bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute and chronic effects of dinner with alcoholic beverages on nitric oxide metabolites in healthy men
Authors: Sierksma Aafje , Van Der Gaag Martijn S , Grobbee Diederick E , Hendriks Henk FJ
Published: December 2004

1. The present study investigated the acute and chronic effect of dinner with alcoholic beverages on serum nitric oxide (NO) metabolites, namely nitrate and nitrite (NOx), in 11 healthy, non‐smoking middle‐aged men.

2. In a randomized, diet‐controlled, cross‐over trial, subjects consumed dinner with four glasses of red wine, beer, spirits (Dutch gin) or sparkling mineral water (control) for 3 weeks. At the end of each 3 week period, serum NOx concentrations were measured just before and 1, 5 and 13 h after dinner.

3. Serum NOx concentrations were approximately 50% higher 1 and 5 h after dinner with any beverage compared with just before dinner (P = 0.0001). At 1 h after dinner, the serum NOx concentration was approximately 11% lower after dinner with alcoholic beverages compared with concentrations observed after dinner with water (P = 0.01). The fasted serum NOx concentration (13 h after dinner) was similar to the preprandial concentration and there were no differences in serum NOx concentrations between the alcoholic beverages.

4. Food intake acutely and transiently increased serum NOx concentrations, an effect that was slightly attenuated if combined with alcoholic beverages. Chronic moderate alcohol consumption had no effect on serum NOx concentration.
The New Zealand cataract and refractive surgery survey 2001
Authors: Elder Mark , Leaming David
Published: December 2004

Background: This study documents the current practice for cataract and refractive surgery in New Zealand.

Methods: A postal questionnaire was distributed late in 2000 to all consultant ophthalmologists in New Zealand. Most questions were identical to the 2000 survey of the American Society of Cataract and Refraction Surgeons (ASCRS) enabling a comparison.

Results: There was an 84% return rate from the 103 surveys distributed. In regards to cataract surgery, topical anaesthesia was used by 12% of respondents, clear corneal incisions by 64%, no suture was used by 94%, diamond blades were used by 33%, disposable blades were reused by 64%, preoperative antibiotics were used by 28%, anti­biotic was used in the irrigant by 10%, postoperative injections of steroid/antibiotics were used by 63% and 41% of patients had three postoperative visits after cataract surgery. In regards to refractive surgery, 51% of respondents had access to an excimer laser and clear lens extraction was performed by 13 ophthalmologists. Advice to a 30‐year‐old −7.00 myope wanting refractive surgery was to have LASIK (88%), wait (8%) or have no surgery (4%).

Discussion: In broad terms, New Zealand ophthalmologists’ cataract and refractive practice is similar to that of the members of ASCRS with the exception of the use of topical anaesthetic (NZ 12%vs USA 49%) and the higher use of postoperative injections of steroid and antibiotic at the end of surgery (NZ 63%vs USA 20%).
Toxocara canis: egg presence in Melbourne parks and disease incidence in Victoria
Authors: Carden Susan M , Meusemann Robin , Walker John , Stawell Richard J , MacKinnon Jane R , Smith Danielle , Stawell Alison M , Hall Anthony JH
Published: December 2004

Purpose: Toxocara caniscan cause blinding eye disease. This study assessed the presence ofT. caniseggs in soil from parks in Melbourne and also the incidence of presumed ocular toxocariasis in Victoria.

Methods: One hundred and eighty soil samples were collected from nine suburban locations in Melbourne, Australia. These were analyzed for the presence ofT. caniseggs. A search of laboratory records ofT. canisserology requests from Victorian patients over an 8‐year period was performed.

Results: Only one soil sample was positive forT. caniseggs. PositiveT. canisserology was reported in 13 samples from patients. These patients all had ocular features suggestive ofT. canisinfection.

Conclusion: Toxocara caniseggs are rare in public parks in Melbourne and symptomatic ocular toxocariasis is uncommon in the Victorian population. The acquisition of the disease is unlikely to be from public parks.
Pseudo‐hypopyon as the presenting feature in B‐cell and T‐cell intraocular lymphoma
Authors: Lobo Aires , Larkin Genevieve , Clark Brian J , Towler Hamish MA , Lightman Susan
Published: December 2004

The clinicopathologic correlation of two patients with primary intraocular lymphoma is described, both of whom had a rare and unusual presentation of hypopyon uveitis. Sampling of aqueous fluid proved the cytopathologic diagnosis of B‐cell lymphoma in the first patient. In the second patient an iris biopsy confirmed a T‐cell lymphoma. The samples were examined using haematoxylin and eosin, and immunohistochemical stains. These patients were diagnosed with primary intraocular lymphoma on initial presentation with hypopyon uveitis. Secondary glaucoma was noted in the patient with T‐cell lymphoma. Both cases appeared confined to the eye and initially responded favourably to aggressive chemotherapy and radiotherapy, but later went on to develop systemic involvement. Clinicians should be aware of this dramatic mode of presentation, which is unusual for ocular lymphoma.
Efficacy of quadruple therapy for Helicobacter pylori eradication after failure of proton pump inhibitor‐based triple therapy in Singapore
Authors: ANG TL , FOCK KM , NG TM , TEO EK , CHUA TS , TAN YL
Published: December 2004

BACKGROUND:  Helicobacter pylori eradication is the mainstay in the treatment of H. pylori‐associated peptic ulcer disease. Current standard eradication therapy consists of 1 week of treatment with a proton pump inhibitor (PPI) and two antibiotics selected from amoxicillin, metronidazole and clarithromycin. In this study we aimed to assess the efficacy of quadruple therapy consisting of a PPI, bismuth, tetra‐cycline and metronidazole in patients for whom initial H. pylori eradication using a triple therapy regimen consisting of a PPI, amoxicillin and clarithromycin was unsuccessful.

METHODS:  Consecutive patients with H. pylori‐associated peptic ulcer disease, in whom H. pylori with triple therapy had been unsuccessful, were included in the study. These patients had been treated with a regimen that included a PPI (standard dose twice daily), amoxicillin (1 g twice daily) and clarithro­mycin (500 mg twice daily) for 1 week during 1997−2001. Diagnosis of peptic ulcer disease was made at esophagogastroduodenoscopy. Helicobacter pylori infection was considered to be present on the basis of either a positive rapid urease test, positive histo­logical identification of H. pylori or both. Failure of initial H. pylori eradication was established with either a rapid urease test, a 13C urea breath test or histology. Quadruple therapy consisted of a PPI (standard dose twice daily), metronidazole (400 mg three times daily), tetracycline (500 mg four times daily) and bismuth subcitrate (240 mg twice daily). Failure of quadruple therapy was diagnosed on the basis of a positive 13C urea breath test.

RESULTS:  Fifty‐three patients received quadruple therapy. The median age was 52 years (range 20−74) and the male to female ratio was 42 : 11. On an intent‐to‐treat basis, the eradication rate was 69.8%, whereas on a per‐protocol basis, the eradication rate was 82.2%.

CONCLUSION:  We conclude that a 1‐week quadruple therapy regime consisting of a PPI, bismuth, tetracycline and metronidazole was effective in 82.2% of patients who experienced an unsuccessful initial H. pylori eradication attempt with PPI, amoxicillin and clarithromycin.
Intestinal motility: Normal and disturbed patterns
Authors: QUIGLEY Eamonn MM
Published: December 2004

Intestinal manometry has become a part of the gastroenterologists diagnostic armamentarium, albeit confined to a small number of specialist centers. This review traces the development of intestinal mano­metry from its first beginnings to its current status, evaluates its current role in the assessment of intestinal motor disorders and, in doing so, addresses the vexing issue of defining normality and identifying disease from manometric recordings.
Effects of probiotics, lactitol and rifaximin on intestinal flora and fecal excretion of organic acids in cirrhotic patients
Authors: HOTTEN P , MAROTTA F , NAITO Y , MINELLI E , HELMY A , LIGHTHOUSE J , FUJI H , FESCE E
Published: December 2004

AIM:  The aim of the present study was to assess fecal organic acid excretion and gut flora changes in a group of patients with compensated liver cirrhosis without hepatic encephalopathy by comparing pro­biotic therapy with more common therapeutic approaches.

METHODS:  Thirty patients with compensated Child B liver cirrhosis were allocated into one of three matched groups, which were randomly given one of three 3‐week oral treatments: (i) lactitol 20 g t.i.d.; (ii) 400 mg rifaximin b.i.d.; or (iii) the synbiotic SCM‐III (Microflorana‐F, Named, Lesmo, Italy) 10 mL t.i.d. Stool samples were collected at both the time of entry into the study and at the end of the trial period for the assessment of intestinal bacterial flora and for the determination of fecal pH and of organic acid concentration.

RESULTS:  All three tested compounds significantly increased the total anaerobic bacterial count to the same extent. The change was mainly due to a reduction in the Bacteriodes population and an expansion of the bifidobacteria population. However, only SCM‐III significantly decreased the total count of Bacteroides and Clostridium. Lactitol and SCM‐III decreased (to a similar extent) the fecal pH compared with healthy controls and with pretreatment values (P < 0.05). Both lactitol and SCM‐III produced a significant increase in the fecal concentration of acetic acid and lactic acid. However, only SCM‐III decreased the fecal concentration of toxic short‐chain fatty acids.

CONCLUSIONS:  In the present clinical study, we confirmed the findings from an in vitro study of enhanced‐non‐toxic organic acid recovery from stools during treatment with nonabsorbable disaccharides. In the present study, we found that lactitol did not produce any significant effect on Bacteroides and Clostridium, whereas the specific bacterial counts of such species significantly decreased only in the group treated with the synbiotic. These data suggest a potential role of synbiotics in the long term treatment of chronic liver disease.
A comparison of the simultaneous application of sclerotherapy and rubber band ligation, with sclerotherapy and rubber band ligation applied separately, for the treatment of haemorrhoids: a prospective randomized trial
Authors: Kanellos I. , Goulimaris I. , Christoforidis E. , Kelpis T. , Betsis D.
Published: December 2004

Objective  To compare simultaneous application of sclerotherapy and rubber band ligation, with sclerotherapy and rubber band ligation applied separately for the treatment of 2nd degree haemorrhoids.

Patients and methods  Between 1993 and 1996, 255 patients that suffered from 2nd degree haemorrhoids were divided into 3 groups of 85 patients, each to receive either simultaneous sclerotherapy for smaller and rubber band ligation for larger piles (SCL/RBL) in one session, or sclerotherapy (SCL), or rubber band ligation (RBL), respectively. After a period of 4 years all patients were examined and their symptoms were recorded.

Results  The patients of the SCL group developed significantly fewer complications after treatment compared to the other two methods (P < 0.001), which did not differ from each other. After the SCL/RBL treatment, significantly more patients were symptom free (46%) than after SCL (8%), P < 0.001. There was no significant difference between the SCL/RBL (46%) and the RBL (31%) groups (P = 0.217), although the combined treatment seemed to be more effective than rubber band ligation. Only 10% of the patients of the SCL/RBL group needed additional sessions 6–24 months after the initial treatment compared to 30% of the patients of the SCL group (P = 0.001). However, there was no significant difference between SCL/RBL and RBL (17%) groups (P = 0.151).

Conclusion  The combination of sclerotherapy and rubber band ligation for treatment of 2nd degree haemorrhoids is significantly more efficient than sclerotherapy on its own.
Double stapled ileal pouch anal anastomosis (DS‐IPAA) for mucosal ulcerative colitis (MUC): is there a correlation between the tissue type in the circular stapler donuts and in follow‐up biopsy?
Authors: Saigusa N. , Choi Hong‐Jo , Wexner S. D. , Woodhouse S. L. , Singh J. J. , Weiss E. G. , Nogueras J. J. , Belin B.
Published: December 2004

Purpose  This study aims to assess the correlation between the tissue types found in the circular stapler donut at the time of initial double‐stapled ileal pouch‐anal anastomosis (DS‐IPAA) and during subsequent periodic routine random biopsy. Secondarily, we sought to assess the risk of dysplasia, carcinoma or mucosal ulcerative colitis (MUC) recurrence in the retained mucosa.

Methods  The pathology reports of 91 patients (48 males, 43 females) who were operated upon for MUC from September 1988 to June 1997 and were reviewed and had two follow up visits for biopsy. The histological features of the distal donuts and biopsies of retained mucosa obtained at yearly interval follow‐up were assessed in order to determine the epithelial tissue type (columnar, transitional and squamous), inflammation, recurrence of MUC and presence of dysplasia or malignancy.

Results  Median age at surgery was 43 (range 15–71) years and duration of MUC was 9.6 (range 0.3–42) years prior to surgery. The anastomosis was performed at a median height of 1.0 (range 0–2.5) cm cephalad to the dentate line and biopsy follow‐up was undertaken at median 34 (range 2–110) months after DS‐IPAA. The distal donuts were analysed in all cases, as were 305 follow‐up biopsies (median 3.4; range 1–7 per patient). Although columnar epithelium (CE) was found in 62 (68%) donuts, it was absent on follow‐up biopsy in 16 (26%) of these patients. Conversely, although no CE was identified in 29 (32%) donuts, it was identified in 11 (38%) of these patients during follow‐up biopsy. CE in the donut was a significant predictor of CE in subsequent biopsies (P = 0.0012). The histological features consistent with MUC were seen in the biopsies from the retained mucosa in 15 (16%) patients from 0.3 to 7.6 years after DS‐IPAA. While eight (9%) patients exhibited dysplasia or adenocarcinoma in the excised colon or rectum, none of the patients had either dysplastic changes or carcinoma within the retained mucosal biopsies.

Conclusion  The correlation between CE in the circular stapler donut and at follow‐up biopsy was high. However since CE developed in some patients in whom no CE was present in the distal donuts, regardless of the epithelial tissue type finding at the time of DS‐IPAA, periodic follow‐up biopsy should be obtained.
The variable effect on proliferation of a colon cancer cell line by the citrus fruit flavonoid Naringenin
Authors: Frydoonfar H. R. , McGrath D. R. , Spigelman A. D.
Published: December 2004

Objective  Naringenin, a naturally occurring flavonoid found in citrus fruits, is known to have anticarcinogenic properties. We have examined the effect of Naringenin on cell proliferation of an HT‐29 colon cancer cell line.

Methods  HT‐29 colon cancer cells were cultured in 96‐well tissue culture plates. Naringenin concentrations ranging from 0.02 to 2.85 mmol were added to the wells of the Test group. The Control group contained all the elements present in the Test group with the exception of Naringenin. Cell proliferation was measured by colourimetric assay using the 2% WST‐1 cell proliferation kit.

Results  Significant inhibition of cell proliferation was observed in HT29 colon cancer cells exposed to Naringenin at doses greater than 0.71 mmol.

Conclusions  These results suggest a potential role for citrus fruits as a source of chemoprotective agents for colon cancer.
Pathological subgroups may predict complications but not late failure after ileal pouch‐anal anastomosis for indeterminate colitis
Authors: Gramlich T. , Delaney C. P. , Lynch A. C. , Remzi F. H. , Fazio V. W.
Published: December 2004

Introduction  Ileal pouch‐anal anastomosis (IPAA) for indeterminate colitis (IndC) may lead to an increased risk of perineal complications and pouch loss. This study evaluated pathological subgroups of IndC to identify a predictor of increased complication rates after IPAA for IndC.

Patients and methods  Of 171 IPAAs with a postoperative diagnosis of IndC, IndC was confirmed in 115 of the 140 specimens available for re‐examination. These were divided into IndC favouring ulcerative colitis (Group I; n = 99), ‘true’ IndC (Group II; n = 8), and IndC favouring Crohn's (Group III; n = 8). 61 presented with fulminant colitis. Patients in Group I were subdivided into having (A) deep ulcers (B) transmural lymphoid aggregates (C) skip lesions (D) terminal ileal inflammation and/or (E) a caecal patch. Outcome was determined by chart analysis, and compared to 231 randomly selected patients with IPAA for ulcerative colitis (UC) matched for age, gender, and follow‐up.

Results  Only patients with evidence of deep ulceration (Group IA) had a significant increase in the incidence of Crohn's disease (4.3%vs. 0.43%, P = 0.04), complex perianal fistulae (4.3%vs. 0.43%, P = 0.04), and pelvic abscess (12.9%vs. 2.2%, P < 0.001). No pathological subgroup of IndC patients had a significantly different rate of pouch failure or pouch loss.

Conclusions  Pathological stratification may predict those more likely to develop Crohn's disease or other complications, but not pouch failure. On this basis, we feel that patients with IndC should not be precluded from having IPAA surgery.
Nationwide decline in annual numbers of abdomino‐perineal resections: effect of a successful national trial?
Authors: Engel A. F. , Oomen J. L. T. , Eijsbouts Q. A. J. , Cuesta M. A. , Vd Velde C. J. H.
Published: December 2004

Objective  Large national trials may influence surgical practice. In this study the relation between the successful national randomized trial on the management of rectal cancer (the Dutch TME trial) and national ratio of abdomino‐perineal resection to low anterior resection and anastomosis was analysed.

Patients and methods  In the study period, 1994–99, 15978 patients underwent either abdomino‐perineal resection (n = 2575) or low anterior resection and anastomosis (n = 13403). The Dutch TME trial started in 1996 and a total of 1530 patients were included by 83 hospitals and 82.1% of these patients were treated from 1997 to 1999. Teaching sessions, tutor assisted surgery and quality control formed an integral and important part of the TME trial.

Results  Ratio of abdomino‐perineal resection vs. low anterior resection was compared between period I (1994–96) and period II (1997–99). The ratio decreased from 0.19 to 0.13 between period I and II (95% CI, −0.08 to −0.04, P < 0.001). In hospital mortality rate did not change between period I and II (3.5 vs. 3.7, 95% CI, −0.08 to 0.03, P = 0.385).

Conclusion  Significant changes in surgical attitude may accompany successful national randomized trials in which investigated surgical procedures are specified, taught, and controlled. The APR ratio declined by 32% in the Netherlands during and following the Dutch TME trial, without a rise in hospital mortality rate for rectal resections.
Diverticular disease has an impact on quality of life – results of a preliminary study
Authors: Bolster L. T. , Papagrigoriadis S.
Published: December 2004

Objective  Diverticular disease (DD) is common in the western world, and carries a significant morbidity. Although patients can have long standing symptoms no research on quality of life (QoL) in DD exists in the literature. Assessment of QoL may be useful in decision making and selection of patients who would be appropriate candidates for elective surgical treatment. The aim of this study was to examine whether DD has an impact on QoL.

Materials and methods  A combination of structured interview and questionnaire survey was performed. One hundred people were divided into two groups: Group A, 50 patients with symptomatic DD as their primary diagnosis; Group B, A control group of 50 healthy volunteers. A structured QoL questionnaire, examining bowel symptoms, systemic symptoms, emotional symptoms and social function, was completed by the subjects in both the patient and the control group.

Results  In the patient group scores fell well below the optimum QoL scores in each of the subscales particularly in the areas of bowel symptoms (43.8 vs 65.4 for controls) and emotional function (55.1 vs 75.9 for controls). Patients with DD had statistically significantly lower QoL scores than controls and this difference was consistent in all four examined areas (P < 0.003 for all categories).

Conclusion  Our preliminary study suggests that DD does affect a person's QoL. The authors recommend that further research is required in the development of a (QoL) scoring system specific for patients with diverticular disease. Having developed a tool that can accurately measure the subjective health status (QoL) of this disease group we will then be able to develop a more systematic approach to the delivery of treatment, management and care of patients with diverticular disease.
The interrupted serosubmucosal anastomosis – still the gold standard
Authors: Leslie A. , Steele R. J. C.
Published: December 2004

Background  The single‐layer appositional serosubmucosal anastomosis is a well established technique and appears to have a favourable record. Over a 15‐year period the senior author of this paper has performed or directly supervised 553 anastomoses using this technique. This report describes the results of these operations, the results of stapled anastomoses carried out during the same period and discusses the utility of the handsewn technique.

Methods  From August 1986 to July 2001, 553 intestinal anastomoses in 550 patients were fashioned using single‐layer, interrupted serosubmucosal 3/0 braided polyamide and 131 anastomoses in 131 patients were performed using a circular anastomosing stapler.

Results  One anastomotic leakage occurred in the group of patients whose anastomosis was handsewn (0.2%) and 11 leaks occurred in those who had a stapled anastomoses (8.4%). The mortality rate in each group was similar (2% and 2.3%, respectively). There were no deaths attributable to anastomotic dehiscence in either group.

Conclusion  In this prospectively audited series of 553 handsewn anastomoses the leakage rate was 0.2%. These results compare favourably with other published series and continue to support a single layer of interrupted serosubmucosal sutures as the gold standard for anastomoses involving the large or small bowel.
Stapled haemorrhoidopexy: a consensus position paper by an international working party – indications, contra‐indications and technique
Authors: Corman M. L. , Gravié J.‐F. , Hager T. , Loudon M. A. , Mascagni D. , Nyström P.‐O. , Seow‐Choen F. , Abcarian H. , Marcello P. , Weiss E. , Longo A.
Published: December 2004

An international working party with experience in the performance of an alternative haemorrhoid operation through the use of the circular stapler was convened for the purpose of developing a consensus as to the criteria for undertaking this procedure. The agenda consisted of first, naming the operation; second, the indications and contra‐indications for its performance; and third, the preferred surgical technique. Among the recommendations for individuals who plan to embark on this surgery are that experience with anorectal surgery and an understanding of anorectal anatomy are requisites; experience with circular stapling devices is essential; and the surgeon must attend a formal course which should include lectures, videos, the application of the instrument in models, and observation of the operation as performed by a surgeon recognized by his or her peers—leading ultimately to undertaking the procedure while being observed by an experienced surgeon. Following satisfactory completion of the above, independent responsibility should be determined by an individual's department of surgery.
A novel method of demonstrating rectal prolapse
Authors: Paice A. , Buchanan G. N. , Murali K. , Parker M. C.
Published: December 2004

Background  Full thickness rectal prolapse may be difficult to view in the outpatient setting. We present a novel method to demonstrate it using equipment commonly found in the Urology clinic.
Bladder cancer cell implantation in reconstructed bladder in vitro: a model of tumour recurrence
Authors: Nakamura K. , Fujiyama C. , Tokuda Y. , Sugihara H. , Masaki Z.
Published: December 2004

Objective To evaluate the involvement of umbrella cells in tumour adhesion and growth, by examining whether human urinary bladder carcinoma cells (HUBCC) can grow on reconstructed urinary bladder mucosa in vitro, as the implantation of tumour cells after resection is thought to be a cause of bladder tumour recurrence.

Materials and methods Normal transitional epithelial cells isolated from porcine bladder were cultured on reconstructed lamina propria using fibroblasts in type I collagen gel. The urothelium thus reconstructed was artificially injured either by a scalpel or by dilute acid, after which transitional epithelial cells began to grow in a stratified fashion within a few days of culture. A HUBCC line (HT‐1197) was seeded onto this impaired mucosa to determine whether the cells could become implanted. Cultured cells on the reconstructed mucosa were evaluated by histological observation of vertical paraffin sections.

Results The inoculated transitional epithelial cells grew in a stratified fashion and closely resembled urothelium in vivo. The superficial cells that were in contact with the medium solution differentiated into umbrella cells. HUBCC were unable to adhere to reconstructed mucosa which had not been injured, but these cells could adhere to and become implanted on the reconstructed mucosa after it had been injured either by a scalpel or by dilute acid. After acid injury, only the surface‐covering cells were removed sporadically, while the lower epithelial cell layer remained intact. The bladder cancer cells adhered to and proliferated within these stripped regions.

Conclusion These results suggest that the urothelium, especially umbrella cells, seems to be important in preventing the adhesion and growth of urinary bladder tumour cells.
Tubularized incised‐plate urethroplasty for proximal hypospadias
Authors: Snodgrass W.T. , Lorenzo A.
Published: December 2004

Objective To report the experience of one surgeon using tubularized incised‐plate (TIP) urethroplasty to repair proximal hypospadias in a consecutive series of boys.

Patients and methods The records of 33 consecutive patients with midshaft to scrotal hypospadias undergoing TIP repair by one surgeon were reviewed. Dorsal plication was used as necessary for penile straightening, to preserve the urethral plate. Standard TIP urethroplasty was undertaken, and the follow‐up included the selective use of neourethral calibration and urethroscopy.

Results Plication was necessary in 18 (55%) patients. The incised plate had a supple appearance in all but two boys. The mean (range) follow‐up was 9 (1–48) months and included calibration in 16 (48%) and urethroscopy in 13 (39%) patients. Complications were noted in 11 (33%) boys, of whom seven (21%) developed small fistulae. The two patients in whom the incised plate appeared unhealthy had dehiscence of the repair and contracture of the neourethra with recurrent penile curvature, respectively. There was one meatal stenosis and one short neourethral stricture.

Conclusions TIP urethroplasty can be used to repair proximal hypospadias in the absence of severe penile curvature, and if the incised urethral plate has a supple appearance. As with distal hypospadias repair, the procedure creates a normal‐appearing penis with a slit‐like meatus.
Improving glandular coverage during prostate biopsy using a long‐core needle: technical performance of an end‐cutting needle
Authors: Ubhayakar G.N. , Li W.Y. , Corbishley C.M. , Patel U.
Published: December 2004

Objective To compare the technical performance of a 33‐mm core‐length biopsy needle with that of the standard 18 mm needle, as many prostate cancers are isoechoic and in large prostates the tissue coverage with the 18 mm needle is inadequate.

Patients and methods A 33‐mm core length BioPince™ VSL disposable needle (Amedic, Sweden) and a standard TruCut 18 mm needle (Medical Device Technology Inc., FL, USA) were used to take prostatic biopsies in two groups of 15 patients. The following variables were assessed for each group: mean core length, core quality, capsular coverage (one or both capsules within the specimen), and side‐effects in the first week after biopsy (for the BioPince group, surveyed using a self‐completed questionnaire). The results were compared with historical data from a group of 30 patients biopsied using the standard needle.

Results For the BioPince and standard groups the mean (sd) core length was 19.4 (8.9) and 14.9 (5.1) mm, respectively. Four needles in the BioPince group failed to capture a sample, requiring needle replacement. The samples were fragmented in 15 of 90 (17%) and 41 of 90 (46%) biopsies in the BioPince and standard groups, respectively (P < 0.05). Specimens had both capsules present in five of 90 (6%) and four of 90 (4%), respectively. Within 7 days minor bleeding was the most common side‐effect. Pain after biopsy was the only symptom showing a significant difference between the groups, at six of 15 and none (P = 0.001), respectively. The incidence of haematuria, haematospermia and rectal bleeding was similar in the two groups (P > 0.05), but fever more common (three vs none) in the BioPince group (P = 0.06).

Conclusion When set at a 33‐mm stroke length, the BioPince needle increases the mean core length by 30%, with less fragmentation than a standard 18 mm needle. However, it has a significant failure rate for capture (27% needle replacement rate), slightly greater morbidity (pain and possibly fever) and shows no advantage in capsular coverage. Therefore, there are shortcomings with this end‐cutting needle when used at 33 mm core length.
Tubularized incised‐plate urethroplasty for hypospadias reoperation
Authors: Snodgrass W.T. , Lorenzo A.
Published: December 2004

ObjectiveTo review our preliminary results of tubularized incised‐plate (TIP) urethroplasty for reoperative hypospadias repair.

Patients and methodsThe study comprised 15 patients, of whom eight had undergone a previous repair by techniques that included incision into the midline of the urethral plate, while in the remaining seven the midline of the plate had been left undisturbed. The meatus at reoperation was subcoronal or on the distal shaft in all but one boy, who had a midshaft hypospadias. All had previously undergone one attempt at hypospadias repair, except for one patient presenting after two failed ‘meatal advancement and glanuloplasty incorporated’ procedures. The TIP repair was undertaken as described for primary surgery, except that the dorsal dartos flaps for interposition between the neourethra and skin closure were available less often.

ResultsTIP resulted in a functional neourethra and a cosmetically normal meatus in 13 of the 15 patients. One boy healed with a slightly rounded meatus and the other had wound dehiscence; fistulae developed in another two boys, giving three patients with complications. The fistulae occurred in boys whose original surgery did not include urethral plate incision, while the dehiscence was in a patient with partial excision of the plate during previous tubularized preputial flap repair.

ConclusionsTIP urethroplasty can potentially be used for hypospadias reoperation. Previous incision of the urethral plate was not a contraindication in these selected cases in which the plate appeared supple. However, TIP repair should be avoided in repeat hypospadias surgery if the plate has been resected or is obviously scarred.
p53 and bcl‐2 immunohistochemistry in preoperative biopsies as predictors of biochemical recurrence after radical prostatectomy
Authors: Oxley J.D. , Winkler M.H. , Parry K. , Brewster S. , Abbott C. , Gillatt D.A.
Published: December 2004

Objective To evaluate p53 and bcl‐2 immunohistochemistry in preoperative biopsies and radical prostatectomy specimens, as predictors of biochemical recurrence.

Patients and methods Preoperative biopsies from 73 men, and the radical prostatectomies from these men and from a further 47 men, were evaluated. The serum prostate specific antigen (PSA) level, Gleason score, pathological stage and margin involvement were recorded. The immunohistochemical expression of p53 and bcl‐2 was studied on a representative area of tumour with the highest Gleason grade. The median follow‐up was 53 months.

Results During the follow‐up 47 of the 120 patients had a biochemical recurrence. Capsular penetration was present in 63 (53%) and the surgical margins were positive in 47 (39%). The Gleason score was < 7 in 81 (68%) patients; p53 was positive in 40 (66%) of 61 biopsies and 84 (71%) of 118 prostatectomy specimens. Bcl‐2 was positive in eight (13%) of 63 biopsies and 20 (17%) of 118 prostatectomies. On multivariate analysis the biopsy p53, Gleason score and serum PSA were significant predictors of recurrence. On multivariate analysis, capsular penetration, PSA and margin status at prostatectomy were significant predictors of recurrence. There was also a significant interaction between PSA and margin status. Although univariately significant, neither p53 nor bcl‐2 featured in the final multivariate model.

Conclusion Biopsy p53 status significantly predicts recurrence after radical prostatectomy, but its low specificity and technical issues suggest that it will not be useful in the clinical setting. However, a patient with negative p53 on biopsy is likely to have a good prognosis on prolonged follow‐up.
Prognostic significance of tumour angiogenesis in schistosoma‐associated adenocarcinoma of the urinary bladder
Authors: El Sobky E. , Gomha M. , El‐Baz M. , Abol‐Enein H. , Shaaban A.A.
Published: December 2004

ObjectiveTo report on tumour angiogenesis and its relationship with morphological variables and prognosis in adenocarcinoma of the urinary bladder associated with schistosomiasis.

Patients and methodsFifty‐five vesical adenocarcinomas were evaluated from 30 men and 25 women (mean age 47.2 years,sd 8.7, range 30–65) who were followed up after radical cystectomy and urinary diversion for a mean (sd, range) of 61 (43.5, 2.7–159.5) months. Vessels were stained immunohistochemically using an antibody to the platelet endothelial cell‐adhesion molecule CD31. Microvessels were counted in active areas of angiogenesis within the tumours (at × 250) and the microvessel density (MVD) quantified using the mean of three counts. Treatment failure was defined as death from cancer or the development of local recurrence or distant metastasis. Kaplan‐Meier survival curves and Cox's proportional hazard model were used to assess survival.

ResultsThe overall 5‐ and 10‐year survival rates were 57% and 51%, respectively. The presence of lymph node metastasis and high mean vascular density (> 26) were significantly associated with a poor prognosis. The 5‐year survival for patients with negative lymph nodes was 66% while no patients with positive nodes survived for 5 years (P < 0.001); the survival was 72% for patients with a low MVD and 33% for those with a high MVD (P = 0.0016). From individual results plotted against vascularity in lymph node‐negative patients, there was a significantly better outcome for those with a low MVD ( 26;P = 0.0099); this significance was maintained on multivariate analysis. However, there was no significant relationship between angiogenesis and the different clinicopathological factors apart from the grade (P = 0.03); tumour stage, grade and DNA profile had no significant effect on survival in these patients.

ConclusionsThese findings suggest that assessing angiogenesis using the MVD provides an independent predictor of survival in patients with adenocarcinoma of the urinary bladder.
Prenatal diagnosis of cloacal anomalies
Authors: Warne S. , Chitty L.S. , Wilcox D.T.
Published: December 2004

Objective To evaluate prenatal diagnosis in facilitating prenatal counselling and planning optimal perinatal care for persistent cloaca, a complex malformation with variable presentation and a difficult reconstructive challenge for the paediatric urologist and surgeon.

Patients and methods The prenatal records of six patients with a suspected prenatal diagnosis of cloacal anomaly, subsequently confirmed on delivery, were reviewed. All had serial prenatal ultrasonograms. Fetal medicine and paediatric surgical specialists were present for the scans and counselled the parents jointly.

Results The diagnosis was made at 19–33 weeks of gestation; all fetuses had a cystic structure arising from the pelvis and bilateral hydronephrosis, with a poorly visualized fetal bladder in most. Other prenatal features included transient fetal ascites, oligohydramnios, ambiguous genitalia and growth retardation. Female karyotype was confirmed in all cases by amniocentesis. Diagnosis was aided in two patients by fetoscopy and in another by magnetic resonance imaging.

Conclusions Cloacal anomalies can be diagnosed prenatally and should be considered in any female fetus presenting with bilateral hydronephrosis, a poorly visualized bladder and a cystic lesion arising from the pelvis. Prenatal diagnosis allows time for parental counselling and planning of the delivery at a centre equipped with neonatal intensive‐care and paediatric surgical facilities.
Continent catheterizable conduits: which stoma, which conduit and which reservoir?
Authors: McAndrew H.F. , Malone P.S.J.
Published: December 2004

Objective To assess the outcome of the various methods used in creating continent catheterizable conduits.

Patients and methods The case notes were reviewed from 89 patients who underwent the formation of 112 continent catheterizable conduits.

Results Sixty‐five conduits were Mitrofanoff and 47 were antegrade colonic enema (ACE); 21 patients had both. At a mean follow‐up of 34 months, 95 (85%) conduits were still in use. There was no difference in complications between the Mitrofanoff and ACE conduits; 109 (97%) conduits were continent and stomal stenosis occurred 35 (31%). There was no significant difference relating to the conduit used, the reservoir, the stoma type or the stoma site. Only 39% of patients required no revisional surgery.

Conclusion Although urinary and fecal continence can be achieved in most patients there is a high burden of complications and revisional surgery. All patients should be counselled accordingly.
Inverse expression of uroplakins and inducible nitric oxide synthase in the urothelium of patients with bladder outlet obstruction
Authors: Romih R. , Korošec P. , Jezernik K. , Sedmak B. , Tršinar B. , Deng F.‐M. , Liang F.‐X. , Sun T.‐T.
Published: December 2004

Objective

To assess the expression and distribution of uroplakins, protein subunits of the asymmetric unit membrane (AUM), and inducible nitric‐oxide synthase (iNOS) in the urinary bladder urothelium of patients with bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia (BPH).

Patients and methods

Urinary bladder urothelium samples from 15 men (mean age 69 years) with BOO secondary to BPH were processed for light and electron immunocytochemistry. Uroplakins and iNOS were detected, and areas of apical surface covered with AUM were compared with those of iNOS‐positive urothelial cells.

Results

Areas of superficial urothelial cells with no AUM were found in all obstructed bladder samples. The immuno‐electron microscopy showed that the uroplakin‐positive cells had the characteristic appearance of terminally differentiated umbrella cells, whereas cells from the uroplakin‐negative regions were undifferentiated, typically showing microvilli on their apical surface. iNOS was not detected in areas with continuous AUM staining, but was readily detected in the uroplakin‐negative areas. There was an inverse correlation between the intensity of uroplakin and iNOS staining.

Conclusions

In patients with BOO associated with BPH, some superficial urothelial cells lacked the AUM, suggesting focal compromise of the blood–urine permeability barrier. In such relatively undifferentiated urothelial zones there was an accompanying increase in the expression of iNOS, which marks perturbed urothelial differentiation and may modulate bladder response to the outlet obstruction.
The validity of sacral ratios to identify sacral abnormalities
Authors: Warne S.A. , Godley M.L. , Owens C.M. , Wilcox D.T.
Published: December 2004

Objective

To test the repeatability and validity of a previously described sacral ratio measurement as a method for detecting sacral abnormalities, as the association between sacral abnormalities and neuropathic bladder is well known but the diagnosis of subtle sacral anomalies is often delayed.

Materials and methods

Fifty sacral radiographs (from 30 patients with anorectal anomalies and 20 normal children) were viewed and reported as normal or abnormal by an expert spinal radiologist (reference standard). Sacral ratios (anteroposterior, AP, and lateral) were measured while unaware of origin by four investigators and the inter‐ and intra‐observer variability examined. Validity was assessed by comparing individual sacral ratio values with the radiological diagnosis, using Pena's criteria for a normal sacrum (normal ≥ 0.74 AP; ≥ 0.77 lateral).

Results

Sacral ratio estimates were possible in 48 of the 50 selected radiographs. There was good repeatability of measurements and moderate variability among investigators (P > 0.1). For the 20 normal children the mean (sd) AP sacral ratio was 0.74 (0.156); in the 14 with anorectal conditions and a normal sacrum it was 0.87 (0.16) and in the 12 with an abnormal sacrum 0.64 (0.27). There was a difference (P < 0.02) among the three groups (analysis of variance) but there was wide variability in individual sacral ratios within each group, and considerable overlap of values between normal and abnormal sacra. When all sacra were defined as normal or abnormal using Pena's criteria, there was poor agreement using Cohen's κ (AP and lateral view) with the radiological diagnosis by all four investigators.

Conclusion

The sacral ratio has good inter‐ and intra‐observer repeatability. The mean value for a normal AP ratio concurred with that described previously by Pena but the variability of values among similar patients was large, suggesting this single value is of limited value in discriminating a normal from an abnormal sacrum.
Human DNA topoisomerase‐IIα expression as a prognostic factor for transitional cell carcinoma of the urinary bladder
Authors: Koren R. , Kugel V. , Dekel Y. , Weissman Y. , Livne P.M. , Gal R.
Published: December 2004

Objective

To investigate the immunohistochemical expression of topoisomerase II‐α (TII‐α, a nuclear enzyme, the expression of which increases rapidly at the end of the S to G2/M phase and declines when mitosis ends) in bladder urothelial neoplasms (transitional cell carcinoma), and its correlation with grade, stage and survival.

patients and methods

Histological sections from 57 urothelial neoplasms were stained immunohistochemically for TII‐α expression; the percentage of positive cells in the area of greatest staining was recorded as the TII‐α index.

Results

TII‐α nuclear staining was positive in all the samples except one. The mean (sd) TII‐α index was 10.7 (5.9) in urothelial neoplasms of low malignant potential (grade 1), 15.5 (5.0) in low‐grade (grade 2) and 42.1 (13.4) in high‐grade urothelial carcinoma (grade 3). The mean TII‐α index was 10.7 (5.9), 26.3 (14.8) and 44 (19) in stages pTa, pT1 and pT2, respectively. The TII‐α index was significant for predicting death from cancer, independently of the stage or grade of the disease (P = 0.019, hazard ratio 1.1).

Conclusions

A higher TII‐α index indicates a greater probability of recurrence of disease and lower overall survival. Therefore TII‐α expression has prognostic value in bladder carcinoma.
A comparison of physical examination and imaging in determining the extent of primary penile carcinoma
Authors: Lont A.P. , Besnard A.P.E. , Gallee M.P.W. , Van Tinteren H. , Horenblas S.
Published: December 2004

Objective

To determine the accuracy of physical examination and imaging in assessing the extent of the primary tumour in squamous cell carcinoma of the penis.

Patients and methods

A physical examination, ultrasonography and magnetic resonance imaging (MRI) were used before surgery in 33 patients with penile carcinoma. The tumour size, infiltration of the penile structures and infiltration depth were assessed. The results were compared with the histopathological examination of the resected specimen.

Results

Tumour size was determined with the highest precision by the physical examination (residual sd of 8.1 mm); ultrasonography and MRI were less precise (residual sd 8.9 mm and 9.3 mm). In assessing infiltration depth, ultrasonography and MRI had comparable precision (residual sd 3.7 mm and 3.8 mm). The positive predictive value of corpus cavernosum infiltration was 6/6 for physical examination, 4/6 for ultrasonography and 6/8 for MRI; the sensitivity was 6/7, 4/7 and 6/6, respectively.

Conclusion

Physical examination is a reliable method for estimating penile tumour size and predicts corpus cavernosum infiltration with a high positive predictive value. Tumours for which the infiltration of the corpora cannot be determined properly by physical palpation only should be examined by imaging.
Laparoscopically assisted ureterocystoplasty
Authors: Cilento B.G. , Diamond D.A. , Yeung C.K. , Manzoni G. , Poppas D.P. , Hensle T.W.
Published: December 2004

The concept of ureterocystoplasty, in this case laparoscopically assisted, is addressed by several authors from the USA. The details of their technique are described, and avoiding a large midline incision was found to be particularly beneficial to the patient.

Authors from Paris and Toronto describe a further laparoscopic study. They describe a trial comparing the retroperitoneal approach to open partial nephrectomy. These authors also feel that the laparoscopic approach to surgery, in this case partial nephrectomy, is safe and feasible in children, with no increase in operative duration and a shorter hospital stay.

Objective

To assess the efficacy and safety of laparoscopically assisted ureterocystoplasty (LAU) in children.

Patients and methods

From 1999 to 2001, five patients (mean age 7 years, range 3.5–13) from four centres underwent LAU with laparoscopic mobilization of the small kidney and upper ureter combined with ureterocystoplasty, with exposure of the bladder through a Pfannenstiel incision. The details and outcomes are reviewed.

Results

The LAU was successful in all five patients; there were no complications. A large midline incision was avoided and the LAU carried out through the better tolerated and less painful Pfannenstiel incision.

Conclusion

LAU is an appealing technique that is safe with the added benefit of a reduced abdominal incision and acceptable operative duration. This represents the first published report of LAU.