bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of high‐risk superficial bladder cancer with maintenance bacille Calmette‐Guérin therapy: preliminary results
Authors: Kolodziej A. , Dembowski J. , Zdrojowy R. , Wozniak P. , Lorenz J.
Published: March 2003

Objective To evaluate, in a prospective study, the effects and results of maintenance therapy with bacille Calmette‐Gue´rin (BCG) in treating patients with high‐risk superficial bladder cancer.

Patients and methods In all, 155 patients were enrolled in a randomized study of transurethral resection alone (53) or combined with intravesical BCG (102) as a treatment for superficial bladder cancer. BCG was administered for six consecutive weeks followed by three weekly instillations in months 3, 6, 12, 18, 24, 30 and 36 after resection. Recurrence, progression, prognostic factors and side‐effects were assessed and analysed.

Results After a median (range) follow‐up of 23 (6–42) months, 83 of the 102 patients treated with BCG (81%) were disease‐free, compared with 24 of the 53 treated with resection alone (45%). There was also a significant difference in tumour progression and time to progression between the trial arms. The disease progressed in eight patients (8%) treated with BCG and in 12 (23%) of those treated by resection alone. Independent risk factors for progression were DNA ploidy status and stage. Only the completion of treatment was predictive of outcome (risk of recurrence) for patients treated with BCG.

Conclusion Maintenance BCG therapy was better than resection alone in reducing the incidence of recurrence and progression in patients with high‐risk superficial bladder cancer.
Usefulness of power Doppler ultrasonography in evaluating erectile dysfunction
Authors: Golubinski A.J. , Sikorski A.
Published: March 2003

Objective To evaluate deep penile arterial flow after an intracavernosal injection with papaverine in patients with erectile dysfunction (ED).

Patients and methods Twenty patients with ED were evaluated using power Doppler ultrasonography with a linear probe (8 MHz). Diagnostic tests were undertaken after an intracavernosal injection with 40 mg papaverine. The peak systolic velocity (PSV), end‐diastolic velocity (EDV) and resistive index (RI) were analysed.

Results After injecting papaverine, seven patients had a normal erection and appropriate waveform patterns; their mean PSV was 30.7 cm/s, the EDV 4.42 cm/s and the RI 0.85. There was tumescence and elongation of the penis with no rigidity in eight patients; their mean PSV was 23.9 cm/s, the EDV 7.34 cm/s and the RI 0.72. There was no erection in five patients. The abnormal flow values showed insufficient arterial vessels in a quarter of the men, venous leakage in 15% and mixed ED in 20%.

Conclusion The power Doppler technique allows the accurate location and evaluation of deep penile arteries. Vascular pathology may be differentiated after an intracavernosal injection with a vasomotor agent. Recognising the pathological pattern assists in choosing the best method of treatment.
Transurethral microwave thermotherapy: first experiences in Poland
Authors: Jakubczyk T. , Stoklosa A. , Borkowski A. , Habrat W. , Dobrowolski Z.
Published: March 2003

Objective To present early experiences in Poland with high‐energy transurethral microwave thermotherapy (HeTUMT), considered as a serious alternative to surgery in managing benign prostatic hypertrophy (BPH).

Patients and methods Sixty‐one patients were treated in two centres using a commercial TUMT system. The patients were assessed at 5–6 weeks, 3 and 6 months after treatment, evaluating subjective complaints, the International Prostate Symptom Score (IPSS), urinary flow rate and postvoid residual volume.

Results A complete follow‐up was available in 44 patients; most had symptomatic improvement 3 months after HeTUMT but it was slightly less pronounced after 6 months. The improvement in objective variables increased up to 6 months after HeTUMT. There was  50% improvement in subjective complaints in 43% of the patients, in urinary flow rate in 25% and in residual urine in half. Two patients required re‐treatment for a urethral stricture and ineffective HeTUMT.

Conclusions HeTUMT may be a useful treatment for BPH but the outcome for an individual patient seems to be unpredictable. The indications for TUMT should be reviewed individually for each patient.
Delay and survival in bladder cancer
Authors: Wallace D.M.A. , Bryan R.T. , Dunn J.A. , Begum G. , Bathers S. ,   on behalf of the West Midlands Urological Research Group
Published: March 2003

Objective To assess in detail and evaluate the effect on survival of delays in the diagnosis and treatment of cancer (which might lead to a worse prognosis), dividing the delay from onset of symptoms to first treatment into several components, comprising patient delay, general practitioner (GP) delay, and two or more periods of hospital delay.

Patients and methods Data were prospectively collected on 1537 new cases of urothelial cancer in the West Midlands from 1 January 1991 to 30 June 1992. Death information was obtained from the West Midlands Cancer Intelligence Unit and censored at 31 July 2000. The influence of delay times on survival was explored.

Results The median delay from onset of symptoms to GP referral was 14 days (Delay 1), from GP referral to first hospital attendance was 28 days (Delay 2), and from first hospital attendance to first transurethral resection of bladder tumour was 20 days (Delay 3). The median hospital delay (Delay 2 + 3) was 68 days and the median total delay (Delay 1 + 2 + 3) was 110 days. Patients with a shorter Delay 1 had a lower tumour stage and a 5% better 5‐year survival. Patients with a shorter hospital delay had worse survival; total delay had no effect on survival.

Conclusions There was significantly better survival for patients referred to hospital within 14 days of the onset of symptoms. The relationship between delay and survival in bladder cancer is complex. Hospital delays may be influenced more by comorbidity than by the characteristics of the tumour. However, the adverse effects of delay seem to be most pronounced for patients with pT1 tumours.
High initial efficacy of full‐spectrum therapy for nocturnal enuresis in children and adolescents
Authors: Van Kampen M. , Bogaert G. , Feys H. , Baert L. , De Raeymaeker I. , De Weerdt W.
Published: March 2003

Objective  To investigate the initial efficacy and predictive factors of full‐spectrum therapy in the treatment of children and young adolescents with nocturnal enuresis (NE).

Patients and methods  Combined therapy for NE comprises an enuresis alarm, bladder training, motivational therapy and pelvic floor muscle training, and is more effective than each of the components alone or than medical intervention. A total of 60 children and adolescents (aged 4–20 years) with NE were treated once a week with full‐spectrum therapy for a maximum of 6 months.

Results  Overall the therapy was successful (14 consecutive dry nights) in 52 of 60 patients. At 30 days the cure rate was 33%, after 60 days 72% and after 98 days, 87%. The remaining 13% did not achieve 14 consecutive dry nights; seven patients improved, having fewer dry nights/week. One patient discontinued the treatment because of lack of motivation. In children with an initial maximum bladder capacity less than normal for age, the capacity increased from 53% of the normal maximum bladder capacity in week 1 to 88% at the end of treatment. Neither age, gender, sleep arousal, bladder capacity, family history and pathophysiological profile had any association with the success rate.

Conclusion  The short‐term success rate of full‐spectrum therapy for NE is high. Age, gender, sleep arousal, bladder capacity, family history and pathophysiological profile of enuresis are unrelated to the success of the intervention.
Diuretic Doppler ultrasonography in chronic unilateral partial ureteric obstruction in dogs
Authors: Yokoyama H. , Tsuji Y.
Published: March 2003

Objective  To compare the effects of diuresis induced by a loop diuretic (frusemide), an osmotic diuretic (mannitol) and a high‐osmolar radio‐contrast medium (sodium iothalamate) on the intrarenal resistive index (RI) in dogs with chronic unilateral partial ureteric obstruction (UPUO).

Materials and methods  The split renal clearance and intrarenal RI were estimated in 11 dogs with chronic UPUO. Doppler ultrasonography measurements of the interlobar arteries were obtained before and 10 min after the intravenous infusion of 1 mg/kg frusemide, 1 g/kg mannitol or 20 mL 60% sodium iothalamate. The same experimental protocol was repeated with another drug at 1‐week intervals.

Results  There was a significant difference between the intrarenal RI of obstructed and unobstructed kidneys in the chronic phase of UPUO. While mannitol and sodium iothalamate significantly increased the RI in both kidneys, differences in RI between the kidneys decreased after infusing the two drugs. However, while frusemide insignificantly increased the RI in the obstructed kidney, it decreased the RI in unobstructed one. Consequently, the difference in RI between the kidneys increased significantly after administering frusemide. There were no significant differences in urinary volume after administering each of the drugs.

Conclusions  As there were no significant differences in the diuretic effects of the drugs, frusemide may have additional effects on the RI of unobstructed kidneys other than diuresis. Frusemide increased the difference between the intrarenal RI of the kidneys and therefore may improve the detection of unilateral urinary obstruction in humans.
Prognostic significance of the mode of detection in renal tumours
Authors: Patard J.‐J. , Rodriguez A. , Rioux‐Leclercq N. , Guillé F. , Lobel B.
Published: March 2003

Objective  To evaluate the mode of detection of 400 renal tumours as a prognostic factor compared with the usual clinical and pathological prognostic variables.

Patients and methods  The data were reviewed for 400 patients operated for a renal tumour at our institution between 1984 and 1999, analysing the prognostic value of age, sex, tumour size, stage, grade, vein invasion, adrenal gland invasion, lymph node invasion, metastasis, and mode of detection (incidental or not). The survival rates were assessed using the Kaplan‐Meier method and log‐rank test, and the data evaluated using multivariate analysis with the Cox proportional‐hazard model.

Results

 In all, 151 (38%) renal tumours were discovered incidentally. There was no significant difference in the percentage of renal cell carcinoma found between the groups of patients discovered incidentally or not (94.4% vs 93.9%). Tumours were smaller in the incidental group (5.7 cm vs 8.7 cm,
P

 < 0.001). In the incidental group, 15.2% of the tumours were treated with partial nephrectomy, against 1.2% in the symptomatic group (
P

 < 0.001). The specific survival was significantly better in patients with renal tumours discovered incidentally (log‐rank test,
P

 < 0.001). The multivariate analysis showed that the mode of detection, stage, grade, metastasis (all
P

 < 0.001), and lymphatic extension (
P   =  0.005) were independent prognostic factors.

Conclusion  The incidental discovery of renal tumours gives a supplementary benefit to patients in terms of survival, and should be considered as a prognostic factor in addition to stage and grade.
Laparoscopic radical cystectomy with intracorporeal ileal conduit diversion: five cases with a 2‐year follow‐up
Authors: Gupta N.P. , Gill I.S. , Fergany A. , Nabi G.
Published: March 2003

Objective  To assess the feasibility and intermediate‐term outcome of laparoscopic radical cystectomy (LRC) with ileal conduit urinary diversion in patients with organ‐confined muscle‐invasive carcinoma of the urinary bladder, the entire procedure undertaken intracorporeally only using laparoscopic techniques.

Patients and methods  Five patients (four men and one woman) underwent LRC with intracorporeal ileal conduit diversion in February 2000, using a six‐port transperitoneal technique. LRC, ileal conduit exclusion, restoration of ileo‐ileal continuity, and bilateral stented uretero‐ileal anastomoses were completed intracorporeally in all patients. The follow‐up data up to 2 years are reported.

Results  All procedures were completed laparoscopically with no open conversion or intraoperative complications. The mean duration of surgery was 7.5 h; the blood loss was 360 mL and no patient required perioperative blood transfusion. The mean (range) hospital stay was 7 (6–22) days; the specimen weight was 225–400 g. The surgical margins of the bladder specimen were negative in each patient. One patient developed intestinal obstruction after surgery, requiring a diverting ileostomy for 12 weeks. At a follow‐up of 2 years, two patients died, both from unrelated causes (myocardial infarction and septicaemia from pulmonary infection in one each). The three surviving patients are asymptomatic with normal upper tracts and no evidence of local recurrence or metastatic disease.

Conclusion  LRC with ileal conduit diversion undertaken completely intracorporeally is a feasible option for muscle‐invasive organ‐confined carcinoma of the urinary bladder, with good outcomes over a 2‐year follow‐up.
Recurrence and progression in stage T1G3 bladder tumour with intravesical bacille Calmette‐Guérin (Danish 1331 strain)
Authors: Kulkarni J.N. , Gupta R.
Published: March 2003

Objective  To report recurrence and progression rates in patients with T1G3 superficial bladder carcinoma treated with intravesical bacille Calmette‐Guérin (BCG, Danish 1331 strain) after complete transurethral resection.

Patients and methods  Data from the records of 111 patients with T1G3 bladder carcinoma treated between January 1991 and December 1999 were analysed for recurrence, progression, salvage therapy and survival.

Results  Of the 111 patients with T1G3 bladder tumours, 69 had intravesical BCG therapy, 20 radical cystectomy and 22 only transurethral resection (TUR). Of the 69 patients receiving BCG therapy 37 (54%) had no recurrence, and 24 (35%) had a recurrence that was not muscle‐invasive (Ta/T1) and were treated with TUR only. The remaining eight (12%) progressed to muscle invasion and had salvage cystectomy. During the follow‐up six patients died, four from disease and three from other causes, while the remaining 63 are alive and well. Of the other 42 patients, 15 are alive after radical cystectomy and 18 after TUR.

Conclusion  This series further confirms the benefits of intravesical BCG (Danish 1331) in an adjuvant setting; furthermore, this treatment facilitates bladder preservation by reducing recurrences and delaying the progression in many patients.
Antimicrobial prophylaxis for transrectal prostatic biopsy: a prospective study of ciprofloxacin vs piperacillin/tazobactam
Authors: Cormio L. , Berardi B. , Callea A. , Fiorentino N. , Sblendorio D. , Zizzi V. , Traficante A.
Published: March 2003

Objective  To compare the efficacy of short‐term parenteral prophylaxis with piperacillin/tazobactam (P/T) with long‐term oral prophylaxis with ciprofloxacin in preventing infective complications after transrectal prostatic biopsy (TPB).

Patients and methods  Patients scheduled for TPB were randomized to receive P/T (2250 mg intramuscular) twice daily for 2 days (Group 1), or ciprofloxacin (500 mg orally) twice daily for 7 days (Group 2), beginning on the evening before the procedure in both groups. All patients received a 100‐mL phosphate enema 3 h before TPB. Evaluation included self‐recording of body temperature in the 3 days after TPB, and culture of mid‐stream urine (MSU) samples taken before and 3 and 15 days after TPB. Patients with indwelling urethral catheters or taking antibiotics or immunosuppressive drugs were excluded, as were patients with positive MSU cultures before TPB.

Results  Of the 138 evaluable patients, 72 received parenteral P/T and 66 oral ciprofloxacin. Bacteriuria (> 105 c.f.u./mL) after TPB occurred in two of 72 (2.8%) patients in Group 1 and in three of 66 (4.5%) patients in Group 2; this difference was not statistically significant (P > 0.1). However, of the five patients with bacteriuria, two were symptomatic and both were in Group 2. Pyrexia occurred in only one patient in Group 2 with symptomatic urinary tract infection, and required hospitalization. No other patient reported a body temperature openface> 37.5°C or drug‐related side‐effects.

Conclusions  This prospective study showed that short‐term prophylaxis with P/T was associated with a low rate of asymptomatic bacteriuria, requiring no further treatment, whereas although the rate was similar on long‐term prophylaxis with ciprofloxacin patients required further treatment, with one needing hospitalization. We recommend short‐term prophylaxis with P/T despite its disadvantages of cost and parenteral administration.
Benign prostatic hyperplasia: the opposite effects of alcohol and coffee intake
Authors: Gass R.
Published: March 2003

Objective  To assess several lifestyle factors influencing benign prostatic enlargement and therefore the severity of benign prostatic hyperplasia (BPH).

Subjects and methods  In age‐stratified cohorts from population‐based random samples of 882 men (aged 65, 70, 75 and 80 years) each participant completed a standardized questionnaire, including weight, height, socio‐economic status, use of cigarettes, alcohol and coffee consumption. The questionnaire also elicited detailed information on the medical history of prostatic and (over the past month) lower urinary tract symptoms, applying all questions from the American Urology Association instrument. The lifestyle variables were evaluated for confounding by multiple logistic regression, controlling for age, relative weight and professional education, with those classified as having BPH analysed as the dependent variable.

Results  The prevalence of surgery for BPH increased with age from 15% at 65 years to 41% at 80 years. There was a strong inverse association between alcohol intake and men treated surgically for BPH or in ‘watchful waiting’ for surgical intervention, but a positive correlation with coffee consumption, and although not significantly, with the number of cigarettes smoked. Nevertheless, those who had never smoked have a slightly greater risk of BPH than current smokers. The body mass index and professional education were not associated with the risk of BPH.

Conclusions  Given the opposite effects of coffee and moderate alcohol consumption, together with the increased risk for clinical BPH in men with coronary heart disease, coffee constituents, which increase the serum concentration of low‐density lipoprotein cholesterol, may be involved in the pathophysiology of BPH. Further epidemiological studies are needed to evaluate whether avoiding coffee intake reduces the risk of BPH.
Nocturia in the Dutch adult population
Authors: Van Dijk L. , Kooij D.G. , Schellevis F.G.
Published: March 2003

Objective  To estimate the prevalence of nocturia in the Dutch adult population, its association with sociodemographic and health characteristics, and to assess problems experienced by persons with nocturia.

Subjects and methods  In spring 2001 a telephone survey was conducted among a representative sample of 4721 Dutch respondents (response 53%). Using questions from the Bristol Lower Urinary Tract Symptoms questionnaire respondents were asked about having nocturia and the problems they experienced. In addition, questions were asked about sociodemographic and health characteristics.

Results  The prevalence of nocturia (a mean of twice or more/night) among Dutch men and women over 18 years old was 13%, standardized for age and sex. Women had nocturia more often than men (16% vs 9%) and the prevalence was positively associated with age, poor health status and use of medication.

Conclusion  The prevalence of nocturia in Dutch men and women differs more than reported in earlier studies. The prevalence in the Netherlands seems slightly higher than in other Western countries, but Dutch persons with nocturia report fewer problems. Nocturia does not occur in isolation and is associated with sleep disturbances. It is worthwhile for general practitioners to routinely check whether patients who contact them for lower urinary tract symptoms or sleeping disorders have nocturia.
Does pericapsular lignocaine reduce pain during transrectal ultrasonography‐guided biopsy of the prostate?
Authors: Walker A.E. , Schelvan C. , Rockall A.G. , Rickards D. , Kellett M.J.
Published: March 2003

Objective  To evaluate whether injection with pericapsular lignocaine before transrectal ultrasonography (TRUS)‐guided biopsy reduces the perceived pain of prostatic biopsy.

Patients and methods  The study included 121 patients referred for TRUS‐guided biopsy of the prostate; 27 underwent biopsy with no previous injection and 94 were randomized to pericapsular injection with either 1% lignocaine or a placebo (saline). Both patient and operator were unaware of the content of the injection. The injection was delivered under TRUS guidance to the apex of the prostate. Routine sextant biopsies were taken using an 18 G needle in a spring‐loaded biopsy gun. A validated pain scale, the NRS11 (0, no pain, to 10, unbearable pain), was used to record the pain of each biopsy.

Results  No significant placebo effect was detected between the ‘no injection’ and the placebo‐injection group, with mean (95% confidence interval) pain scores of 3.58 (2.77–4.39) and 4.01 (3.46–4.51), respectively, using the unpaired Student's t‐test (P = 0.409). There was a statistically significant lower mean pain score in the lignocaine group, at 2.54 (2.00–3.10), than in the placebo‐injection group (P < 0.001).

Conclusion  Pericapsular injection with 1% lignocaine significantly reduces the perceived pain of TRUS‐guided prostatic biopsy.
Laparoscopic radical prostatectomy: the initial UK series
Authors: Eden C.G. , Cahill D. , Vass J.A. , Adams T.H. , Dauleh M.I.
Published: March 2003

Objective  To test the reproducibility of other series of laparoscopic radical prostatectomy (LRP) for safety, efficacy and early oncological and functional results.

Patients and methods  One hundred consenting patients with clinically localized adenocarcinoma of the prostate and a Gleason sum of ≤ 8 opting for surgery underwent LRP undertaken by one surgeon. Their mean (range) age was 62.2 (52–72) years, weight 78.8 (65–100) kg, prostate specific antigen (PSA) level 8.0 (2–32) ng/mL, and Gleason sum 6.0 (4–8). A five‐port antegrade transperitoneal technique was used in all cases.

Results  The mean (range) operative duration was 245 (145–600) min, blood loss 313 (50–1300) mL, parenteral morphine sulphate administration 20.2 (0–160) mg and hospital stay after LRP 4.2 (3–13) nights. Bilateral neurovascular bundle preservation was attempted in 58% of patients. The transfusion rate was 3%. The conversion and re‐intervention rates were 1% and 2%, respectively. There were eight complications, six of which were in the initial 26 cases, i.e. bladder neck stenosis (two), and rectal injury, laparotomy for bleeding, premature drain removal leading to urinary peritonitis, ulnar nerve neuropraxia, port‐site hernia and paralytic ileus in one each. The positive surgical margin rate was 16%. All patients had a PSA level of ≤ 0.1 ng/mL at 3 months. By 1 year 90% of patients were pad‐free and 62% operated on using a bilateral nerve‐sparing technique had erections. There were no biochemical failures. The mean (range) follow‐up was 9.8 (1–24) months.

Conclusion  The present results are similar to those reported by other centres with greater experience and confirm that LRP is an effective, safe and precise technique. Once intial experience has been gained it offers advantages over open surgery in the form of a dry and magnified operative site, and a lower likelihood of blood transfusion, in addition to the generic advantages of laparoscopy.
Testicular growth and gonadotrophin response associated with varicocele repair in adolescent males
Authors: Fisch H. , Hyun G. , Hensle T.W.
Published: March 2003

OBJECTIVE

To measure testicular volume and the gonadotrophin response to gonadotrophin‐releasing hormone (GnRH) stimulation in adolescents undergoing left varicocelectomy.

PATIENTS AND METHODS

Thirteen adolescents undergoing varicocelectomy had their testicular volume and endocrine function evaluated before and after surgery.

RESULTS

The initial left testicular volume was consistently smaller than the right but after surgery both increased. Baseline follicle‐stimulating hormone (FSH) levels and the FSH response to GnRH stimulation increased after surgery. There were no differences in luteinizing hormone and testosterone levels, and no changes in Tanner staging.

CONCLUSIONS

Unilateral varicocelectomy with ipsilateral testicular atrophy results in bilateral testicular growth and increased FSH levels. In adolescent development, elevated FSH levels in conjunction with an increased response to the GnRH stimulation test represent a normal physiological response. The GnRH stimulation test cannot be used to determine which adolescent would benefit from surgical repair.
Clinical management of prostatic intraepithelial neoplasia as diagnosed by extended needle biopsies
Authors: San Francisco I.F. , Olumi A.F. , Kao J. , Rosen S. , DeWolf W.C.
Published: March 2003

OBJECTIVE

To examine the results of the clinical management of patients with high‐grade prostatic intraepithelial neoplasia (PIN), as diagnosed by extended needle biopsies.

PATIENTS AND METHODS

The clinical data were reviewed from a cohort of 387 men who underwent ≥ 10 core prostate needle biopsies between 1 January 1996 and 31 December 1997 by one urologist (W.C.D.). Two study groups were identified; the first comprised 47 patients with only high‐grade PIN and the second was a control group of 137 patients with only benign findings on their biopsies. Those patients with cancer, atypia or a prostatic biopsy with fewer than 10 cores were excluded. The clinical and histological data were evaluated. The criteria for re‐biopsy were two successive increases in prostate specific antigen (PSA) level or any change in the findings on digital rectal examination (DRE). All patients were monitored at 6–12 month intervals.

RESULTS

Of the 387 patients, 46% had normal findings, 5.2% had atypia, 12.6% had PIN alone, 15 (3.9%) had PIN plus atypia, 6.7% had PIN plus cancer and 32.3% had cancer. There was no significant difference between the PIN and control groups in age, DRE, PSA level, prostate size (by ultrasonography), free testosterone level, number of the cores and time of follow‐up (median 34.8 and 36.6 months for the PIN and control groups, respectively). Of the PIN and control groups, 21 (45%) and 43 (31%) respectively had at least one re‐biopsy. Five patients (24%) in the PIN and one (2.3%) in the control group developed cancer (P = 0.0124). All these patients had organ‐confined disease and were found to have either Gleason scores 3 + 3 or 3 + 4 on surgical specimens. There was no correlation between the original location of PIN and the location of subsequent malignancy.

CONCLUSIONS

Patients with one set of extended needle biopsies with high‐grade PIN should be followed clinically every 6–12 months, and it may be safe to reserve repeat biopsy for those with changes in PSA level and/or in the DRE.
The use of tolterodine in children after oxybutynin failure
Authors: Bolduc S. , Upadhyay J. , Payton J. , Bägli D.J. , McLorie G.A. , Khoury A.E. , Farhat W.
Published: March 2003

OBJECTIVE

To assess the safety and efficacy of tolterodine tartrate prescribed to children who previously failed to tolerate oxybutynin chloride.

PATIENTS AND METHODS

We reviewed 34 children, followed for>1 year, who were prospectively crossed‐over from oxybutynin to tolterodine because of side‐effects. The initial diagnosis was dysfunctional voiding in 31 patients. All patients were placed on a behavioural modification protocol. When their symptoms did not improve after 6 months, treatment with an anticholinergic agent was considered. Urodynamic studies were conducted in 20 patients, confirming uninhibited contractions in 19. The remaining 14 patients were empirically started on antimuscarinic or anticholinergic agents. The 34 patients were treated with oxybutynin for a median (range) of 6 (2–84) months. When significant side‐effects were reported, they were crossed over to tolterodine. The efficacy of tolterodine was assessed as defined by the International Children's Continence Society, with tolerability assessed and side‐effects documented using a questionnaire.

RESULTS

The mean age at the first dose of tolterodine was 8.9 years; the dose was 1 mg twice daily for 12 patients and 2 mg twice daily for 22. The median treatment with tolterodine was 11.5 months, with 20 (59%) patients reporting no side‐effects; six described the same but tolerable side‐effects as with oxybutynin. Eight patients discontinued tolterodine because of side‐effects after a median (range) of 5 (1–11) months. The efficacy of tolterodine was comparable with that of oxybutynin, as reported by the questionnaire and voiding diaries. The reduction in wetting episodes at 1 year was> 90% in 23 (68%), more than half in five and less than half (or failure) in six patients.

CONCLUSION

Tolterodine is tolerated well in children. In this subgroup of patients who could not tolerate oxybutynin, 77% were able to continue tolterodine treatment with no significant side‐effects.
Hand‐assisted laparoscopic vs the open (flank incision) approach to radical nephrectomy
Authors: Busby E. , Das S. , Rao Tunuguntla H.S.G. , Evans C.P.
Published: March 2003

OBJECTIVE

To compare the outcome in contemporaneous groups of patients undergoing hand‐assisted laparoscopic radical nephrectomy (HALRN) or open (flank) radical nephrectomy (ORN), as many series worldwide have confirmed the feasibility and advantages of LRN in managing renal cell carcinoma (RCC).

PATIENTS AND METHODS

We retrospectively evaluated 44 patients who underwent radical nephrectomy for RCC from 1999 to 2001, 22 by HALRN and 22 by ORN, through an extraperitoneal 11th or 12th rib flank incision. Standard perioperative variables were assessed; a validated questionnaire was also sent to each patient after surgery, allowing them to report their overall satisfaction and the period needed for them to return to both routine and full activities. The outcomes of HALRN and ORN were compared using Wilcoxon rank‐sum analysis.

RESULTS

There was a statistically significant difference between HALRN and ORN in operative duration, length of hospital stay, total narcotic requirement, pain scores at 1 week and 1 month after surgery, and the time to resume routine and full activity, with all variables (except operative duration) lower in the HALRN group. There were no significant differences between the groups in pain at 1–3 days, estimated blood loss or overall satisfaction.

CONCLUSION

Compared with ORN, HALRN is associated with lower narcotic requirement, pain scores, a shorter hospital stay and earlier resumption of routine and full activities. However, several obstacles remain, including increased operative duration and the increased equipment costs.
Loss of CD38 correlates with simultaneous up‐regulation of human leukocyte antigen‐DR in benign prostatic glands, but not in fetal or androgen‐ablated glands, and is strongly related to gland atrophy
Authors: Kramer G. , Steiner G.E. , Sokol P. , Mallone R. , Amann G. , Marberger M.
Published: March 2003

As genes and their products are identified to play important roles in disease. Understanding what and how they are regulated has significant importance, as these gene products could then be blocked before they are expressed. NF‐κB represents an important transcription factor that drives the expression of specific gene product, ie proteins. The paper by Lessard et al. demonstrates the localization of this transcription factor in prostate cancer. Targeting this transcription factor could well represent an interesting therapeutic site to prevent the expression of proteins that may contribute to the development of the disease.

OBJECTIVE

To determine whether CD38 loss in benign and malignant prostatic disease is related to human leukocyte antigen (HLA)‐DR up‐regulation, by assessing the histopathology of the prostate and the effect of androgen deprivation.

MATERIALS AND METHODS

Serial sections of frozen fetal (eight), infant (six), normal adult (10), benign hyperplastic (BPH, 24), and primary (10) and hormone‐treated (11) carcinomatous human prostatic tissues were analysed by immunohistology for anti‐CD38 and HLA‐DR antigens.

RESULTS

In BPH samples there was a significant correlation between CD38 loss (mean 21% of acini) and HLA‐DR up‐regulation (mean 20%; P < 0.001). Moreover, 76% of all CD38‐negative acini in BPH had HLA‐DR up‐regulation in the same prostate epithelial cells, predominantly in atrophic and cystic glands, and in cells with retained secretions (74%). In contrast to the uniform expression in normal adult prostate, CD38 was negative or partly expressed in fetal acini (mean 19%) and almost completely negative in acini of the early infant period (mean 0.7%). In contrast to BPH, cancer cells did not selectively up‐regulate HLA‐DR when CD38 was lost. In patients with cancer treated by androgen deprivation, cancer cells were CD38‐negative.

CONCLUSIONS

The absence of CD38 and presence of HLA‐DR expression in prostatic epithelium is consistent in BPH and tissue surrounding tumour, and strongly related to gland atrophy. This is particularly interesting as HLA‐DR triggering can induce apoptosis of cells, whereas CD38 prevents it. A permissive role for androgens to maintain full CD38 expression in epithelial cells is suggested.
Association of British Clinical Diabetologists (ABCD): survey of specialist diabetes care services in the UK, 2000. 3. Podiatry services and related foot care issues
Authors: Winocour P. H. , Morgan J. , Ainsworth A. , Williams D. R. R. ,   the Association of British Clinical Diabetologists
Published: March 2003

Aim To examine the provision of, and variations in, podiatry and other services for diabetic foot care in the UK.

Method A postal survey of secondary care providers of diabetes services in the UK in 2000.

Results Following two reminders a 77% response rate was achieved. The responses indicated that 97% had a state‐registered podiatrist attached to the service, providing three (median) sessions each week for diabetes care, although only 44% had availability at all diabetic clinics, and only 3% had availability at paediatric diabetic services. Podiatry access at all diabetic clinics increased the likelihood of associated preventative as opposed to reactive (‘trouble shooting’) care (P < 0.05). All individuals with feet at ‘high risk’ of ulceration had access to ‘at least 2 monthly review’ in 15% of trusts, and with active foot ulceration at least weekly in 43%. Over 70% used at least one form of equipment to assess peripheral neuropathy, but peripheral blood flow was only formally measured in 13%. Although podiatry input to patient education was common (84%), only 6% had received formal training in education. Guidelines and strategies for management of active foot problems were available in 50−74% of cases. Orthotic input was highly variable, and absent in 15% of responses. Podiatrist fitting and application of foot protective apparatus was only recorded in 22−61% of responses. Access to isotopic and/or MR foot imaging and peripheral angiography and angioplasty was recorded in 75−83% of responses. Separate specialist foot clinics were available in 49%, and where this was the case the use of newer foot ulcer healing applications was higher (P < 0.01). Clear regional differences were apparent in the nature of the service, the use of newer treatments, and in access to an orthotist, a local ‘dedicated’ foot surgeon or a separate diabetic foot clinic. Of 245 documented bids for service improvements, only 19 related to foot care and only 21% of bids were successful.

Conclusions Despite an increase in podiatry support to diabetes care over the last 10 years, the level of access and the nature of the services provided is much less than recommended in many advisory documents. The strategy of a co‐ordinated ‘team’ approach to foot care still takes place in less than 50% of centres. There are clear regional differences in diabetes foot care services. Both providers and purchasers of diabetes services may not have given sufficient attention to this area, given the relatively small number of documented bids for service improvements in this area, and the very low success rate of such bids.
Current status of screening for diabetic retinopathy in the UK
Authors: Younis N. , Broadbent D. M. , James M. , Harding S. P. , Vora J. P.
Published: March 2003

This article reviews the current status of retinopathy screening schemes in the UK. There is evidence that high‐quality diabetic retinopathy screening schemes are in existence but provision is patchy. Many health authorities have ad hoc screening programmes reaching only about 60% of patients, with unacceptable or undocumented efficacy and minimal quality control. Several models of screening are currently in use with the current preferred option being camera‐based screening. Digital imaging systems offer the best prospects for image acquisition, although at present evidence of adequate effectiveness only exists for 35 mm film‐based systems. The final report of the National Diabetic Retinopathy Screening Programme commissioned by the UK National Screening Committee for inclusion into the national service framework for diabetes, is thus eagerly awaited and should set standards for screening programmes, in order to improve the care of all those with diabetes. Quality assurance will be the main driver in the immediate future of improvements in screening programmes. Research data will provide the evidence to refine techniques and set targets in the longer term, with the emphasis on cost‐effectiveness and quality of life.
Screening for Type 2 diabetes mellitus in the UK Indo‐Asian population
Authors: Davies M. J. , Ammari F. , Sherriff C. , Burden M. L. , Gujral J. , Burden A. C.
Published: March 2003

Aims Type 2 diabetes mellitus (DM) has a high prevalence in Asian subjects. A simple method of screening using self‐testing for postprandial glycosuria achieved a good response rate and a sensitivity which compared favourably to more expensive and invasive methods in a semirural Caucasian population. We examined its effectiveness in Asian subjects.

Methods Caucasian and Indo‐Asian subjects aged 35–70 years in two general practices in Leicester (n = 9896 (6198 = Asian subjects, 3698 = Caucasian)) were screened. Those known to have diabetes were excluded. Subjects were asked to self‐test for glycosuria 1 h after their main meal. Instruction and response cards were translated in Punjabi and Gujarati and sent to the Asian subjects, depending on age and surname.

Results Response rate was 34.4% in Asian subjects compared to 54.0% in Caucasian subjects. Prevalence of glycosuria was 8.2% in Asian subjects and 3.2% in Caucasian subjects. Two hundred and thirty‐nine subjects recorded glycosuria and 202 (84.5% of the total, 86.9% of Asian subjects, 78.1% of Caucasian) attended for oral glucose tolerance test (OGTT). Sixty‐three (31.2%) were found to have diabetes (46, 73% Asian), 29 (14.4%) impaired glucose tolerance (24, 82.8% Asian) and 110 (54.4%) normal glucose tolerance (82, 74.6% Asian). Thus 30% of Asian subjects and 34% of Caucasian subjects had diabetes on OGTT. The prevalence of diabetes in 35–70 years in the total population after screening was 5.6% (6.8% in Asian subjects, 3.6% in Caucasian) and in the screened population was 12.7% (17.9% in Asian subjects, 6.3% in Caucasian).

Conclusions Screening for diabetes using this method, in terms of response rate, is not as effective in a large city setting, particularly in the Asian population. However, the yield of diabetes in the age group 35–64 years compares well to much more expensive and labour intensive approaches and its use in this population in a primary care setting is justified.

Diabet. Med. 16, 131–137 (1999)
A comparative study of the Podotrack, a simple semiquantitative plantar pressure measuring device, and the optical pedobarograph in the assessment of pressures under the diabetic foot
Authors: Van Schie C. H. M. , Abbott C. A. , Vileikyte L. , Shaw J. E. , Hollis S. , Boulton A. J. M.
Published: March 2003

Aims To test the Podotrack, a simple inexpensive semiquantitative footprint mat, for potential use as a screening tool for high plantar pressures, against the optical pedobarograph (a computerized device).

Methods The Podotrack was superimposed on the pedobarograph for simultaneous measurement of pressures from both systems. Three independent observers quantified the pressures of Podotrack footprints from healthy controls and diabetic patients, both before (n = 164) and after (n = 183) training. The sensitivity of the Podotrack to identify high pressure areas measured by the pedobarograph (> 12.3 kg/cm2) was 78.7%, 45.8% and 44.3% (observer A, B and C) before training, but improved to 96.2%, 92.4% and 91.1% after training (P < 0.01). Specificity for all three observers was more than 90% before and after training. Inter‐observer agreement improved significantly after training (P < 0.001).

Conclusion After a simple training of the observers, the Podotrack identified approximately all high pressure areas, suggesting that the Podotrack could be a useful screening tool to identify areas at risk of ulceration in diabetic patients. We recommend a standard training package for new Podotrack users, to optimize identification of diabetic patients at risk of foot ulceration.

Diabet. Med. 16, 154–159 (1999)
Codon 54 polymorphism of the fatty acid binding protein gene and insulin resistance in the Japanese population
Authors: Ito K. , Nakatani K. , Fujii M. , Katsuki A. , Tsuchihashi K. , Murata K. , Goto H. , Yano Y. , Gabazza E. C. , Sumida Y. , Adachi Y.
Published: March 2003

Aim To determine the relationship of the polymorphism at codon 54 of the intestinal fatty acid binding protein gene (FABP2) with insulin resistance and susceptibility to Type 2 diabetes mellitus (DM) in the Japanese population.

Methods We evaluated the polymorphism by the polymerase chain reaction‐restriction fragment length polymorphism (PCR‐RFLP) in 150 Type 2 DM patients and 147 healthy control subjects. The frequency of alleles encoding threonine (Thr54) and alanine (Ala54) at codon 54 of FABP2 in Type 2 DM patients was compared with that of healthy controls. Insulin sensitivity was assessed by the hyperinsulinaemic euglycaemic clamp in Type 2 DM patients with Ala54 homozygotes, Ala54/Thr54 heterozygotes and Thr54 homozygotes and by homeostasis model assessment (HOMA) in the nondiabetic group.

Results The frequency of alleles encoding Ala54 and Thr54 was 0.59 and 0.41 in Type 2 DM patients, respectively, similar to that observed in nondiabetic controls (0.64 for Ala54 and 0.36 for Thr54). Insulin sensitivity was not significantly different between subjects with and without Thr54 allele either within the DM group or healthy controls.

Conclusions The allele encoding threonine in the FABP2 does not predispose to Type 2 DM or insulin resistance in the Japanese population

Diabet. Med. 16, 119–124 (1999)
Impaired fasting glucose is not a risk factor for atherosclerosis
Authors: Hanefeld M. , Temelkova‐Kurktschiev T. , Schaper F. , Henkel E. , Siegert G. , Koehler C.
Published: March 2003

Aim To determine a new category of dysfunctional glucose homeostasis – impaired fasting glucose (IFG) – introduced by the American Diabetes Association (ADA) and the World Health Organization (WHO) defining those with abnormal but nondiabetic fasting glucose values and with a possible risk for developing diabetes. It is not known whether IFG is a risk factor for atherosclerosis, as is impaired glucose tolerance (IGT).

Methods In this case‐control cross‐sectional study in which the oral glucose tolerance (75‐g OGTT) and the carotid intima‐media thickness (IMT) with B mode ultrasound, as a marker of atherosclerosis, were measured, together with HbA1c, lipids, plasminogen activator (PAI), insulin and proinsulin concentrations in blood plasma. Out of 788 subjects of the risk factors in IGT for Atherosclerosis and Diabetes (RIAD) study we found 104 IFG cases that were compared to 104 controls with fasting plasma glucose (FPG) < 6.1 mmol/l, matched for age, sex and body mass index. Subjects with 2 h postprandial (pp) plasma glucose ≥ 11.1 mmol/l were excluded. The rest were subdivided into those with 2 h plasma glucose < 7.8 mmol/l (63 pairs, NGT) and those with plasma glucose > 7.8 mmol/l and < 11.1 mmol/l (41 pairs, IGT).

Results The case and control groups showed no significant differences in the major risk factors except for waist‐to‐hip ratio (WHR) which was higher in the IFG with NGT. IFG with NGT exhibited significantly higher levels of HbA1c, true insulin and proinsulin. In IFG with IGT, only HbA1c and proinsulin were significantly increased vs. controls. IMT was in the same range for cases and controls in both subgroups. However, IMT mean and IMTmax were significantly increased in IFG with IGT vs. IFG with NGT (0.95 mm vs. 0.80 mm and 1.10 mm vs. 0.90 mm). Cumulative distribution analysis of IMT illustrates that IMT in IFG with IGT is more shifted to higher artery wall thickness than in IFG with NGT.

Conclusions In our case‐control study IFG alone was not related to increased IMT. Only IFG in a combination with IGT exhibited atherosclerotic changes of the carotid arteries. IFG is not analogous to IGT as a risk factor for atherosclerosis.

Diabet. Med. 16, 212–218 (1999)
Effect of management policy upon 120 Type 1 diabetic pregnancies: policy decisions in practice
Authors: Brown S. Carron , Kyne‐Grzebalski D. , Mwangi B. , Taylor R.
Published: March 2003

Aims To evaluate the outcome of two specific changes in the policy of managing pregnancy in Type 1 diabetes over a 5‐year period. The need for change had been identified following an audit in the previous 5‐year period: firstly, the need for intensive effort to improve the uptake of pre‐pregnancy counselling; secondly, a modest relaxation of the targets for blood glucose control during labour to minimize the risk of maternal hypoglycaemia.

Methods Data were collated from maternal and neonatal case notes from all women with Type 1 diabetes mellitus managed by Newcastle obstetric services between August 1989 and July 1994 (n = 80), comparing data with 40 such women looked after between November 1985 and July 1989.

Results The age of the women, blood glucose control during pregnancy, gestation at delivery, and birth weight were similar in the 5‐year period under study to those previously reported for the first study period. Mean blood glucose in labour for Period 2 was 5.5 + 0.6 mmol/l, exactly 1.0 mmol/l higher than the mean blood glucose achieved in labour for Period 1. As a consequence, only 22.5% women (18/80) experienced one or more episodes of blood glucose less than 3.0 mmol/l compared with 40.0% women in Period 1 (16/40) (P < 0.01). There was no effect of maternal blood glucose on neonatal blood glucose provided the former was within the range 4–8 mmol/l during labour. However, if maternal blood glucose was over 10 mmol/l, the infant’s blood glucose was always low (1.3 ± 0.8 vs. 2.5 ± 1.5 P < 0.02). Macrosomia (over the 90th percentile for gestational age) was observed in 43.1% of infants in Period 1, and the mean birth weight was not different from Period 1. In the initial 5‐year period 27.5% (11/40) women received specific pre‐pregnancy care for their diabetes, compared with 21.3% (17/80) in Period 2 despite the intensive programme of education. There were six cases of congenital abnormality and two antepartum deaths (10% adverse outcome).

Conclusions The target range for blood glucose control in labour of 4–7 mmol/l minimizes maternal hypoglycaemia in labour and the data indicate that an upper limit of 8 mmol/l would not increase the risk of neonatal hypoglycaemia. Fresh thought is required about the matter of preventing congenital abnormalities by achieving better pre‐pregnancy and peri‐conception blood glucose control.