterized by localized high‐temperature mylonite zones along the rim of some of the 120 Ma granitoids that cut the major folds and baked the ‘slate’ in the older shear zones mentioned above. The rocks of the South Kitakami Belt, which had undergone two stages of shearing, were rapidly exhumed before the deposition of the Late Aptian–Albian Miyako Group. Finally, a restoration model is presented of the Early Cretaceous sinistral displacement and deformation in the study area.
Dinosaur tracks from the Cretaceous of South Korea: Distribution, occurrences and paleobiological significance
Authors: Huh Min , Hwang Koo Geun , Paik In Sung , Chung Chull Hwan , Kim Bo Seong
Published: May 2003

Abstract  Abundant dinosaur fossils including dinosaur footprints, eggs and nests, teeth and bones have been found from the Cretaceous non‐marine deposits of Korea. Among them, dinosaur tracks are the most distinctive, and some track sites are among the most famous in the world. Until now, 27 dinosaur track localities have been discovered from the Cretaceous strata in the Gyeongsang Basin and several small basins. Ornithopod tracks are most abundant at most Korean track sites, and most of them are identified as Caririchnium; that is, large ornithopod footprints with wide hoof impressions. Most theropod tracks are found in Neungju Basin and they consist of various types of small or medium‐sized bird‐like footprints, and other large footprints. Sauropod tracks are also abundant in the Gyeongsang Basin. The sauropod tracks vary in size, shape, and pattern of trackway, and suggest that diverse sauropods existed in this area. These diverse tracks in South Korea suggest that various dinosaurs flourished at the margins of lakes distributed in the southern part of the Korean Peninsula during the Cretaceous.
Fusulinoidean faunal succession of a Paleo–Tethyan oceanic seamount in the Changning–Menglian Belt, West Yunnan, Southwest China: An overview
Authors: Ueno Katsumi , Wang Yujing , Wang Xiangdong
Published: May 2003

Abstract  Fusulinoidean faunal succession from Paleo–Tethyan seamount‐type carbonates of the Yutangzhai section in the Central zone of the Changning–Menglian Belt of West Yunnan, Southwest China, is presented for the first time. The Changning–Menglian Belt is one of the orogenic belts that represent the closed main Paleo–Tethys in East Asia. The Yutangzhai section is represented by basalts and overlying carbonates, about 1100 m thick. It exhibits a continuous faunal succession composed of 17 fusulinoidean assemblages ranging from the Serpukhovian (late Mississippian/late Early Carboniferous) to Midian/Capitanian (late Middle Permian/late Guadalupian). No significant faunal break can be recognized in this section. The generic and some specific composition of the Yutangzhai assemblages indicates that the faunal succession is similar to those observed in Tethyan and Panthalassan areas and is of tropical Tethyan type although their generic diversity is definitely lower than those of Paleo–Tethyan shelves, such as South China, Indochina, and Central Asia. Throughout the Yutangzhai section, the carbonate rocks are essentially massive, very pure in composition, and devoid of terrigenous siliciclastic inputs. These lithologic characters are identical to those observed in accreted shallow‐marine carbonate successions of seamount origin in Permian and Jurassic accretionary complexes of Japan, for example the Akiyoshi Limestone. This evidence further demonstrates the seamount origin of the basalt–limestone succession in the Central zone of the Changning–Menglian Belt from the viewpoint of lithofacies. In middle Mississippian (middle Early Carboniferous) time, oceanic submarine volcanism that was probably related to hot spot activities formed a number of seamounts and oceanic plateaus. It was active not only in the Panthalassa, but also in the Paleo–Tethys.
Paleozoic sedimentation and tectonics in Korea: A review
Authors: Lee Yong Il , Lee Jae Il
Published: May 2003

Abstract  The geological history of the Korean Paleozoic is recorded in lower and upper Paleozoic strata, mostly distributed in two relatively large sedimentary basins, the Taebaeksan and Pyeongnam basins. The lower Paleozoic sedimentary rocks are exclusively of marine origin, dominated by shallow platform carbonate rocks with minor interbedded siliciclastic rocks. The development of the lower Paleozoic sequence was mostly controlled by eustatic changes, having cyclic sedimentation of various temporal scales. During the early Paleozoic the Korean Peninsula was located in a low‐latitude tropical region and experienced frequent storm activities. The upper Paleozoic sequence comprises paralic to non‐marine rocks with minor limestone intercalations in the lower part of the sequence. Upsection changes in sandstone composition and mudrock geochemistry of the upper Paleozoic Pyeongan Supergroup in the Samcheok coalfield indicate that sediments may have been derived from the continued uplift and unroofing of a collisional orogen source. There exists a great unconformity between the lower and upper Paleozoic strata, which spans the geological time from the Late Ordovician to Early Carboniferous. The unconformity period is conventionally thought to be of non‐deposition, but a recent study suggests that it is characterized by continuous sedimentation and significant removal (>1 km thick) of sediments by erosion. No Paleozoic tectonic history has been addressed so far, and thus it needs further study to elucidate geological events during the middle–late Paleozoic in the Korean Peninsula. Tectonostratigraphic correlation of the Korean Peninsula with neighboring Chinese blocks has been a hot issue for a long time. Although the eastward extension of the Chinese collision belt has been recently suggested to be the Imjingang belt located in the middle of the peninsula, further studies are needed to test this hypothesis because results of recent paleontological, sedimentological and stratigraphic studies on Paleozoic sediments are not in agreement with this possibility.
Paleozoic ophiolites and blueschists in Japan and Russian Primorye in the tectonic framework of East Asia: A synthesis
Authors: Ishiwatari Akira , Tsujimori Tatsuki
Published: May 2003

Abstract  Ophiolites and high‐pressure (HP) metamorphic rocks are studied to test continuation of Paleozoic and early Mesozoic geological units from Japan to Primorye over the Japan Sea. The early Paleozoic ophiolites are present on both sides, and the late Paleozoic ophiolite of south‐western Japan may also have its counterpart in Primorye. The Shaiginskiy HP schist and the associated Avdakimov gneiss in Primorye, both tectonically underlying the early Paleozoic ophiolitic complex, yield a 250‐Ma phengite and hornblende K–Ar age, which is intermediate between those of the Renge (280–330 Ma) and Suo (170–220 Ma) blueschists in south‐western Japan. This age also coincides with that of the coesite‐bearing eclogites in the Sulu–Dabie suture in China and several medium‐pressure metamorphic rocks in East Asia. On the basis of these results and other geological data, the authors propose the ‘Yaeyama promontory’ model for an eastward extension of the Sulu–Dabie suture. The collision suture warps southward into the Yellow Sea and detours around Korea, turns to the north at Ishigaki Island in the Yaeyama Archipelago of Ryukyu, where it changes into a subduction zone and further continues toward south‐western Japan and Primorye. Most ophiolites from this area represent crust–mantle fragments of an island arc–back‐arc basin system, and the repeated formation of ophiolite–blueschist associations may be due to the repetition of the Mariana‐type non‐accreting subduction and Nankai‐type accreting subduction.
Petrological feature of spinel lherzolite xenolith from Oki‐Dogo Island: An implication for variety of the upper mantle peridotite beneath southwestern Japan
Authors: Abe Natsue , Takami Masao , Arai Shoji
Published: May 2003

Abstract  Spinel lherzolite is a minor component of the deep‐seated xenolith suite in the Oki‐Dogo alkaline basalts, whereas other types of ultramafic (e.g. pyroxenite and dunite) and mafic (e.g. granulite and gabbro) xenoliths are abundant. All spinel lherzolite xenoliths have spinel with a low Cr number (Cr#; < 0.26). They are anhydrous and are free of modal metasomatism. Their mineral assemblages and microtextures, combined with the high NiO content in olivine, suggest that they are of residual origin. But the Mg numbers of silicate minerals are lower (e.g. down to Fo86) in some spinel lherzolites than in typical upper mantle residual peridotites. The clinopyroxene in the spinel lherzolite shows U‐shaped chondrite‐normalized rare‐earth element (REE) patterns. The abundance of Fe‐rich ultramafic and mafic cumulate xenoliths in Oki‐Dogo alkali basalts suggests that the later formation of those Fe‐rich cumulates from alkaline magma was the cause of Fe‐ and light REE (LREE)‐enrichment in residual peridotite. The similar REE patterns are observed in spinel peridotite xenoliths from Kurose and also in those from the South‐west Japan arc, which are non‐metasomatized in terms of major‐element chemistry (e.g. Fo > 89), and are rarely associated with Fe‐rich cumulus mafic and ultramafic xenoliths. This indicates that the LREE‐enrichment in mantle rocks has been more prominent and prevalent than Fe and other major‐element enrichment during the metasomatism.
Even moderate chronic renal failure is associated with impaired acute and long‐term outcome after coronary angioplasty
Authors: REINECKE HOLGER , REGETMEIER ANDREA , MATZKIES FRITZ , BREITHARDT GÜNTER , SCHAEFER ROLAND M
Published: May 2003

SUMMARY: End‐stage renal failure requiring maintenance haemodialysis is known to be a strong independent predictor of mortality and complications after coronary interventions. In contrast, data about the outcome of patients with moderate chronic renal failure is very limited and was therefore evaluated in this study in patients with coronary angioplasty (PTCA). This was a retrospective case‐control study of 66 patients with moderate chronic renal failure who underwent PTCA, and who were matched to 66 PTCA patients with normal renal function and followed up by telephone interviews. In hospital, patients with renal failure suffered significantly more often from local complications (12.1 vs 0%, P = 0.004) and acute deterioration of renal function after PTCA (7.6 vs 0%, P = 0.023) than their matched controls. Angiographic success after PTCA was not significantly different (85 vs 83%, n.s.) as was the case with in‐hospital mortality (6.1 vs 3.0%, n.s.). During follow up (100% complete), 18 patients (27.3%) with renal failure had died compared with seven controls (10.6%; OR 3.2, P = 0.015). Even if deaths from non‐cardiac causes in three patients with renal failure were excluded, death after PTCA occurred significantly more often in the renal failure group (P = 0.015, log rang test). Multivariate analyses with stepwise logistic regression identified impaired left ventricular function (OR 2.24, 95%CI 1.33–3.77), elevated serum creatinine (OR 2.02, 95%CI 1.24–3.31) and smaller height (OR 0.91, 95%CI 0.86–0.98) to be independently associated with death. In conclusion, in this matched‐pair study, patients with chronic renal failure suffered from more in‐hospital complications and from markedly increased long‐term mortality after PTCA.
Effects of bicarbonate buffered dialysate on human peritoneal mesothelial cell intracellular calcium homeostasis
Authors: BIRD STEPHEN D , WALKER ROBERT J
Published: May 2003

SUMMARY: This study compares the biocompatibility of two bicarbonate‐based peritoneal dialysis (PD) solutions using the measurement of intracellular free calcium (Cai2+) as a sensitive parameter of cell function in human peritoneal mesothelial cells (hPMC). Fura‐2‐loaded hPMC suspensions were exposed to bicarbonate (38 mmol/L) and bicarbonate (25 mmol/L), lactate‐buffered PD (15 mmol/L) solutions at pH 7.4 and compared with Krebs–Ringer physiological saline (KRS; pH = 7.4). Resting Cai2+ values and 4br‐A23187 (1.0 µmol/L) induced transients were compared in treatment and control groups. In separate studies, the effect that low saline pH had on Cai2+ homeostasis was examined. Suspended cells or cells attached to coverslips were bathed in citric acid‐phosphate (McIllvaine’s) buffered saline (MBS, pH = 7.4). Cells were acidified (pH = 5.3) with citric acid and then challenged with ionophore. Ionophore challenge produced a significantly reduced Cai2+ transient response in cells exposed to the bicarbonate/lactate fluid compared with bicarbonate or KRS. Acidified cell suspensions produced a small monophasic Cai2+ transient rise that was short lived. Gradual recovery of MBS to pH 7.4 produced no changes to Cai2+ homeostasis of cell monolayers. Ionophore treatment produced a biphasic response identical to cells bathed in KRS. This study has demonstrated that short‐term exposure to bicarbonate did not alter Cai2+ homeostasis directly, or subsequent modulation of intracellular pH. The MBS system provided a reliable method of modifying the external pH during continuous Cai2+ measurement.
Mast cells in the kidney
Authors: EHARA TAKASHI , SHIGEMATSU HIDEKAZU
Published: May 2003

SUMMARY: Mast cells have become a recent concern in the nephrological world. The development of antibodies to mast cell‐specific enzymes, tryptase and chymase, has facilitated the study of mast cells in the kidney. Now, they are investigated immunohistochemically as well as histochemically. There are three types of human mast cells, MCT, which contains exclusively tryptase, MCTC, which has both tryptase and chymase, and MCC, which contains only chymase. Many immunohistochemical studies involving mast cells have been conducted through the use of renal biopsy specimens. As a result, human renal diseases including various glomerulonephritis and pyelonephritis are found to have increased the number of mast cells in the renal cortex, especially in the area of fibrosis. The relationship between the number of mast cells and the prognosis of renal diseases has been proved to be significantly correlated in many reports. The subtypes of mast cells in these diseases are variably present, and no tendency of subtype specificity has been found. With the use of electron microscopically, mast cells are observed to be in contact with other interstitial cells or to infiltrate into tubules. Functionally, human renal mast cells resemble lung mast cells. Inhibitory substances for mast cell proliferation have been found in the mouse kidney. Compared with the results of human studies, mast cells are not found in the interstitum in animal models of renal diseases, except in a few transgenic mouse models and magnesium‐deficient rats. Little is known about the exact roles that mast cells play in the renal interstitium. Future studies will hopefully make their characteristics clear.
Urinary aquaporin‐2 levels in healthy volunteers
Authors: AL‐DAMEH ALI , BEDFORD JENNIFER J , LEADER JOHN P , WALKER ROBERT J
Published: May 2003

SUMMARY:  Renal water handling is regulated by the release of arginine vasopressin (AVP) and the subsequent insertion of aquaporin 2 (AQP2) in the apical membrane of collecting duct cells. This in turn increases the membrane permeability to water and the passive reabsorption of water down the concentration gradient present in the medulla. Aquaporin 2 can be detected in the urine under conditions of antidiuresis. We wish to validate an assay for urinary AQP2. Fourteen volunteers participated in studies of water loading and water deprivation followed by the administration of 1‐deamino‐8‐d‐arginine vasopressin (dDAVP). Urine osmolality was measured by vapour pressure osmometry. Urinary AQP2 was measured by using a chemiluminescent assay. Baseline correlations between serum AVP levels, urinary osmolality and urinary AQP2 levels were not significant. Following the administration of dDAVP, a positive correlation between urine osmolality and urinary AQP2 was evident (r = 0.762). For specific conditions where renal water retention is stimulated via AVP, urinary AQP2 measurements provide a reproducible measurement of the renal actions of AVP.
Spontaneous regeneration of the seriously injured sympathetic pathway projecting to the prostate over a long period in the dog
Authors: Kobayashi T. , Kihara K. , Hyochi N. , Masuda H. , Sato K.
Published: May 2003

OBJECTIVES

To explore the spontaneous regeneration, over a long period, of the seriously injured sympathetic pathway controlling the prostate.

MATERIALS AND METHODS

The hypogastric nerve (HGN), which is part of the sympathetic pathway from the spinal cord to the prostate, was partly removed over half of its length on both sides in six dogs. Four years after surgery the responses of the prostate to electrical stimulation of the lumbar splanchnic nerve (LSN) or the HGN proximal to the site removed, were assessed.

RESULTS

In six dogs, 10 of the 17 LSNs (second to fourth) and four of the 10 HGNs stimulated elicited prostatic contraction. The pathways via the ipsilateral HGN and/or the contralateral HGN from the LSNs to the prostate were identified as having regenerated in four of six dogs.

CONCLUSION

These results indicate that the sympathetic pathways via the HGN to the canine prostate can regenerate spontaneously over a long period after serious injury, and that their cross‐innervation system can also be repaired.
Detection of vesico‐ureteric reflux in children by colour‐flow Doppler ultrasonography
Authors: Koşar A. , Yeşi̇ldağ A. , Oyar O. , Perk H. , Gülsoy U.
Published: May 2003

OBJECTIVES

To assess the findings of colour‐flow Doppler ultrasonography (DUS) in the diagnosis of vesico‐ureteric reflux (VUR), as an alternative to the primary diagnostic tool, voiding cysto‐urethrography (VCUG).

PATIENTS AND METHODS

Thirty‐five children (aged 2–15 years) were examined for VUR by DUS and standard VCUG. All patients underwent DUS and VCUG within 48 h but the findings of the latter were not reported to the ultrasonographer. The DUS was undertaken using a colour Doppler real‐time system; a positive ultrasonogram was defined by visualizing Doppler signals from the bladder to the ureter during the course of bladder filling.

RESULTS

Of the 70 ureters assessed, 28 were refluxing on DUS and 29 on VCUG; there were two false‐positive and three false‐negative results. Comparing the two methods showed DUS to be 90% sensitive with a specificity of 93% for detecting VUR. Four patients underwent reimplantation during their treatment. DUS findings correlated well with standard VCUG in these patient as a method of follow‐up.

CONCLUSION

DUS can be used as an alternative to standard VCUG for screening and following VUR. In addition, DUS avoids the danger of exposure to ionizing radiation and the unpleasant catheterization that many of these children fear.
Structural and ultrastructural studies of the urinary tract of mice inoculated with Lactobacillus fermentum
Authors: Silva de Ruiz C. , Del R. Rey M. , Nader‐Macías M.E.
Published: May 2003

OBJECTIVE

To assess, using structural and ultrastructural studies of the urinary tract, the effects of the intraurethral inoculation of lactobacilli (probiotic treatment) as lactobacilli are the predominant micro‐organisms of the urogenital tract of humans, monkeys and mice.

MATERIALS AND METHODS

Previous work showed the protective effect of Lactobacillus fermentum CRL 1058 intraurethrally inoculated against the challenge of uropathogenic Escherichia coli. There was also an effect of oestrogens and antibiotics in the kinetics of colonization of both micro‐organisms in mice. In the present study L. fermentum was inoculated with agarose beads (107 colony‐forming units) and the number of micro‐organisms determined by plating in selective media, giving a high degree of colonization in all the organs studied. The urinary tract organs were processed by histological and electron microscopy techniques standardized in our laboratory.

RESULTS

The intraurethral inoculation of lactobacilli produced no adverse effects or significant changes in any of the organs assessed (kidney, ureter, bladder or urethra), when evaluated by histological and ultrastructural techniques.

CONCLUSION

The use of lactobacilli as a probiotic treatment is probably safe.
Improvement in urinary symptoms after radical prostatectomy: a prospective evaluation of flow rates and symptom scores
Authors: Masters J.G. , Rice M.L.
Published: May 2003

OBJECTIVE

To evaluate the change in flow patterns and urinary symptoms before and after radical retropubic prostatectomy (RRP).

PATIENTS AND METHODS

Between 1994 and 1998 one surgeon undertook RRP in 125 men. Urinary flow rates and the International Prostate Symptom Score (IPSS) were recorded before and at each visit after RRP; only voids of> 150 mL were included. Strictures and bladder neck stenoses requiring surgical intervention were noted. Statistical significance was determined using Student's t or the chi‐squared test.

RESULTS

Before RRP 38% men had a flow rate of ≤ 10 mL/s, suggesting obstruction. At the first review (median 2 months) there was an increase in flow rate (median 16.8 vs 11.6 mL/s, P < 0.001) and at the 6‐, 14‐ and 20‐month visits this improved further, to 20, 21 and 24 mL/s, respectively. Before RRP 56% of men had moderate or severe symptoms, with an IPSS of ≥ 8. At 2, 6, 14 and 20 months the proportion of men with an IPSS of ≥ 8 decreased to 26%, 14.5%, 18% and 14% (P < 0.001); 20% developed stricture/stenosis and initially these men had a decrease in flow rate and a higher IPSS. Their symptoms improved when the stricture was treated.

CONCLUSIONS

Two‐fifths of men with prostate cancer undergoing RRP have bladder outlet obstruction, as defined by a flow rate of < 10 mL/s and bothersome symptoms. This study showed that there is a very significant increase in flow rate and decrease in IPSS after surgery. RRP offers improved voiding function and urinary symptoms, and the possibility of curing the cancer.
A systematic review and meta‐analysis of familial prostate cancer risk
Authors: Johns L.E. , Houlston R.S.
Published: May 2003

OBJECTIVE

To identify published studies quantifying familial prostate cancer risks in relatives of prostate cancer cases and, by meta‐analysis, obtain more precise estimates of familial risk according to the family history.

METHODS

Thirteen case‐control and cohort studies were identified which have reported risks of prostate cancer in relatives of prostate cancer cases. Pooled estimates of risk for various categories of family history were obtained by calculating the weighted average of the log relative risk (RR) estimates from studies.

RESULTS

The pooled RR (95% confidence interval) in first‐degree relatives was 2.5 (2.2–2.8). There was evidence that this was highest in relatives of cases diagnosed before age 60 years and that RRs declined with age. The risk for the few men with two affected relatives was increased 3.5‐fold (2.6–4.8). RRs to sons of cases appeared to be lower than in brothers; a complete explanation of this observation is uncertain.

CONCLUSION

Men with a family history of prostate cancer have a significantly greater risk of developing prostate cancer than those with no such history. Risks are greatest for relatives of cases diagnosed when young and those with more than one relative affected.
The acute effect of magnetic stimulation of the pelvic floor on involuntary detrusor activity during natural filling and overactive bladder symptoms
Authors: Bradshaw H.D. , Barker A.T. , Radley S.C. , Chapple C.R.
Published: May 2003

OBJECTIVE

To evaluate the effect of magnetic stimulation of the pelvic floor (MSPF) on involuntary detrusor activity observed during natural filling, and on the overactive bladder symptom complex.

PATIENTS AND METHODS

Eighteen women with detrusor overactivity on conventional cystometry underwent ambulatory urodynamic monitoring over two filling cycles. Fluid intake was standardized, provocative manoeuvres applied at regular intervals and symptoms documented contemporaneously. During the second filling cycle MSPF was delivered whenever the detrusor pressure increased by> 5 cmH2O. The women were subsequently treated with MSPF for 6 weeks; their lower urinary tract symptoms were assessed before and after treatment.

RESULTS

Comparing the second (stimulated) cycle with the first (unstimulated) cycle, cystometric capacity was higher (373 vs 224 mL, P < 0.03). and involuntary detrusor activity of shorter duration (370 vs 427 s, P < 0.82) and lower amplitude (53 vs 63 cmH2O, P ≤ 0.05). All women tolerated the procedure comfortably, but nine found it too time‐consuming and withdrew. In the nine women who completed treatment there was no consistent change in overactive bladder symptoms.

CONCLUSIONS

In this pilot study, MSPF during natural filling was associated with a decrease in the amplitude of involuntary detrusor contractions and a significant increase in cystometric capacity. However, MSPF had a variable effect on sensations of urgency, both acutely and after treatment, and currently there is no evidence to suggest that MSPF has an enduring effect on symptoms of the overactive bladder.
Morbidity of transrectal ultrasonography‐guided prostate biopsies in patients after the continued use of low‐dose aspirin
Authors: Maan Z. , Cutting C.W. , Patel U. , Kerry S. , Pietrzak P. , Perry M.J.A. , Kirby R.S.
Published: May 2003

OBJECTIVE

To determine whether low‐dose aspirin increases morbidity after transrectal ultrasonography‐guided sextant prostate biopsy.

PATIENTS AND METHODS

In a single‐centre prospective cohort study of 200 patients who underwent sextant prostate biopsies, those routinely taking low‐dose aspirin were encouraged to continue to do so before and after biopsy. The morbidity in each case was assessed using a standardized questionnaire that patients completed in the 7 days after biopsy. The presence of haematuria, rectal bleeding and haematospermia were recorded. The questionnaire also directed the patient to record fevers, use of analgesia and any further treatment received.

RESULTS

In all, 36 patients took aspirin whilst the other 141 did not. There were no major complications in either group. Of the patients on aspirin, 20 (56%) had haematuria, compared with 83 (59%) of those not taking aspirin (difference 3%, 95% confidence interval, CI, −15 to 21). Overall bleeding (haematuria, rectal bleeding and haematospermia) occurred in 22 patients (61%) of the aspirin group and 105 (74%) of the other group (difference 13%, 95% CI −4 to 31). Comparisons of other morbidities between the groups are also discussed.

CONCLUSIONS

There was no statistically significant difference in the incidence of haematuria or overall bleeding after biopsy between the groups. There is no evidence that aspirin needs to be discontinued before sextant prostate biopsy.
Problems with prostate specific antigen screening for prostate cancer in the primary healthcare setting in South Africa
Authors: Heyns C.F. , Mathee S. , Isaacs A. , Kharwa A. , De Beer P.M. , Pretorius M.A.
Published: May 2003

OBJECTIVES

To assess the feasibility of detecting early‐stage prostate cancer in the primary healthcare setting, and to investigate whether there is a higher incidence of prostate cancer in Black African men.

PATIENTS AND METHODS

The study was a collaboration with registrars in the authors’ institutions and primary healthcare centres serving mainly a Black African or mixed ancestry (Coloured) population in the semi‐urban Cape Town metropolitan area of South Africa. Men aged 50–70 years attending the clinics were counselled about prostate cancer and invited to have a digital rectal examination (DRE), serum prostate‐specific antigen (PSA) assay and transrectal ultrasonography‐guided sextant prostate biopsy if the DRE was clinically suspicious of malignancy or the serum PSA was ≥ 4.0 ng/mL. An American Urological Association Symptom Index (AUA‐SI) was obtained, and urine analysed using dipsticks.

RESULTS

From May 2000 to November 2001, 660 men were assessed (mean age 59.4 years, range 30–82); 60.6% were Black African, 37.3% mixed (Coloured), 1.8% White (Caucasian) and 0.2% Asian (Indian). The mean (range) AUA‐SI was 5.98 (0–35) in the whole group; the DRE was recorded as clinically suspicious of malignancy in 3.2%. The mean PSA was 20.39 (0.04–10 000) ng/mL in the whole group, but when two outliers (1865 and 10 000 ng/mL) were disregarded, it was 2.4 ng/mL. In Black patients the mean PSA was 31.8 (0.04–10 000) ng/mL, and without the outliers, 2.1 ng/mL; in Coloured patients it was 2.94 (0.05–50) ng/mL. The PSA was ≥ 4.0 ng/mL in 9.6% of the whole group, in 7.8% of Black and in 13% of Coloured patients. Prostate biopsies were taken in 21 patients (3.2% of the whole group and a third of those with a PSA of ≥ 4.0 ng/mL); in Black patients, biopsies were taken in 1.5% and 19.4%, respectively, and in Coloured patients in 6.1% and 46.9%, respectively. The prostate biopsy showed cancer in 43% of the whole group, in a third of Black and in 47% of Coloured patients; prostate cancer was detected in 1.4%, 0.5% and 2.8%, respectively.

CONCLUSIONS

That prostate biopsies were obtained in only 19% of Black and in only 47% of Coloured men with a serum PSA of ≥ 4.0 ng/mL is of concern. This indicates that there is a significant problem in getting men with an elevated serum PSA level to undergo a prostate biopsy in the primary healthcare setting in South Africa.
Transdermal electromotive administration of verapamil and dexamethasone for Peyronie's disease
Authors: Di Stasi S.M. , Giannantoni A. , Capelli G. , Jannini E.A. , Virgili G. , Storti L. , Vespasiani G.
Published: May 2003

Peyronie's disease continues to be a fascinating topic for urologists, and two papers in this section, one from Rome and one from Los Angeles, describe new insights into this disease.

Authors from the UK write about the current practice of vasectomy reversal and the management of unobstructive azoospermia in a region of that country. Although this is a questionnaire‐based survey, a 74% response rate justifies the authors’ conclusions and their comments, which will be of value to the reader.

OBJECTIVE

To evaluate the effects of the transdermal electromotive administration of verapamil and dexamethasone on plaque size, penile deviation, pain, erectile function and capacity for vaginal penetration in patients with Peyronie's disease.

PATIENTS AND METHODS

Forty‐nine patients were treated four times weekly for six consecutive weeks. During each session the drug mixture was administered from a receptacle fixed to the skin overlying the plaques, using 2.4 mA pulsed current for 20 min. Plaque size and penile deviation were evaluated by dynamic penile duplex ultrasonography, X‐ray and photographs; pain, erectile function and capacity for vaginal penetration were assessed using a questionnaire. Vital signs and side‐effects were recorded. Differences before and after treatment were assessed.

RESULTS

The plaque disappeared in 8% of patients, with a measurable reduction in volume in 74% and no change in 18% (P < 0.001). Penile deviation resolved in 10% of the men, decreased in 74% and remained unchanged in 16% (P < 0.001). The plaque volume was halved in two‐thirds of the men, to a mean (sd) of 515 (301) mm3, and the penile deviation halved in 45% of patients, to 24 (5)°; pain was completely eliminated in 88% (P < 0.001). Erectile function was completely restored in 42% of patients with initial erectile dysfunction and improved in 17% (P < 0.001); vaginal penetration improved in 73%. No toxicity was noted, except for a transient skin erythema at the site of the penile and dispersive electrodes.

CONCLUSION

The transdermal electromotive administration of verapamil and dexamethasone is clinically safe and appears to be an effective treatment in patients with Peyronie's disease.
Myths and marital discord in a family with a child with profound physical and intellectual disabilities
Authors: Withers Paul , Bennett Lara
Published: May 2003

The pressures involved in caring for a child with profound physical and intellectual disabilities are well documented in the literature. The present article offers a brief overview of this literature, followed by a description of an intervention with a family caring for their young daughter with profound physical and intellectual deficits. At the time of the intervention, the parents had been experiencing considerable intramarital difficulties and were considering a separation. They had also encountered difficulties in coping with the practical demands of caring for their daughter and in obtaining appropriate respite services. Following the intervention, the emotional climate of the parents' marriage was reportedly much improved and the parents felt more able to cope with the strains of caring for their daughter.
An assessment tool for investigating paedophile sexual interest using viewing time: an application of single case methodology
Authors: Glasgow David V. , Osborne Andrew , Croxen Justine
Published: May 2003

The present paper describes the development and piloting of a computer‐based single case methodology for the assessment of paedophile sexual interest in people with learning disabilities. Clinical, methodological and ethical issues with respect to the assessment of sexual interest are raised. Data from a series of assesments is presented graphically and the implications of the findings are discussed.
Setting up participatory research: a discussion of the initial stages
Authors: Burke Anne , McMillan Jane , Cummins Lorraine , Thompson Agnes , Forsyth Watson , McLellan James , Snow Linda , Fraser Anne , Fraser Mary , Fulton Charity , McCrindle Elizabeth , Gillies Lorraine , LeFort Shelley , Miller Gail , Whitehall John , Wilson John , Smith Janet , Wright David
Published: May 2003

Participatory research is becoming a very popular way of helping to empower people with learning disabilities. All stages of this kind of research are conducted in partnership with non‐disabled researchers. Furthermore, the research agenda in learning disability is moving towards increasing participation in all forms of research. As a group undertaking participatory research, the present authors wish to share their experience of setting up a project over a period of 9 months to examine ‘keeping fit’. The authors include adults with learning disabilities, clinicians and a researcher from a primary care NHS trust, and support workers who work directly with the adults with learning disabilities in various community settings. An understanding of what is involved in participatory research is important as a first stage, and so the present authors invited speakers undertaking a similar project investigating direct payments to a one‐day conference that was set up locally. At the end of the conference, the present authors requested volunteers for the local project to investigate health. This approach enabled well‐informed agreement to participate. The present paper discusses the initial 9 months of the project, including a description of the volunteers and the major issues which all the participants learned during these early stages.
About leaving: making sense of moving on
Authors: Banham Ken , Garrett Malcolm , McClean Arlene , Strydom Andre , Hassiotis Angela
Published: May 2003

This article is written by two people with learning disabilities and their health care team. It is about our wish to move into homes in the community after years in hospitals. In it we explain the experiences we had of services in the past and what we are looking forward to for the future. We felt that preparing to move on was very exciting. We also thought about what we would be leaving behind and tried to make sense of it all.
Challenging behaviour and communication difficulties
Authors: Kevan Fiona
Published: May 2003

Over the last 10 years as a speech and language therapist, working with adults with learning disabilities and challenging behaviour, the author has noted the tendency of services to focus their attention on the observable behaviours of the people with learning disabilities. Such observable behaviours include expressive communication behaviours. However, the ‘hidden’ phenomenon of receptive communication skill tends to be neglected. The present paper highlights the fact that to date, emphasis has been upon promotion of the expressive communication skills of the person with a learning disability and challenging behaviour: whether by direct skills teaching or via modification of the communication environment. It is suggested that we need to pay closer and express attention to the neglected and largely unmet need of receptive communication (comprehension) difficulties.
Working with an adult male with Down's syndrome, autism and challenging behaviour: evaluation of a programme of staff support and organizational change
Authors: Newman David W. , Summerhill Lisa , Mosley Ellis , Tooth Claire
Published: May 2003

The dual diagnosis of Down's syndrome and autism is a relatively rare clinical phenomenon. The identification of multiple diagnostic presentations in individual cases can bring acomplex clarityto what is an initially confusing picture. This paper examines the case of a male who has Down's syndrome and has been referred to a Clinical Psychology Service because he is presenting with ‘severe challenging behaviour’. The paper provides: (i) a case history and rationale for the assessment of autism, (ii) a description of methodology incorporating a single case design and (iii) an intervention aimed at increasing staff awareness of autism, improving staff communication and implementing an integrated care plan across environments. It was hypothesized that an intervention incorporating these important organizational changes would support staff in meeting the client's needs. The success of the intervention was measured in terms of the frequency of (i) positive behaviours and (ii) challenging behaviours displayed by the client. Frequencies are charted and statistical analysis applied. Results illustrate a positive change in the day centre environment but no significant change in the home environment. These results are discussed in relation to methodological considerations and issues for future service provision.
Critical issues for service planners and providers of care for people with Down's syndrome and dementia
Authors: Watchman Karen
Published: May 2003

The role of service planners and providers of care is one that cannot be understated while considering the future needs of people with Down's syndrome and dementia. This discussion paper raises critical issues that need to be addressed along with suggestions as to how they may be met with.