bluuebunny/crossref_metadata_2025 huggingface dataset:
Minor long‐term changes in weight have beneficial effects on insulin sensitivity and β‐cell function in obese subjects
Authors: Rosenfalck A. M. , Hendel H. , Rasmussen M. H. , Almdal T. , Andersen T. , Hilsted J. , Madsbad S.
Published: March 2003

SUMMARY

Aim  To evaluate the long‐term effect of changes in body composition induced by weight loss on insulin sensitivity (SI), non‐insulin mediated glucose disposal, glucose effectiveness (SG) and β‐cell function.

Design  Glucose metabolism was evaluated before and after participation in a two‐year weight loss trial of Orlistat vs. placebo, combined with an energy and fat restricted diet.

Subjects  Twelve obese patients (11 women, 1 man), age 45.8 ± 10.5 years, body weight (BW) 99.7 ± 13.3 kg, BMI 35.3 ± 2.8 kg/m2.

Measurements  At inclusion and 2 years later an oral glucose tolerance test (OGTT) and a frequently sampled intravenous glucose tolerance test (FSIGT) were performed. Body composition was estimated by a dual‐energy X‐ray absorptiometry (DXA) whole body scanning.

Results  The patients obtained varying changes in BW ranging from a weight loss of 17.8 kg to a weight gain of 6.0 kg. Corresponding changes in fat mass (FM) varied from a 40% reduction to a 19% increase. A significant decrease in both fasting (p = 0.038) and 2 h (p = 0.047) blood glucose at OGTT was found. The improvement in insulin sensitivity (SI) estimated by means of Bergmans Minimal Model, was significantly and linearly correlated to change in total FM (r = − 0.83, p = 0.0026). A multiple regression analysis showed that changes in truncal FM was the strongest predictor of change in SI explaining 67% of the variation. First phase insulin response (AIRg) remained unchanged whereas insulin disposition index increased significantly (p = 0.044). At inclusion five patients had impaired glucose tolerance of which four, who lost weight, were normalized at the retest 2 years later.

Conclusion  In obese subjects long‐term minimal or moderate changes in weight were found to be linearly associated with changes in insulin sensitivity. In obese subjects with impaired glucose tolerance even a minor weight loss was able to normalize glucose tolerance.
Obesity is not a confounding factor for performing autonomic function tests in individuals with diabetes mellitus
Authors: Maser R. E. , Lenhard M. J.
Published: March 2003

Aim: Cardiovascular autonomic neuropathy is a serious complication of diabetes mellitus. Previous studies have revealed conflicting results with regard to the role of obesity and its effect on the performance of tests (e.g. RR‐variation during deep breathing) for the determination of the presence of cardiovascular autonomic dysfunction. The objective of this study was to determine if obesity affects the performance and the reproducibility of autonomic function tests.

Methods: This cross‐sectional study included 159 diabetic individuals. Autonomic function tests included: RR‐variation during deep breathing and the Valsalva ratio. These tests were assessed using the ANS2000 ECG Monitor and Respiration Pacer. RR‐variation was measured by vector analysis (i.e. mean circular resultant, MCR). Reproducibility of the autonomic function tests was assessed by determining the coefficient of variation (CV) on repeat testing.

Results: Using cut‐off points to describe normal weight (body mass index (b.m.i.) ≤ 25 kg/m2), overweight (b.m.i. 25.01–30 kg/m2), obese (b.m.i. 30.01–40 kg/m2), and morbidly obese (b.m.i. ≥ 40.1 kg/m2), no difference was found for the MCR, Valsalva ratio, CV of the MCR, or CV of the Valsalva ratio among the various weight levels for individuals with type 1 or type 2 diabetes.

Conclusions: The results of this study indicate that obesity is not a confounding factor in the performance of autonomic function tests. Likewise, the reproducibility of autonomic function testing is not affected by obesity. Assessment of autonomic function is important for obese and non‐obese individuals given that reduced RR‐variation is associated with exercise intolerance, intraoperative cardiovascular lability and increased risk of mortality.
Classification, epidemiology, risk factors, and natural history of peripheral arterial disease
Authors: Novo Salvatore
Published: March 2003

Peripheral arterial disease (PAD) is a clinical condition that has often been neglected. The clinical diagnosis of PAD may be made on the basis of an accurate history by using the WHO/Rose Questionnaire or the Edinburgh Questionnaire. From a clinical point of view, PAD may be classified into four stages. The PARTNERS Programme (PAD Awareness, Risk and Treatment: NEw Resources for Survival) is a recent study based on a partnership to improve PAD care. In this population, the prevalence of patients who were PAD+/CVD‐ was approximately 12% in males and 15% in females; PAD+/CVD+ approximately 18% in males and 14% in females; PAD‐/CVD+ 28% in males and 17% in females; and finally, patients without vascular disease (PAD‐/CVD‐) 42% in males and 54% in females. The lessons derived from the PARTNERS Programme Study were informative; PAD is detectable in routine practice, using a simple, inexpensive, always available, clinical test such as calculation of the ankle–brachial pressure index (ABPI). Fewer than half of individuals with PAD are aware of their condition, while physicians are unaware of the presence of PAD in 70% of their patients with the condition. Diabetics and smokers are at high risk for PAD. Diabetes is present in about 41% of patients with PAD and a history of smoking (> 10 pack for year) is present in over 63% of patients with PAD. Antiplatelet therapy is taken by only about half of patients with PAD. Finally, the lack of diagnosis and treatment means that PAD patients remain at elevated risk of heart attack and stroke. Efforts must be made to diffuse this information to improve the diagnosis and treatment of PAD to reduce the risk of future fatal and nonfatal cardiac and cerebrovascular events.
Differential effects of metformin on bile salt absorption from the jejunum and ileum
Authors: Carter D. , Howlett H. C. S. , Wiernsperger N. F. , Bailey C. J.
Published: March 2003

Aims: The antidiabetic drug metformin is often associated with a small reduction in total circulating cholesterol, but the mechanism responsible is unknown. As bile salts contribute significantly to cholesterol homeostasis, this study has investigated the effect of metformin on the absorption of bile salts by the jejunum and ileum, and their transfer into bile.

Methods: Sodium‐[1‐14C]‐glycocholate was administered into the jejunum or ileum of anaesthetized rats with and without metformin (250 mg/kg). Appearance of 14C‐glycocholate in plasma and bile was followed for 150 min.

Results: Absorption of 14C‐glycocholate from the ileum, which is a high‐capacity active process, was 10‐fold greater than absorption from the jejunum, which is mainly a passive process. Metformin increased threefold the absorption of 14C‐glycocholate from the jejunum. Metformin similarly increased the appearance of jejunal 14C‐glycocholate in plasma and bile. In contrast to the jejunum, absorption of 14C‐glycocholate from the ileum was suppressed by more than half with metformin. This was associated with corresponding reductions of 14C‐glycocholate in plasma and bile.

Discussion: Thus, metformin induced a large suppression of active bile salt absorption from the ileum compared with a small increase in passive absorption from the jejunum. This suggests that the ileal effect of metformin to reduce overall bile salt absorption could contribute to the modest cholesterol‐lowering effect of this drug.
Somatic motoneurones in amphioxus larvae: cell types, cell position and innervation patterns
Authors: Lacalli Thurston C. , Kelly Samantha J.
Published: March 2003

Serial transmission electron microscopy and 3D reconstruction were used to document cell morphology and position of the motoneurones innervating somites 1 and 2 of a 12.5‐day amphioxus larva, of Branchiostoma floridae, and also those innervating the dorsal compartment of somites 3 through 6 of an 8‐day larva. Motoneurones supplying the ventral and dorsal compartments can be distinguished from one another on a number of morphological criteria. The ventral compartment motoneurones are neither symmetrical nor particularly ordered in arrangement. Their cilia are short and point forward or obliquely across the central canal; their axons run along the basal lamina adjacent to processes from muscle fibres, with which they make extended linear series of synapses containing 45–60 nm synaptic vesicles. The dorsal compartment motoneurones are paired and tend to be positioned at or near the junctions between somites. Their cilia are longer and project caudally; their axons are large, filled with mitochondria and 30–45 nm synaptic vesicles, and make synapses only at specific, segmentally repeated sites.

 An unusual feature of both cell types is that synaptic input occurs all along the axon, either by direct axo‐axonal synapses or via slender dendritic processes. This allows for redundancy and multiple inputs, and is possible only because amphioxus somatic motor axons lie entirely within the nerve cord, which is itself an unusual feature among chordates. The possible significance of dual somatic innervation is discussed in relation to the dual innervation of the head in vertebrates, which has separate sets of somatic and visceral/branchiomotor nerves.
The infundibular balance organ in amphioxus larvae and related aspects of cerebral vesicle organization
Authors: Lacalli Thurston C. , Kelly Samantha J.
Published: March 2003

Serial EM reconstructions were used to examine the organization and constituent cell types of the infundibular region of the cerebral vesicle (c.v.) in a 12.5‐day larva ofBranchiostoma floridae. The balance organ lies just in front of the infundibular cells and consists of 10 electron‐dense cells with long, bulbous cilia, each surrounded by a ring of accessory cells. The ciliary bulb cells have axons that terminate in vesicle‐filled swellings that lack identifiable synapses. The accessory cells have short basal processes that are minor contributors to the adjacent neuropile. Based on morphology, we suggest a mechanosensory function for the ciliary bulb cells, possibly related to balance or motion detection. Scattered cells of similar type are found elsewhere in the cerebral vesicle, along with a variety of other neurones with caudally projecting axons and varicosities, but few synapses. Instead, nonsynaptic, paracrine secretion appears to be the predominant mode of transmitter release in the neuropile and ventral tracts of the cerebral vesicle. The closest vertebrate homologue of this part of the amphioxus brain is arguably the limbic core of the caudal diencephalon and mesencephalon, including the homeostatic control centres of the hypothalamus. We postulate that this limbic core is an ancient structure traceable at least as far back in evolution as the common ancestor of amphioxus and vertebrates.
Ossicle change in Holothuria scabra with a discussion of ossicle evolution within the Holothuriidae (Echinodermata)
Authors: Massin Claude , Mercier Annie , Hamel Jean‐François
Published: March 2003

Ossicles of Holothuria (Metriatyla) scabra Jaeger 1833 vary mainly in early juveniles between 0.9 and 15mm long. While ossicles were not observed in auricularia and doliolaria larvae, which instead possessed elastic balls, ossicles were present in late pentactulae. Specimens 0.9–1.5mm long have tables with tall spire (4–5 cross beams), no buttons, and large irregular perforated plates. Specimens 5–6mm long have tables with moderate spire (2–4 cross beams) and a few smooth buttons. Specimens 9–16mm long have tables with low spire (1–2 cross beams) and knobbed buttons. From 30mm, ossicle are similar to those of adults, with more buttons and fewer tables. Several features of the ossicles of early juveniles, including their size, shape and prevalence, are unique to the species. Comparison with holothurian juveniles of other species indicates that presence of tables with tall spire and absence of buttons are plesiomorph characters in the evolution of the Holothuriidae.
The male postabdomen of Stolotermes inopinus: a termite with unusually well‐developed external genitalia (Dictyoptera: Isoptera: Stolotermitinae)
Authors: Klass Klaus‐Dieter , Thorne Barbara L. , Lenz Michael
Published: March 2003

Klass, K.‐D., Thorne, B. L. and Lenz, M. 2000. The male postabdomen of Stolotermes inopinus: a termite with unusually well‐developed external genitalia (Dictyoptera: Isoptera: Stolotermitinae). —Acta Zoologica (Stockholm) 81: 121–130

Stolotermes inopinus has large external male genitalia (phallic lobe), which contrast with the small genital papillae or lack of external genitalia of other Isoptera. As in the genital papilla of Mastotermesdarwiniensis, a ventral sclerite pair is present, the gonopore is located ventroterminally on the phallic lobe, and the genital area is entirely symmetrical – suggesting that this may be the groundplan condition of Isoptera. The relations of the phallic lobe to surrounding components like the subgenital plate, paraprocts, and certain muscles and nerves indicate that the lobe of S. inopinus is homologous with the phallomeres of other Dictyoptera. The bilateral symmetry and simple structure, however, are in strong contrast to the asymmetry and high complexity found in male genitalia of Blattaria and Mantodea. The postabdominal nervous system of S. inopinus resembles that of the cockroach Periplaneta americana. Indications are given that the Stolotermitinae are related to the Kalotermitidae, Rhinotermitidae, and Termitidae rather than to the Termopsinae.
Structure and chemistry of the Dufour gland in Pristomyrmex ants (Hymenoptera, Formicidae)
Authors: Billen Johan , Ito Fuminori , Tsuji Kazuki , Schoeters Eric , Maile Roland , Morgan E. David
Published: March 2003

Billen, J., Ito, F., Tsuji, K., Schoeters, E., Maile, R. and Morgan, E. D. 2000. Structure and chemistry of the Dufour gland in Pristomyrmex ants (Hymenoptera, Formicidae). —Acta Zoologica (Stockholm) 81: 159–166

All individuals of the three species of Pristomyrmex studied have a Dufour gland with a conspicuous hammer‐shaped distal part, that is connected to a thin‐walled proximal reservoir through a very narrow stalk. The secretory distal part is formed by high columnar cells that are characterized by a highly folded apical wall. The lateral cell junctions apically correspond with the crenel tops, which gives individual cells a peculiar shape with a deep apical depression. The cytoplasm of the secretory cells contains a very well developed smooth endoplasmic reticulum and Golgi apparatus, numerous mitochondria and lysosomes. Histochemical analysis indicates a positive reaction for the presence of a lipid secretion in the hammer‐like part. Gas chromatographic analysis of glands of P. pungens workers reveals the secretion to be formed of a mixture of simple volatile monoterpene hydrocarbons; α–pinene, β–pinene, limonene and camphene. Similar, but species characteristic mixtures of four monoterpenes were found in Pristomyrmex brevispinosus and Pristomyrmex sp.1. Behavioural experiments did not allow a conclusive determination of the function of the gland.
On the anatomy of the central nervous system and the morphological value of the anterior end appendages of Ampharetidae, Pectinariidae and Terebellidae (Polychaeta)
Authors: Orrhage Lars
Published: March 2003

Earlier papers dealing with the anatomy of the central nervous system of ampharetids, pectinariids and terebellids were studied. On this basis a re‐investigation appeared necessary: statements in the literature about the structure of the brain and the innervation of the appendages of the anterior end were incomplete and contradictory. In the present paper, the brain, the circum‐oesophageal connectives and the innervation of, inter alia, the tentacular membrane (including the dorsal ridge), the buccal tentacles, the alimentary canal, the nuchal organs and the branchiae (when present) of Amphicteis gunneri, Anobothrus gracilis, Melinna cf. cristata, Pectinaria auricoma, P. belgica, P. koreni, Petta pusilla, Pista cristata, Eupolymnia nebulosa, Thelepus cincinnatus and Polycirrus medusa are described. The results are summarized in schematic diagrams and compared with each other and with the central nervous system of other polychaetes. It is concluded that the ampharetids, the pectinariids and the terebellids bear no antennae and no palps and that their buccal tentacles belong to the alimentary canal. It is emphasized that all attempts to range their cephalic nervous system into previously proposed common and general schemes of ‘the polychaete nervous system’ seem totally fruitless.
Anterior neural centres in echinoderm bipinnaria and auricularia larvae: cell types and organization
Authors: Lacalli Thurston C. , Kelly Samantha J.
Published: March 2003

Serial and interval electron micrograph series were used to examine the anterior part of the ciliary band system in the bipinnaria larva of Pisaster ochraceus and the auricularia larva of Stichopus californicus for evidence of ganglion‐like organization. The bipinnaria has paired concentrations of Multipolar with Apical Processes (MAP) cells in this region that correspond in position with previously identified clusters of serotonergic and peptidergic neurones. MAP cells located in the centre of the band have well‐developed apical processes, but no cilium. Those at the sides of the band have fewer processes, but some have recumbent cilia that extend under the glycocalyx, suggesting a sensory function. Comparable cell types are not found elsewhere in the band, a clear indication that the apical parts of the ciliary band system are organized in a distinctive fashion. Two neuronal cell types were identified in the apical region of the auricularia larva, a conventional bipolar neurone that corresponds with previously described serotonergic apical cells, and more numerous MAP cells for which there is no previous record and hence, no known transmitter. Previous immunocytochemical studies are summarized and re‐examined in the light of these results. Relevant evolutionary issues are also discussed, but the data fail to provide strong evidence either for or against Garstang’s hypothesis that the chordate brain and spinal cord derive from larval ciliary bands resembling those of modern echinoderms.
Evolution of the middle leg basal articulations in flies (Diptera)
Authors: Frantsevich Leonid , Gladun Dmitri
Published: March 2003

The morphology of the coxa and trochanter was studied in 205 species from 68 fly families to compare these structures with respect to ability to fly in a streamlined posture, with the middle legs pointing forward and pressed to the thorax. Only Brachycera are able to attain this posture. The forward turn of the coxa at this position is hindered by the junction of the coxa with the pleuron. Recovery of mobility is gained in two ways. (1) By reduction of the contact zone between coxa and pleurite, as in Asiloidea, Bombyloidea, and Empidoidea. Within these flies, the streamlined posture was recorded in Bombyliidae and in a robber‐fly, Laphria flava. Others fly with their middle legs straddled laterally or trailing backwards. (2) Longitudinal splitting of the coxa into three coxites provides intracoxal mobility in most Tabanoidea and Cyclorrhapha. The hind and medial coxites rotate about the front coxite and change the coxo‐trochanteral axis, thus compensating for restricted protraction. Separation of the hind coxite appears in primitive Tabanoidea, and a separate middle coxite was found in several families among the Nematocera. The streamlined posture was recorded in horse‐flies, stratiomyids, and in many Cyclorrhapha except Micropezidae and Hippoboscidae. There is morphological evidence for a possible secondary fusion of coxites at least in Dolichopodidae and Opetidae as well as for the origin of Cyclorrhapha from a miniature ancestor.
Flies and concealed nectar sources: morphological innovations in the proboscis of Bombyliidae (Diptera)
Authors: Szucsich N. U. , Krenn H. W.
Published: March 2003

Bee‐flies (Bombyliidae) have morphological adaptations of the mouthparts to particular floral traits. To investigate this the short, plesiomorphic proboscis of Hemipenthes morio was compared with the long, apomorphic proboscis of Bombylius major. A novel feeding position enables B. major to use flowers that open to the side as additional nectar sources. The new horizontal feeding position is enabled by the prolonged ventral base of the proboscis. Bombylius major exploits deep corolla tubes with an elongate proboscis, and an increased efficiency in both the suction pumps and the sealing mechanisms of the proboscis. The exploitation of narrow corolla tubes is made possible by the shift from a sponging feeding mode, exhibited by H. morio, to the exclusively sucking mode in B. major. Besides quantitative changes in the proportions of the different proboscis components, labellar movements as well as the structures of saliva distribution are changed along with this shift. The labial musculature of B. major does not significantly differ from the plesiomorphic state, since both examined species do not only feed on nectar, but also on pollen.
The circulatory system in Chilopoda: functional morphology and phylogenetic aspects
Authors: Wirkner Christian S. , Pass Günther
Published: March 2003

The circulatory organs of nine representative species of all five chilopod orders were examined by light microscopy and byin vivoobservations of haemolymph flow. InScutigera coleoptrata, the heart ultrastructure was studied. The circulatory system in Craterostigmomorpha is described for the first time. Further focus is placed on the Geophilomorpha since previous descriptions in this group have been only superficial. In all investigated species, the circulatory system consists of two longitudinal central vessels which are connected in the first body segment by the maxilliped arch. The posterior part of these vessels is contractile and thus haemolymph is pumped anteriorly in the heart, while it is pumped posteriorly in the supraneural vessel. From these central vessels numerous peripheral vessels branch off. Differences among the chilopod orders lie mainly in the distribution of the peripheral vessels. The circulatory system in Scutigeromorpha shows some striking morphological adaptations with regard to the functional coupling of circulatory and respiratory tasks. The most peculiar structures are the aortic diverticles which act as accessory pumps in the head. Phylogenetic analysis of the circulatory organ traits within Chilopoda supports the Pleurostigmophora hypothesis. Synapomorphies supporting the Myriapoda hypothesis or the Tracheata concept were not found.
Reinterpretations of clypeus and maxilla in Psocoptera, and their significance in phylogeny of Paraneoptera (Insecta: Neoptera)
Authors: Yoshizawa Kazunori , Saigusa Toyohei
Published: March 2003

Morphology of the head and mouthparts in Psocoptera was investigated, and revised interpretations for clypeus and maxilla were proposed. The convex plate in the frontal region of the head capsule is the postclypeus, rather than the frons; the galea is clearly differentiated from the stipes and the origin of the stipito‐lacinial muscle is partly shifted from the stipes to the base of the galea; the cardo is completely fused with the stipes without any suture or sulcus. Brief discussions on the evolution of piercing and sucking mouthparts and on the phylogeny of Paraneoptera were provided, based on these revised interpretations.
Spermiogenesis and spermatozoa in Acanthodasys aculeatus (Gastrotricha, Macrodasyida): an ultrastructural study
Authors: Guidi Loretta , Ferraguti Marco , Pierboni Lara , Balsamo Maria
Published: March 2003

The spermatogenesis, the spermiogenetic process and the structure of the mature spermatozoon of Acanthodasys aculeatus (Gastrotricha, Macrodasyida) are described from an ultrastructural point of view. Several spermatogonia in mitotic divisions were seen, proving that euthely of gastrotrichs does not concern gonads. Spermiogenesis is characterized by the early formation of both the acrosome and the axoneme, by the subsequent appearances of a perinuclear helix and of a complex axial tubular structure in the acrosome and by the late development of the peraxonemal striated cylinder. The mature spermatozoon is filiform, and composed of a spiralized acrosome, a helical nuclear–mitochondrial complex and a long flagellum. The acrosome contains an axial tubular structure and the spring‐shaped nucleus delimits a single, long mitochondrion. A perinuclear helix formed by the pro‐acrosome surrounds the nuclear–mitochondrial complex extending for its whole length. A monolayered, obliquely striated cylinder encloses the 9 × 2 + 2 axoneme; its terminal part is empty because of the shortness of the axoneme.
Laparoscopic ureterolithotomy: technical considerations and long‐term follow‐up
Authors: Gaur D.D. , Trivedi S. , Prabhudesai M.R. , Madhusudhana H.R. , Gopichand M.
Published: March 2003

Objective To analyse the technical details and the long‐term results of laparoscopic ureterolithotomy.

Patients and methods Laparoscopic ureterolithotomy was undertaken in 101 patients between 1991 and 2001; in only one patient with retroperitoneal fibrous adhesions was the procedure transperitoneal, being retroperitoneal in all the others, using Gaur's balloon retroperitoneoscopy. The mean (range) stone size was 16 (10–47) mm, and the stones were in the upper ureter in 75, mid‐ureter in 11 and lower ureter in 15 patients. Nine patients had more than one stone, the maximum being six, in a megaureter. Most were impacted for > 2 months, the maximum being 240 months.

Results Laparoscopic ureterolithotomy was successful in 93 patients, with the eight failures being mostly early in the series. The mean operative duration was 79 min (66 min when the ureter was left open and 92 min when it was sutured). The overall mean duration of urinary leakage was 5.5 days, which was reduced to 3.2 days by stenting and suturing the ureter. The mean (range) blood loss was 25 (5–100) mL. The overall complication rate was high (31%) because of prolonged urinary leakage in 20 patients. No patient required morphine for pain relief and the mean for oral analgesic use was 2.5 days. The mean hospital stay was 3.5 days and that for resuming work 14 (7–28) days.

Conclusions Laparoscopic ureterolithotomy by the retroperitoneal approach is a safe and reliable minimally invasive procedure. Although its role as a salvage procedure for failed extracorporeal shock wave lithotripsy and ureteroscopy is undisputed, in selected patients with large chronically impacted ureteric stones and particularly with solitary kidneys, it may be considered the first‐line treatment.
Transcutaneous electrical nerve stimulation in the treatment of neurological patients with urinary symptoms
Authors: Skeil D. , Thorpe A.C.
Published: March 2003

Objective To determine whether transcutaneous electrical nerve stimulation (TENS) benefits patients with urinary symptoms caused by neurological diseases.

Patients and methods Patients with urinary symptoms from any kind of neurological disease were prospectively recruited between October 1996 and July 1998. Before attending the first assessment patients were asked to complete a week's diary recording the frequency of micturition, incontinence episodes, and frequency of pad and clothes changing. At the first assessment the patients completed the Frimodt–Moller urinary symptom questionnaire, and quality‐of‐life scales including the Nottingham Health Profile and Short‐Form 36. Demographic and disability data (Barthel Index and Frenchay Aphasia Screening Test) were recorded, and patients underwent a neurological examination and urodynamic studies. The placing of electrode pads on the sacral dermatomes 2.5 cm either side of and 2.5 cm above the natal cleft was demonstrated, and the patient instructed to use TENS for 90 min twice a day. The current strength applied was set to that which the patient could tolerate, at a square‐wave of 20 Hz and 200‐µs duration. Six weeks later the patients were further assessed, where the diary exercise, questionnaires and urodynamics were repeated. In all, 44 patients (13 men and 33 women, mean age 50.8 years) were recruited.

Results The commonest disease was multiple sclerosis and the commonest impairments para/tetraplegia or hemiplegia. There was no change in the neurological status of the 34 patients completing the study. Irritative voiding symptoms were significantly decreased (0.68–0.61, P = 0.003) and diaries also showed significant improvements in the 24 h frequency of micturition (P = 0.01), incontinence episodes (P = 0.04) and clothes changes (P = 0.02). Urodynamics showed detrusor hyper‐reflexia in most patients. The only significant changes after TENS were an increased postvoid residual volume (from a mean of 134 mL to 160 mL, P = 0.03) and an increase in the volume leaked during the urodynamic study with TENS on (from a mean of 4.7 mL to 12 mL, P = 0.003). There were no significant changes in the quality‐of‐life scores. Of the 34 patients completing the study, half still reported a benefit from TENS at 1 year, although some patients found it took 3–4 weeks to work.

Conclusion TENS applied to the sacral dermatomes of neurological patients with urinary symptoms had a minimal effect on urodynamic data but significantly improved irritative urinary symptoms, 24‐h urinary frequency, incontinence and clothes changing. The lack of effect on quality‐of‐life measures probably reflects the lack of sensitivity in the tools used in this group of patients. We therefore recommend using TENS in this often problematical group of patients.
Nitric oxide synthase patterns in normal and varicocele testis in adolescents
Authors: Santoro G. , Romeo C. , Impellizzeri P. , Ientile R. , Cutroneo G. , Trimarchi F. , Pedale S. , Turiaco N. , Gentile C.
Published: March 2003

Objective To determine if the testes of normal adolescents can produce nitric oxide (NO), by assessing NO synthase (NOS) activity, and whether this activity changes in adolescents with left idiopathic varicocele.

Patients and methods After obtaining informed consent, testicular biopsies were obtained from eight adolescents (mean age 16.4 years; controls) who underwent surgery for inguinal hernia or hydrocele, and from 20 adolescents (mean age 16.2 years) operated for left idiopathic varicocele. Inducible and endothelial NOS (iNOS and eNOS) isoforms were investigated in the biopsy specimens by immunohistochemical localization and Western blot analysis using specific fluorescein‐conjugated antibodies.

Results Both normal and pathological samples expressed eNOS at the level of vessels and Leydig cells. The iNOS was expressed in Leydig cells of normal testes and over‐expressed in Leydig cells of varicocele testes.

Conclusion Leydig cells of adolescent testes constitutively express iNOS. Under pathological conditions, e.g. varicocele, iNOS is up‐regulated and is a possible source of NO overproduction. These results could be useful in explaining the pathogenesis of both testis and sperm dysfunction in varicocele.
Primary enuresis: a urodynamic evaluation
Authors: Medel R. , Ruarte A.C. , Castera R. , Podesta M.L.
Published: March 2003

Objective

To assess urodynamic and clinical data in patients with primary enuresis for potential prognostic indicators of detrusor instability.

Patients and methods

The records of 33 patients (mean age 8.8 years, range 5–14) with monosymptomatic primary enuresis (MPE, bedwetting as the sole symptom) and 47 patients (mean age 7.1 years, range 5–12) with complicated primary enuresis (CPE, bedwetting associated with diurnal urinary loss, squatting and urge incontinence) were reviewed. The children underwent urodynamic studies to detect detrusor instability and the prevalence was compared with the type of enuresis.

Results

Of 33 patients with MPE, 17 (49%) showed either typical unstable detrusor contractions (16) or low‐compliance bladders (one); in the remaining 16 patients, filling cystometry was normal and micturition was normal in all. Of the 47 patients with CPE, 35 (79%) showed detrusor instability and two decreased bladder compliance; the remaining 10 had stable bladders and micturition was also normal in all patients.

Conclusion

The type of primary enuresis and the maximum cystometric bladder capacity were good indicators of bladder dysfunction.
A modified Mitrofanoff procedure using the rectus abdominis muscle flap technique: a preliminary report in a rabbit model
Authors: Celayir  , Dervisoglu  , Büyükünal
Published: March 2003

Objective

 To create a modified Mitrofanoff continent stoma in a rabbit model, using a rectus abdominis muscle flap (RAMF) with its intact vascular supply.

Materials and methods

 Fifteen New Zealand White male rabbits underwent an operation to create a 6 cm long tube using a RAMF with its vascular pedicle from the inferior epigastric vessels. The internal orifice of the tube was anastomosed to the anterior bladder wall with 5/0 polyglactin sutures. The external orifice was directly sutured to the skin to fashion a catheterizable Mitrofanoff stoma. A 6 F catheter was left in the tube as a stent for 2 weeks. Radiography and histopathological investigations were carried out for 8 weeks after surgery.

Results

 Intravenous pyelography and voiding cysto‐urethrography showed a normal looking urinary system; contrast studies showed an intact RAMF tube with no signs of stricture. Catheterization of the stoma was possible in each animal. Histopathologically, there was no evidence of severe fibrosis or inflammatory changes; the inner surface of the tube (proximal bladder side) was covered by transitional urinary epithelium in most of the animals.

Conclusion

 It is possible to create a Mitrofanoff tube using a vascularized RAMF in a rabbit model. Using this technique there is no need to perform a major operation in the gastrointestinal system. The technique may provide a good alternative treatment in those patients who need a combination of Mitrofanoff and antegrade continence enema surgery, and in patients with previous appendectomy.
Retroperitoneal lymphadenectomy for post‐chemotherapy residual masses: is a modified dissection and resection of residual masses sufficient?
Authors: Rabbani  , Goldenberg  , Gleave  , Paterson  , Murray  , Sullivan
Published: March 2003

Objective

 To determine if post‐chemotherapy retroperitoneal lymphadenectomy for residual masses can be limited to resection of the residual masses and a modified template dissection, without loss of therapeutic efficacy.

Patients and methods

 Between 1985 and 1995, 50 patients underwent one of three types of retroperitoneal lymphadenectomy for a residual mass after cisplatin‐based chemotherapy for stages II and III testicular non‐seminomatous germ cell tumour. The pre‐operative imaging, operative record and pathology reports were reviewed to determine the location of the residual masses and whether tumour, defined as teratoma or viable carcinoma, was within the boundaries of the modified template and/or residual masses. The median (range) follow‐up was 56 (1–140) months.

Results

 Of 39 patients undergoing a bilateral dissection, one (2.6%) with a left testicular cancer had teratoma identified outside the boundaries of the modified template and the residual masses. The nine patients who underwent resection of residual masses and a modified‐template dissection were relapse‐free at a median follow‐up of 55 months. One of two patients undergoing resection of residual mass alone had two recurrences arising from incomplete resection. Four of eight patients undergoing a modified dissection retained ejaculation, compared with seven of 25 (28%) undergoing a non‐nerve sparing bilateral dissection.

Conclusion

 This retrospective study suggests that in patients whose tumour markers become normal and have a residual mass after chemotherapy, residual masses can be resected with a modified‐template dissection with no significant risk of leaving tumour in the retroperitoneum.
Efficacy of orchidopexy on spermatogenesis in the immature mutant ‘trans‐scrotal’ rat as a cryptorchid model by quantitative cytological analysis
Authors: Zhou  , Hutson  , Hasthorpe
Published: March 2003

Objectives

 To determine whether cryptorchidism is a congenital malformation and whether the impaired spermatogenesis in immature testes can be reversed by early orchidopexy, using the mutant trans‐scrotal (T‐S) rat which is normally masculinized but has cryptorchidism in 85% of males.

Materials and methods

 First, T‐S rats (six per group) with ectopic testes destined to be undescended were investigated histologically at 4, 7 and 14 days after birth. Secondly, 12‐day‐old T‐S rats were divided into four groups which underwent different procedures, i.e. 1, with normally descending testes (normal control, 10 rats); 2, with undescended testes (UDT) treated by orchidopexy (treated UDT, eight rats); 3, with UDT treated by a sham operation (sham‐operated UDT, six rats); and 4, with UDT left untreated (untreated UDT, six rats). Thirty days after operation the testicular anatomy was recorded; excised testes were examined histologically and different types of germ cells were counted per tubule cross‐section microscopically.

Results

 There were no quantitative or morphological differences in the numbers of gonocytes, type‐A spermatogonia or Leydig cells in the seminiferous tubules between normal and ectopic testes in the first 14 days after birth. However, by 21 days of age spermatogenesis in the UDT had declined with transformation from primary leptotene spermatocytes to spermatids. There were significantly more Leydig cells in the untreated UDT at 30 days than in normal control testes. The impaired spermatogenesis in UDT was restored by early orchidopexy and there were significantly more seminiferous tubules at stage 3 (pachytene spermatocytes) and stage 4 (spermatids) than in the untreated or sham‐operated groups (P<0.001).

Conclusions

 These results show that in the T‐S rat with cryptorchidism, the testicular damage is not a congenital malformation and can be reversed with early surgical correction.
Transforming growth factor‐β1 serum concentration
Authors: Wolff  , Fandel  , Borchers  , Brehmer Jr  , Jakse
Published: March 2003

Objective

 To assess serum levels of transforming growth factor‐β1 (TGF‐β1), normally markedly elevated in prostate cancer tissue, in patients with cancer of the prostate, and to correlate these levels with tumour stage and serum prostate specific antigen (PSA) levels.

Patients and methods

 Serum TFG‐β1 and PSA levels were determined in 32 patients with untreated prostate cancer. Patients were divided into: group 1, 14 patients with pT1–3pN0M0; group 2, four with T1–3pN+M0; and group 3, 14 with T1–4NxM+. Ten patients with histologically confirmed benign prostatic hyperplasia (BPH) served as controls.

Results

 The median TGF‐β1 levels were no different between patients with cancer or BPH (30.7 ng/mL and 26.9 ng/mL, respectively; P>0.05). Furthermore, there was no increase in TGF‐β1 concentrations with advancing tumour stage (group 1, 34.1 ng/mL; group 2, 33.0 ng/mL; group 3, 28.3 ng/mL; P>0.05). There was no correlation with PSA levels (group 1, r=−0.42; group 2, r=−0.43; group 3, r=−0.23; BPH, r=0.38).

Conclusion

 TGF‐β1 levels did not discriminate between patients with BPH and prostate cancer, and there was no increase in TGF‐β1 levels with advancing tumour stage.
Evaluation of the potential of transferrin‐adriamycin conjugates in the treatment of bladder cancer
Authors: Munns  , Yaxley  , Coomer  , Lavin  , Gardiner  , Watters
Published: March 2003

Objective

 To assess the ability of a transferrin‐adriamycin conjugate (Tf‐ADR) to target transferrin receptor (TfR)‐positive cancer cells selectively and to overcome drug resistance in bladder cancer cell lines.

Materials and methods

 Two paired sets of cell lines were used: the first was Chinese hamster ovary (CHO) cells (TfR‐negative TRVb cells, as a model for normal resting cells, and TRVb‐1 cells which were transfected with human TfR), and the second was a pair of bladder cancer cell lines (ADR‐sensitive MGH‐U1 cells and ADR‐resistant MGH‐U1R cells). Cell survival curves were determined after treatment with ADR, Tf and Tf‐ADR.

Results

 MGH‐U1, TRVb and TRVb‐1 cells required similar concentrations of ADR and Tf‐ADR for 50% inhibition of growth; MGH‐U1R cells were resistant to both ADR and TF‐ADR.

Conclusion

 Tf‐ADR did not prevent toxicity to the TfR‐negative cells nor did it overcome the resistance of the ADR‐resistant cells. These results imply that Tf‐ADR does not provide a better cytotoxic drug delivery system for the treatment of bladder cancer.
Composition and biomechanical properties of the bladder acellular matrix graft: comparative analysis in rat, pig and human
Authors: Dahms  , Piechota  , Dahiya  , Lue  , Tanagho
Published: March 2003

Objective

 To compare the composition and mechanical properties of the newly developed bladder acellular matrix graft (BAMG) with the normal urinary bladder in rat, pig and human.

Materials and methods

Rat, pig and human urinary bladders were harvested and divided into control and experimental groups. For the latter, BAMGs were prepared, and light and transmission electron microscopic studies performed. Strips from the normal bladders and the BAMGs (10 in each group) were tested under tension, and the ultimate tensile strength, maximum strain, and elastic modulus were determined from stress/strain curves.

Results

Both types I and III collagen, as well as elastic fibres, were observed as major components of the matrix scaffold. There were more collagen type I fibres in the rat than in the pig and human BAMGs, whereas the pig, and particularly the human, both showed higher levels of type III collagen and elastic fibres. These different matrix scaffold patterns were confirmed by electron microscopy. Results from biomechanical testing showed no significant differences for strength, strain or elastic modulus between BAMG and control bladder strips, except in the rat where the maximum strain values were significantly lower.

Conclusion

There are variations in the acellular matrix structure with similar biomechanical properties between the BAMG and the normal urinary bladder in three different species. These results may underscore the potential of the BAMG. Furthermore, this in vitro model provides a suitable method to study the mechanical properties of the urinary bladder and may serve as a diagnostic tool for various investigations.
High prevalence of voiding symptoms in Taiwanese women
Authors: YU  , Chen  , Lai  , Chan  , Chie
Published: March 2003

Objective

 To describe the voiding symptoms of Taiwanese women using the International Prostate Symptom Score (IPSS).

Subjects and methods

 A self‐administered questionnaire was used to collect information on demographic characteristics and the IPSS used to determine the voiding symptoms of 583 consecutive women undergoing a health examination. The symptom scores of different age groups were compared using a one‐way analysis of variance with a posteriori comparisons made using Scheffe’s test.

Results

 The seven symptom scores could be separated by factor analysis into two factors which corresponded with obstructive (incomplete emptying, intermittency, weak stream, and hesitancy) and irritative (frequency, urgency, and nocturia) symptoms. Various degrees of frequency and nocturia were commonly reported by the respondents, whereas obstructive symptoms were infrequently reported, except in the elderly (age ≥65 years). The irritative scores, obstructive scores and total scores increased significantly with age (all P<0.001). The total symptom scores correlated significantly with the quality‐of‐life score (Pearson’s r=0.70, P<0.001). Overall, 124 (21%) of the respondents reported an IPSS of >7, and 98 (17%) of the respondents reported being ‘mostly dissatisfied’ with their urination. However, only nine (1.5%) of the respondents had ever consulted a urologist about their voiding problems.

Conclusions

 There was an age‐dependent change in voiding symptoms in these Taiwanese women. The prevalence of voiding symptoms in women is much higher than encountered in clinical practice.
Dysfunctional voiding in women: which muscles are responsible?
Authors: Deindl  , Vodusek  , Bischoff  , Hofmann  , Hartung
Published: March 2003

Objective

 To analyse the striated external urethral sphincter (EUS) and pelvic floor muscles using two different electromyography (EMG) techniques in women with dysfunctional voiding and/or urinary retention.

Patients and methods

 Fifteen women (mean age 38.2 years, range 18–61) with dysfunctional voiding and/or unexplained voiding dysfunction associated with urinary retention were examined neurologically and urologically; urodynamics and kinesiological EMG of the bilateral pubococcygeal and external urethral striated sphincter muscles were obtained. In an additional neurophysiological session, concentric‐needle EMG of the external urethral sphincter was performed.

Results

 Kinesiological EMG recordings revealed inappropriate pelvic floor muscle activation during voiding in 11 and EUS activation in four women. Concentric needle EMG of the EUS revealed complex repetitive discharges in the four women with inappropriate urethral sphincter activation recorded by kinesiological EMG during voiding. Biofeedback training led to improvement in women with inappropriate pubococcygeal activation but not in those with urethral sphincter complex repetitive discharges.

Conclusion

 Urodynamic examinations in combination with kinesiological EMG examination of the pubococcygeal and external urethral sphincter muscles revealed two groups of women with dysfunctional voiding. Further diagnostic evaluation of such patients with concentric‐needle EMG is mandatory. The differentiation of the two groups is therapeutically relevant.
Effect of transurethral electrovaporization of the prostate on serum prostate specific antigen concentration
Authors: Küpeli  , Soygür  , Yilmaz  , Aytaç
Published: March 2003

Objective

To assess the effect of transurethral electrovaporization of the prostate (TUVP) on serum prostate specific antigen (PSA) concentration.

Patients and methods

Twenty‐five men (mean age 61.7 years) with symptoms of prostatism underwent TUVP. Serum PSA levels were determined before any prostatic manipulation, and again at 1 and 24 h after TUVP. In the first 6 weeks after TUVP, serum PSA was measured every week. Prostatic size was measured by transrectal ultrasonography before and again at 6 weeks after TUVP.

Results

The mean serum PSA concentration was significantly higher at 1 and 24 h after TUVP (P<0.001) than before. The PSA level returned to less than the value before TUVP at 2, 3 and 4 weeks afterwards in eight (32%), 13 (52%) and 20 (80%) patients, respectively; five (20%) patients reached the baseline value 6 weeks after TUVP. The mean reduction in prostatic volume 6 weeks after TUVP was 42% and the reduction in tissue volume was significantly correlated with the decrease in serum PSA concentration at 6 weeks (P<0.05).

Conclusion

TUVP increases serum PSA levels, the transient elevation persisting for up to 6 weeks but then declining to a stable, low PSA concentration. Therefore, it is important to wait at least 6 weeks to obtain an accurate and meaningful serum PSA level after TUVP.