bluuebunny/crossref_metadata_2025 huggingface dataset:
Diffuse cutaneous leishmaniasis associated with the immune reconstitution inflammatory syndrome
Authors: Sinha Smeeta , Fernández Geover , Kapila Rajendra , Lambert W. Clark , Schwartz Robert A.
Published: November 2008

Leishmaniasis is an emerging disease in HIV‐infected persons; visceral leishmaniasis is an AIDS‐defining opportunistic infection. The parasite that causes this infection is usually transmitted by the sandfly and occasionally by nonsterile needles among intravenous drug users. Diffuse cutaneous leishmaniasis (DCL) is a rare anergic variant of leishmanial infection with the characteristic presentation of numerous nonulcerating nodules with an abundant parasite load, lack of visceral involvement, negative reaction to the leishmanin skin test, and a chronic course with incomplete response to treatment and frequent relapses. We report a case of DCL that developed in the context of the immune reconstitution inflammatory syndrome (IRIS) in a man with AIDS following initiation of antiretroviral therapy. We also review DCL to emphasize the importance of recognizing and treating this evolving disease in the growing population of patients on immunorestorative therapy.
Informed decision making before initiating screening mammography: does it occur and does it make a difference?
Authors: Nekhlyudov Larissa , Li Rong , Fletcher Suzanne W.
Published: November 2008

Objective  Informed decision making regarding screening mammography is recommended for women under age 50. To what extent it occurs in clinical settings is unclear.

Methods  Using a mailed instrument, we surveyed women aged 40–44 prior to their first screening mammogram. All women were members of a large health maintenance organization and received care at a large medical practice in the Greater Boston area. The survey measured informed decision making, decisional conflict, satisfaction, and screening mammography knowledge and intentions to undergo screening.

Results  Ninety‐six women responded to the survey (response rate 47%). Overall, women reported limited informed decision making regarding screening mammography, both with respect to information exchange and involvement in the decision process. Less than half (47%) reported discussing the benefits of screening; 23% the uncertainties; and only 7% the harms. About 30% reported discussing the nature of the decision or clinical issue; and 29% reported their provider elicited their preferred role in the decision; 38% their preferences; and 24% their understanding of the information. Women who were uninformed had higher decisional conflict (2.37 vs. 1.83, P = 0.005) about screening mammography and were more likely to be dissatisfied with the information and involvement. Women’s screening mammography knowledge was limited in most areas; however being presented with information did not diminish their intentions to undergo screening.

Conclusion  Informed decision making before initiating screening mammography is limited in this setting. There appears to be little indication that information about the benefits and harms decreases women’s intentions to undergo screening. Methods to communicate information to women before initiating screening mammography are needed.
Comparison of the efficacy of levocetirizine 5 mg and desloratadine 5 mg in chronic idiopathic urticaria patients
Authors: Potter P. C. , Kapp A. , Maurer M. , Guillet G. , Jian A. M. , Hauptmann P. , Finlay A. Y.
Published: November 2008

Background:  Nonsedating H1‐antihistamines are recommended for the treatment of urticaria by the recent EAACI/GA2LEN/EDF guidelines. The aim of this study was to compare the efficacy, after 4 weeks of treatment, with levocetirizine 5 mg and desloratadine 5 mg, both once daily in the morning, in symptomatic chronic idiopathic urticaria (CIU) patients.

Methods:  This multi‐center, randomized, double‐blind study involved 886 patients (438 on levocetirizine and 448 on desloratadine). The primary objective was to compare their efficacy on the mean pruritus severity score after 1 week of treatment. Mean pruritus severity score over 4 weeks and pruritus duration score, number and size of wheals, mean CIU composite score (sum of the scores for pruritus severity and numbers of wheals), quality of life, and the patient’s and investigator’s global satisfaction with treatment, were secondary efficacy measures.

Results:  Levocetirizine led to a significantly greater decrease in pruritus severity than desloratadine over the first treatment week; mean pruritus severity scores of 1.02 and 1.18 for levocetirizine and desloratadine, respectively (P < 0.001). The result was similar for the entire 4‐week treatment period (P = 0.004). In addition, levocetirizine decreased pruritus duration and the mean CIU composite scores to a significantly greater extent than desloratadine during the first week (P = 0.002 and 0.005, respectively) and over the entire study (P = 0.009 and P < 0.05, respectively). Similarly, levocetirizine increased the patients’ global satisfaction after one and 4 weeks (P = 0.012 and 0.021, respectively), compared with desloratadine. Safety and tolerability were similar in both groups.

Conclusions:  Levocetirizine 5 mg was significantly more efficacious than desloratadine 5 mg in the treatment of CIU symptoms.
Towards minimizing immunosuppression in pediatric liver transplant recipients
Authors: Turmelle Yumirle P. , Nadler Michelle L. , Anderson Christopher D. , Doyle Maria B. , Lowell Jeffrey A. , Shepherd Ross W.
Published: November 2008

Abstract:  Immunosuppression regimens after liver transplantation focus mainly on preventing rejection and subsequent graft loss. However, in children, morbidity and mortality rates from infections exceed those from rejection after transplant, and immunosuppression can hinder growth, renal function, and graft tolerance. We hypothesized that early steroid withdrawal, with a primary aim of TAC monotherapy would yield no penalty in terms of rejection and graft loss, while reducing risks of infection and maximizing growth. We prospectively evaluated 64 consecutive pediatric liver transplant recipients. One yr patient/graft survival was 93/90%, respectively. At one yr post‐transplant, 75.4% of patients were on TAC monotherapy. No deaths or graft losses were caused by infection. Sixty‐one percent of patients had at least one episode of rejection, most within three months following transplant and 3.8% were treated for chronic rejection. One non‐compliant adolescent died from chronic rejection. CMV, EBV, and lymphoproliferative disease rates were 3.1%, 5.3%, 1.8%, respectively. Pretransplant and one yr post‐transplant glomerular filtration rates were unchanged. One yr improved catch‐up growth was observed. We conclude that immunosuppression minimization after pediatric liver transplant yields no serious complications from rejection, and might confer advantages with respect to infection, renal function, growth, and is deserving of wider application and study.
Allelochemicals of barnyardgrass‐infested soil and their activities on crops and weeds
Authors: KHANH TRAN DANG , XUAN TRAN DANG , CHUNG ILL MIN , TAWATA SHINKICHI
Published: November 2008

Barnyardgrass is one of the most noxious paddy weeds in the world and causes great trouble to many crops. In a bioassay, the aqueous extract of paddy soil infested with barnyardgrass showed phytotoxic action against the growth of the tested crops and paddy weeds, of which rice was the most suppressed among the crops. In contrast, barnyardgrass was the least affected paddy weed. By the use of a separation resin, 18 compounds belonging to terpenes, derivatives of cinnamic acid and ferulic acid, long‐chain fatty acids, and steroids that were potentially involved in the phytotoxic activities in barnyardgrass‐infested soil were isolated and identified by gas chromatography–mass spectrometry analysis. Of these, the quantities of linalool, 4‐terpinenol, coumaran, methyl phenethyl ketone, and methyl ester cinnamic acid were 1.42, 0.37, 0.02, 3.12, and 4.59 μg g−1 of the wet soil, respectively. The herbicidal activity was varied among these qualified test compounds, in which methyl phenethyl ketone and methyl ester cinnamic acid were more herbicidal than coumaran, linalool, and 4‐terpinenol. A mixture of these compounds was also the least inhibitive against the growth of barnyardgrass, but exerted strong suppression against that of rice and monochoria. The present study demonstrates that barnyardgrass possesses strong phytotoxic properties and releases plant growth inhibitors into the soil to compete with rice and other paddy weeds in its vicinity by a chemical pathway.
Assessment of the allelopathic potential of 17 Iranian barley cultivars in different development stages and their variations over 60 years of selection
Authors: OVEISI MOSTAFA , MASHHADI HAMID R. , BAGHESTANI MOHAMMAD A. , ALIZADEH HASSAN M. , BADRI SAMIRA
Published: November 2008

Laboratory experiments were conducted to determine the allelopathic potential of 17 Iranian barley cultivars in four development stages and their variations over the last 60 years of collection. Imbibed seeds and water leachates that were extracted from the barley plants at the seedling, tillering, stem elongation, and heading stages were used for the bioassays, including filter paper, neighboring barley seeds in soil, and soil mixed with dried barley residues. The experiments were conducted with the use of wild mustard (Sinapis arvensis) as the test plant. The Germination Rate Index (GRI) and emergence of S. arvensis were inhibited on both the filter paper and soil. The highest inhibitory effect was seen with the tillering stage's water leachate on filter paper. The GRI decreased in response to the increased density of barley imbibed seeds. The germination was less affected by the presence of barley seeds from the soil than those from the filter paper. The GRI of S. arvensis seeds was lower in the older than in the recently developed cultivars. Although there were some fluctuations in the GRI value with time, the germination inhibitory effect has decreased as new, higher‐yielding cultivars have been released.
Proximate composition, mineral content, and antioxidant properties of 14 Mexican weeds used as fodder
Authors: GUTIÉRREZ DORA , MENDOZA SANDRA , SERRANO VALENTINA , BAH MOUSTAPHA , PELZ RICARDO , BALDERAS PATRICIA , LEÓN FIDEL
Published: November 2008

Many wild weeds are used in Mexico as fodder. Due to their economic value, this investigation was undertaken to determine the chemical composition of 14 species. The mineral, crude protein, fiber, and total phenolic content, as well as the antioxidant activity, was determined. There was a significant variation in the mineral content among the 14 weeds, which all had calcium and potassium as the predominant elements. According to the results, some of the weeds might represent possible mineral deficiency sources, making the supplementation of certain minerals advisable. Although five of the species contained a low concentration of magnesium, the overall mineral ratios of the forage weeds were at safe levels, preventing grazing animals suffering from grass tetany, in contrast to the excessive calcium : phosphorus ratios that can affect their normal growth and bone development. The crude fiber and protein content in most of the weeds fell into the recommended range for the maintenance of cattle. The phenolic content of the studied weed extracts was higher than that reported for several Mediterranean forage species. These phenolic profiles correlate well with the radical scavenging activities of the extracts.
Con: pediatric anesthesia training in developing countries is best achieved by out of country scholarships
Authors: WALKER ISABEAU A.
Published: November 2008

Medical migration is damaging health systems in developing countries and anesthesia delivery is critically affected, particularly in sub‐Saharan Africa. ‘Within country’ postgraduate anesthesia training needs to be supported to encourage more doctors into the specialty. Open‐ended training programs to countries that do not share the same spectrum of disease should be discouraged. Donor agencies have an important role to play in supporting sustainable postgraduate training programs.
Doppler‐guided haemorrhoidal artery ligation, rectoanal repair, sutured haemorrhoidopexy and minimal mucocutaneous excision for grades III–IV haemorrhoids: a multicenter prospective study of safety and efficacy
Authors: Theodoropoulos G. E. , Sevrisarianos N. , Papaconstantinou J. , Panoussopoulos S. G. , Dardamanis D. , Stamopoulos P. , Bramis K. , Spiliotis J. , Datsis A. , Leandros E.
Published: November 2008

Objective The isolated use of Doppler‐guided haemorrhoidal artery ligation (DGHAL) may fail for advanced haemorrhoids (HR; grades III and IV). Suture haemorrhoidopexy (SHP) and mucopexy by rectoanal repair (RAR) result in haemorrhoidal lifting and fixation. A prospective evaluation was performed to evaluate the results of DGHAL combined with adjunctive procedures.

Method The study included 147 patients with HR (male patients: 102; grade III: 95, grade IV: 52) presenting with bleeding (73%) and prolapse (62%).

Results More ligations were required for grade IV than grade III HR (10.7 + 2.8vs8.6 + 2.2,P < 0.001). SHP (28 patients) and RAR (18 patients) at 1–4 positions were deemed necessary in 46 (31%) patients. Minimal (muco‐)cutaneous excision (MMCE) was added in 23 patients. SHP/RAR was applied more frequently in grade IV HR (60%vs16%,P < 0.001). In patients not having MMCE, SHP/RAR was added in 57% of grade IV cases (P < 0.001). Complications included residual prolapse (10; two second surgery), bleeding (15; two second DGHAL), thrombosis (four), fissure (three) and fistula (one). Analgesia was required not at all, up to 1–3 days, 4–7 days and >7 days by 30%, 31%, 16% and 14% of the patients, respectively. SHP/RAR was associated with greater discomfort (17%vs6%,P < 0.001). No differences were found between SHP and RAR. At an average follow‐up of 15 months, 96% of patients were asymptomatic and 95% were satisfied.

Conclusions DGHAL with the selective application of SHP/RAR is a safe and effective technique for advanced grade HR.
Myocutaneous flap reconstruction of the pelvis after abdominoperineal excision
Authors: Nisar P. J. , Scott H. J.
Published: November 2008

Objective  Perineal wound complications after abdominoperineal excision (APE) for anorectal cancer represent a considerable source of morbidity for patients. Strategies to improve wound healing include reconstruction with myocutaneous flaps. This is an evidence‐based review of reconstruction of pelvic defects after APE, using rectus abdominus (RAM), gracilis and gluteus maximus flaps.

Method  A Pubmed search was performed using MESH headings.

Results  Thirty‐six studies reported outcomes of interest. Five controlled studies reported improved outcomes after APE and chemoradiotherapy with RAM reconstruction and two controlled studies reported improved outcomes with gracilis reconstruction. There were seven patients with total flap loss after RAM reconstruction, in a combined 300 patients. There were eight patients with complete cutaneous necrosis after gracilis reconstruction in a combined 83 patients.

Conclusion  Data from the controlled studies support the use of myocutaneous flaps for single‐stage reconstruction after APE in the presence of chemoradiotherapy. Ultimately, the choice of flap depends on the goals of reconstruction, size of the defect and the availability of donor tissue. The implications of an expanding role for radiotherapy in the treatment of low rectal cancer and radical dissection to achieve negative circumferential margins, necessitate close co‐operation between colorectal and reconstructive surgeons to achieve APE with reduced wound morbidity.
Diagnosis of Clinically Occult Bladder Cancer by in vivo Staining with Methylene Blue
Authors: MUFTI G. R. , SHAH P. J. R. , PARKINSON M. C. , RIDDLE P. R.
Published: November 2008

Summary— In vivo staining of the bladder mucosa with 0.1% methylene blue in normal saline was performed on 23 randomly selected patients with known and previously treated transitional cell tumours of the bladder in whom routine check cystoscopy failed to demonstrate any mucosal abnormality. In 21 patients differential staining of the bladder mucosa resulted, with no mucosal staining in 2. Cold cup biopsies were obtained from stained as well as unstained areas. Although positive staining did not prove the presence of a pre‐malignant or malignant area, lack of staining was more likely to exclude mucosal abnormalities.
Prostatic Stenting for Outflow Obstruction
Authors: HARRISON N. W. , DE SOUZA J. V.
Published: November 2008

Summary— A series of 30 patients with outflow obstruction underwent treatment with prostatic stents. Most had retention of urine and were unfit for conventional surgery. The prostatic stent was readily inserted under local anaesthesia and successfully relieved obstruction in 80% of patients with acute retention. Minor problems were common but there were few major complications.
Malignant Lymphoma of the Lower Urinary Tract: A Clinicopathological Study with Review of the Literature
Authors: SIMPSON R. H. W. , BRIDGER J. E. , ANTHONY P. P. , JAMES K. A. , JURY I.
Published: November 2008

Summary— The clinical and histopathological findings are reported in 3 primary malignant lymphomas of the lower urinary tract. Two arose in the bladders of a 70‐year‐old man and a 67‐year‐old woman. The first was histologically low grade and the patient remains free of disease after more than 7 years. The second was an intermediate grade neoplasm and the patient died after 39 months. The third tumour was found in the urethra of a 76‐year‐old woman and it appears to represent only the third primary malignant lymphoma described at this site. The bladder is an uncommon primary site of extranodal lymphoma. Most patients present with haematuria and cystoscopy shows 1 or more solid, round, tumour‐like masses. Histological grade, particularly follicle formation, appears to have predictive value.
Urine Flow Rates in Male and Female Urodynamic Patients Compared with the Liverpool Nomograms
Authors: HAYLEN B. T. , PARYS B. T. , ANYAEGBUNAM W. I. , BY DEBORAH ASH , WEST C. R.
Published: November 2008

Summary— The Liverpool male and female nomograms provide normal reference ranges for the maximum and average urine flow rates over a wide range of voided volumes. A known urine flow rate, in combination with the respective voided volume (and in men the age), can be converted into an equivalent centile ranking, using the equation for the relevant nomogram. Centile rankings allow the urine flow rates of specific male and female populations to be compared.

The maximum and average urine flow rates of urodynamic patients (504 consecutive male and 168 consecutive female) were converted into centile rankings. These centile rankings were then compared with the respective urodynamic diagnoses.

The median centile rankings for their maximum and average urine flow rates were 21 and 11 (male) respectively and 31 and 18 (female) (vs 50 for the normal populations). The low urine flow rates applied to all diagnostic groups, including those symptomatic men and women who were found to be urodynamically normal. Low urine flow rates may be one of a number of subtle manifestations of urological disease in these patients.

Men with obstruction and women with voiding difficulties had the lowest urine flow rates. The 25th centile (men) and the 10th centile (women) appeared to be most appropriate lower limits of normality for both urine flow rates to identify those men more likely to be obstructed and those women at higher risk of voiding difficulties.

Men and women with detrusor instability had the highest urine flow rates. Detrusor instability was present in 71% of men with centile rankings for the maximum urine flow rate over 50; 50% of women whose maximum urine flow rate centiles were over 90 had detrusor instability.
Comparison of Primary Orchiectomy and Polyoestradiol Phosphate in the Treatment of Advanced Prostatic Cancer
Authors: HAAPIAINEN R. , RANNIKKO S. , ALFTHAN O.
Published: November 2008

Summary— The primary clinical efficacy of orchiectomy and polyoestradiol phosphate (PEP) 160 mg/month i.m. was evaluated by progression and cancer mortality rates in a Finnish multicentre study comprising 200 prostatic cancer patients. After the minimum follow‐up time of 2 years there was a significant difference between the groups–orchiectomy delayed progression of the disease more effectively. The follow‐up time is rather short for prostatic cancer, but on the basis of this preliminary study the dose of PEP seems to be insufficient in the treatment of advanced prostatic cancer.
Radiotherapy for Palliation of Locally Advanced Prostatic Carcinoma
Authors: KYNASTON H. G. , KEEN C. W. , MATTHEWS P. N.
Published: November 2008

Summary— Some patients present with distressing symptoms due to locally advanced prostatic carcinoma which may be refractory to hormonal manipulation and/or surgical treatment. Over an 8‐year period 26 patients received local palliative radiotherapy for recurrent bleeding and lower urinary outflow tract obstruction. All were treated with conventional external beam radiotherapy and all but 2 obtained useful palliation of symptoms, especially those with recurrent bleeding. We also found that radiotherapy could be given to the majority of patients on an out‐patient basis in 2 or 3 fractions. This was well tolerated and there were few side effects.
Haemodynamic Evidence for Per‐operative Cardiac Stress during Transurethral Prostatectomy
Authors: EVANS J. W. H. , SINGER M. , CHAPPLE C. R. , MACARTNEY N. , COPPINGER S. W. V. , MILROY E. J. G.
Published: November 2008

Summary— Haemodynamic changes were measured during routine transurethral prostatectomy (TU RP). The heart rate and stroke volume fell progressively over the first 30 min of surgery, resulting in a steady reduction in cardiac output. There was a significant increase in left ventricular afterload from commencement of the procedure. These findings demonstrate that haemodynamic responses, which are not detectable using conventional methods of monitoring, occur during TURP. Increased left ventricular afterload indicates increased myocardial work and oxygen demand which could result in myocardial ischaemia. This may contribute to the increased cardiovascular morbidity and mortality which have been reported to occur after TURP. The possible underlying mechanisms are discussed.
Urethral Pressure and Power Generation during Coughing and Voluntary Contraction of the Pelvic Floor in Healthy Females
Authors: LOSE G. , COLSTRUP H.
Published: November 2008

Summary— A probe which permits continuous measurement of the related values of pressure and cross‐sectional area in the female urethra was used to provide a quantitative description of the adjunctive occlusive forces in terms of pressure and power (mWatt) generation. Measurements were carried out at the bladder neck, midurethrally and distally in the urethra in 30 healthy women during coughing and squeezing.

Statistically significant variations were found in pressure and power generation between the 3 sites of measurement both during coughing and squeezing. Power generation and the pressure increase were significantly greater during coughing than during squeezing along the entire length of the urethra. The presence of a dynamic active closure mechanism was demonstrated at the bladder neck in addition to that located midurethrally. This bladder neck mechanism is thought to be due to the vagino‐levator sling system (the urethral supports).
Para‐urethral Collagen Implantation for Female Stress Incontinence
Authors: ECKFORD S. D. , ABRAMS P.
Published: November 2008

Summary— A series of 25 women with genuine stress incontinence were treated by para‐urethral injection of glutaraldehyde cross‐linked collagen. The technique was simple and associated with few complications. Follow‐up at 3 months revealed 20 patients (80%) to have been symptomatically improved or cured. An increase in urethral closure pressure together with a decrease in urine flow rate and increase in detrusor pressure was found post‐operatively. The success rate was significantly higher (90%) in patients who had undergone previous surgery for urinary incontinence when compared with those who had had no previous surgery (73%).
Experience with the Intraprostatic Spiral
Authors: VAN POPPEL H. , BAERT L. , ASWARIE H. , OYEN R.
Published: November 2008

Summary— Thirty‐six patients have been followed up after insertion of an indwelling intraurethral device for prostatic obstruction. Follow‐up exceeded 1 year in some cases. The main problem was dislocation of the spiral not only in the early stages but also after several months. Endoscopic assessment of the obstruction seems important during the pre‐operative investigations. The ideal indication is prostatic obstruction in patients who are unsuitable for surgery and who need relief of acute retention for a limited time only. In selected patients the prostatic spiral has a place in the treatment of obstructive prostatism.
Validation of a Non‐invasive Radioisotope Method of Imaging Ureteric Urine Transport
Authors: WEMYSS‐HOLDEN G. D. , HOSKER G. L. , ROSE MARJORIE R. , PAYNE S. R. , TESTA H. J.
Published: November 2008

Summary— Measurement of ureteric function has hitherto involved the use of invasive techniques. A non‐invasive, radioisotope method of imaging and displaying individual ureteric boluses has been described, a refinement of which is used in this department. Each “spindle” displayed using this technique theoretically represents an individual ureteric bolus of urine, but the technique has never been validated in the normal ureter in either the experimental model or man.

A porcine model was set up to allow simultaneous measurement of ureteric bolus transmission using the radioisotope (compressed image) method and by the accepted techniques of electromyography (EMG) and urine drop counting. The timing of each urinary bolus, as recorded by the different modalities, was then compared.

The results from 11 studies showed a significant correlation between the radioisotope and EMG methods (mean r= 1.00, P=0.0003). There was a constant relationship between the part of the radioisotopic image representing the rear end of the bolus and the EMG complex (mean time difference = 5.32 ± 1.067s), thus defining that part of the image representing the peristaltic contraction wave. There was a variable relationship between the EMG and the part of the image representing the leading edge of the bolus (mean time difference = 13.36 ± 5.23s), emphasising that bolus length is variable, being dependent on bolus volume.

The radioisotope “spindle” concurs with EMG activity in the porcine ureter. The compressed image technique is thus validated as a non‐invasive method of demonstrating ureteric urine transport.
Non‐invasive Investigation of Normal Individual Ureteric Activity in Man
Authors: WEMYSS‐HOLDEN G. D. , ROSE MARJORIE R. , PAYNE S. R. , TESTA H. J.
Published: November 2008

Summary— This study was designed to investigate non‐invasively human ureteric function between individuals and with increasing diuresis, using the radioisotope compressed image technique.

Five normal males underwent fast frame renography with ureteric spindle imaging in dehydrated and hydrated states, urine production being measured in each individual for each scan.

Urine flow rates and renographic parameters demonstrated that each ureter carried more urine in the hydrated state. The velocity at which individual boluses passed down the ureter was constant for each ureter and did not change with diuresis.

The ureteric peristaltic rate showed wide individual variation between ureters in the same subject, but fell within what is becoming accepted as the “normal range” of < 4 urine boluses per minute.

Some ureters accommodated an increase in urine flow by an increased peristaltic frequency, some showed no change and others showed a decreased frequency. In those ureters in which there was no change, or a decrease in perstaltic frequency with diuresis, the increased urine flow must have been handled by increases in bolus volume. Thus increases in ureteric urine flow in man are accommodated by changes in both peristaltic frequency and bolus size.

The results are discussed in relation to previous studies which used invasive techniques.
Intra‐operative Myocardial Ischaemia detected by Biplane Transoesophageal Echocardiography during Transurethral Prostatectomy
Authors: HEYNS C. F. , RITTOO D. , SUTHERLAND G. R. , DAVIE I. T. , SCOTT N. B. , CHISHOLM G. D.
Published: November 2008

Summary— Recent studies have shown an increased late mortality rate due to cardiovascular causes after transurethral compared with open prostatectomy. This has been linked to the demonstration of haemodynamic changes during transurethral prostatectomy, which may cause ischaemic myocardial injury. We used transoesophageal echocardiography (currently the most sensitive modality for detecting myocardial ischaemia) to study 26 patients during prostatectomy under general anaesthesia. Evidence of myocardial ischaemia (as shown by the development of new regional wall motion abnormalities of the left ventricle) occurred in 4 of 22 patients during transurethral and in 3 of 4 patients during retropubic prostatectomy. An intra‐operative fall in systolic as well as diastolic blood pressure occurred in 21 of 22 patients during the transurethral procedure and in all 4 patients during retropubic prostatectomy. The duration of anaesthesia and the operation, and the intra‐operative blood loss did not differ significantly between patients with and without evidence of intra‐operative myocardial ischaemia. However, the maximum intra‐operative fall in systolic and diastolic blood pressure, as well as the mass of the prostatic tissue removed, were significantly greater in patients with than in those without evidence of intra‐operative myocardial ischaemia, suggesting that the latter may be related to the extent of surgery and the degree of intraoperative hypotension. In this study, 7 of 26 patients (27%) showed evidence of myocardial ischaemia during prostatectomy. However, it remains difficult to explain why intra‐operative myocardial ischaemia should result in an increased cardiovascular mortality rate several years after the operation.
Effects of Neurogenic Bladder Dysfunction in utero seen in Neonates with Myelodysplasia
Authors: KOPP C. , GREENFIELD S. P.
Published: November 2008

Summary— Twenty neonates with myelodysplasia were prospectively evaluated during the first month of life with urodynamic studies, contrast voiding cystourethrograms (VCUG) and renal ultrasound scans. Ten of 20 infants had abnormal VCUGs—6 with vesicoureteric reflux (VUR) and 4 with bladder trabeculation alone. Only 2/20 neonates had abnormal ultrasounds—both with hydroureteronephrosis secondary to VUR. Elevated leak point pressure (LPP) and/or detrusor sphincter dyssynergia (DSD) were present in 10/20 infants—6 with elevated LPP and DSD, 3 with elevated LPP alone and 1 with DSD alone. Eight of 10 neonates with DSD or elevated LPP had abnormal VCUGs—4 with VUR and 4 with bladder trabeculation alone. Conversely, 8/10 neonates without DSD or elevated LPP had normal VCUGs. Contrast VCUG performed shortly after birth, therefore, is essential for the discovery of bladder trabeculation and reflux. There is a strong correlation between an abnormal VCUG and the presence of DSD and elevated LPP, suggesting that neurogenic bladder dysfunction in utero can lead to these structural abnormalities.
In vitro analysis of Urinary Calculi: Type Differentiation using Computed Tomography and Bone Densitometry
Authors: HERREMANS D. , VANDEURSEN H. , PITTOMVILS G. , BOVING R. , OYEN R. , GEUSENS P. , BAERT L.
Published: November 2008

Summary Thirty‐six urinary stones were studied by computed tomography and bone densitometry in order to find a correlation between the chemical composition of the stones and the densitometric data.

In vitro, the more common cases of lithiasis can be divided into 3 main groups: uric acid, cystine and the calcium salts, e.g. calcium oxalate monohydrate, calcium oxalate dihydrate and calcium phosphate. Struvite stones fall between the second and third groups. Computed tomography and bone densitometry can differentiate between the groups, provided that the value of the “stone mineral or calcium content” is correlated with the true calculated volume of the stone (resulting in the specific stone density) instead of the projection area (resulting in the area density). This is only possible in vitro. The in vivo application of these technologies in the treatment of stones of unknown composition could provide important information, but major restrictive factors pose difficulties. Further clinical studies are necessary, especially to define the role of bone densitometry.
Ultrastructural Features of Penile Tissue in Impotent Men
Authors: LIU LI‐CHANG , HUANG CHUN‐HSIUNG , HUANG YEONG‐LEI , CHIANG CHIN‐PEI , CHOU YII‐HER , LIU LO‐HUI , SHIEH SHENG‐RENN , LU PO‐SHING
Published: November 2008

Summary Penile erection is related to the integrity of penile tissue. In order to study the ultrastructural histopathological changes in penile erectile tissue in impotent men, biopsies were taken from 29 impotent and 5 normal patients during surgical treatment.

Light microscopy revealed insignificant histological changes and various degrees of fibrotic change in the corpora cavernosa of impotent men, and electron microscopy revealed severe myopathic, fibrotic changes in the penile tissue.

These non‐specific changes could not be used to determine the aetiology of impotence, and the relationship between the ultrastructural apperances, the causes of impotence and the results of treatment was unclear. Further studies are required to establish the value of intracorporeal biopsy in selecting treatment for impotent patients.
Urodynamic and Clinical Aspects of Ileal Low Pressure Bladder Substitutes
Authors: CASANOVA G. A. , SPRINGER J. P. , GERBER E. , STUDER U. E.
Published: November 2008

Summary Twenty‐three patients with an ileal bladder substitute formed after cystectomy for invasive bladder cancer were evaluated clinically and urodynamically between 3 and 38 months post‐operatively. The urodynamic measurements were compared with the clinical findings. After reeducation of the patients' voiding habits the mean voiding volumes of the bladder substitutes stabilised 6–9 months post‐operatively at 350 ml. The frequency of micturition was 3 to 5 times during the day and once or twice at night. The maximum functional capacity (maximum voiding volume) was about 490 ml. Ninety‐one per cent of the patients were continent during the day 18 months after the operation and 82% were continent during the night. Micturition was problem‐free with an average maximum flow of 25 ml/s and an average micturition time of 50 s.

The mean voiding volume of ileal bladder substitutes was 50% of the measured cystometric capacity; the maximum functional capacity (= max. micturition volume) was 80% of the cystometric capacity. The average basal pressure was <20 cm H2O from the third post‐operative month onwards. Eleven of the 23 patients had contractions in the bladder substitute (average at 30 cm H2O) at 55–76% of the maximum cystometric capacity or at approximately 90% of the maximum functional capacity. Such spike waves had no clinical or radiological consequences.

If the patients were shown how to increase the functional capacity of a reservoir made from only 40 cm of ileum, the clinical results were excellent.
Transitional Cell Carcinoma of the Bladder in Young Adults
Authors: KUTARSKI P. W. , PADWELL A.
Published: November 2008

Summary A retrospective survey of young servicemen presenting with transitional cell carcinoma of the bladder aged 40 years or below is presented, 19 such patients having been identifed over a 20‐year period. The results were compared with those of other similar series. The tumour behaviour appears to vary with age at presentation, its propensity for multifocal presentation, recurrence, progression to invasion and mortality all rising over the first 4 decades of life. These trends appear to be linked to grade and stage at presentation, and also tend to rise with age rather than altered tumour behaviour. The follow‐up of young adults should thus be the same as for older patients presenting with the same grade and stage tumours.
Comparison of Laparoscopic and Open Ligation of the Testicular Vein
Authors: LYNCH W. J. , BADENOCH D. F. , McANENA O. J.
Published: November 2008

Summary Scrotal varicoceles undoubtedly contribute to subfertility in an as yet undefined group of patients. The best method of treatment of varicoceles, however, remains controversial. Laparoscopic testicular vein ligation has recently been offered as a new option.

We examined the feasibility of laparoscopic testicular vein ligation (n = 11) compared with standard high ligation (n = 11). The mean post‐operative stay in the open group was 25.6 h compared with 7.1 h in the laparoscopic group. Analgesic requirements were a mean of 4.73 Co‐proxamol tablets for the open group and 0.18 tablets for the laparoscopic group. All operations were successful. Laparoscopic ligation of the testicular vein is an effective treatment of varicocele with decreased post‐operative morbidity.
Posterior Urethral Valves. Does Prenatal Diagnosis Influence Prognosis?
Authors: JEE L. D. , RICKWOOD A. M. K. , TURNOCK R. R.
Published: November 2008

Summary Forty‐eight boys with posterior urethral valves were reviewed to assess the impact on prognosis of prenatal ultrasonography, which had been the method of diagnosis in 17 of them; the remaining 31 presented postnatally. Renal function before treatment was mildly to moderately impaired in 59% of those presenting prenatally, 42% presenting before 3 months of age and 25% of those first presenting when older than 3 months. All but one of the infants diagnosed prenatally had clinical signs and/or elevated serum creatinine in the early neonatal period. Eight had associated maternal oligohydramnios, of whom 6 presented prenatally and 2 postnatally: this factor was associated with a poor prognosis, with renal impairment persisting in 6 of these patients after treatment. Renal function did not relate consistently to the presence or otherwise of vesicoureteric reflux (unilateral or bilateral).

Twelve of the patients who presented postnatally had normal fetal ultrasonography late in pregnancy, of whom 11 had upper tract dilatation when investigated. Six of these patients who currently have impaired renal function did not have maternal oligohydramnios, and it is argued that antenatal detection of the condition would have been beneficial in less than 20% of patients presenting postnatally with posterior urethral valves.
Patterns of Bone Metastasis and their Prognostic Significance in Patients with Carcinoma of the Prostate
Authors: RANA A. , CHISHOLM G. D. , KHAN M. , SEKHARJIT S. S. , MERRICK M. V. , ELTON R. A.
Published: November 2008

Summary The different patterns of bone metastasis, metastatic load and their prognostic significance were examined in a consecutive series of 169 men with prostatic cancer and bone metastasis at presentation. Patients with an isolated metastasis in the pelvis or dorsal vertebrae had a better prognosis than those whose metastases were either diffuse or involved more distal sites such as the skull or the sternum, although all of these patients were classified as having M1 disease. Bone metastasis involving an area equivalent to 1 vertebral body equalled a metastatic load of 2. Based on their total metastatic load, 3 prognostic groups were identified with significant differences in case‐specific survival despite receiving the same hormonal treatment. When comparing the potential efficacy of various treatments one must stratify the metastatic load, which is a powerful prognostic indicator of the outcome in patients with metastatic carcinoma of the prostate.
Renal parenchyma‐sparing surgery as conservative treatment of renal cell carcinoma*
Authors: CIANCIO G. , POLITANO V.A. , FERRELL S. , BLOCK N.L.
Published: November 2008

Objective To evaluate the role of parenchyma‐sparing surgery in patients with renal cell carcinoma (RCC).

Patients and methods Between 1965 and 1990, 34 patients with RCC underwent renal parenchyma‐sparing surgery. There were 22 men and 12 women with a mean age of 62 years (range 40–89). Ten patients underwent enucleation (Group A), 15 partial nephrectomy (Group B), and nine a combination of procedures (Group C). Conservative surgery was performed in the presence of a normal contralateral unit in four patients (12%).

Results Five patients developed local recurrence. Metastases appeared in six patients (18%) from 12 to 58 months post‐operatively. Adequate renal function was obtained in 32 of the 34 patients. The mean follow‐up for all patients was 64.6 months overall, 75.6 months for group A, 64.1 months for group B and 53.4 months for group C. The 3 and 5 year probabilities of survival for all patients were 77.8% and 69.5% respectively. The probabilities of 3 and 5 year survival were 80% for group A, 80% for group B and 71.4% and 57.1% for group C.

Conclusion Enucleation and partial nephrectomy are both viable options in the management of solitary or bilateral RCC, as there is no decline in effective tumour control and prognosis. Larger groups and longer follow‐ups are needed to assess the role of renal parenchyma‐sparing surgery more definitively.
Immunological parameters in peripheral blood of patients with renal cell carcinoma before and after nephrectomy
Authors: DADIAN G. , RICHES P. G. , HENDERSON D. C. , TAYLOR A. , MOORE J. , ATKINSON H. , GORE M.E.
Published: November 2008

Objective To determine the effects of nephrectomy on the immune response of patients with renal cell carcinoma (RCC).

Patients and methods Five patients with RCC were monitored before and over a period of up to 3 months after nephrectomy. The aspects measured were the phenotypic expression of markers on circulating lymphocytes, circulating concentrations of cytokines, markers of inflammatory and immune responses, and natural killer (NK) cell and lymphokine‐activated killer (LAK) cell activity in peripheral blood mononuclear cells (PBMC). The suppressive activity of patients' plasma on NK activity and ability to generate interleukin‐2 (IL‐2) induced LAK cells in PBMC of normal volunteers was also investigated.

Results The results indicated that high CD4/8 ratios were present pre‐nephrectomy with evidence of inflammatory responses and immune activation in some patients, particularly those with metastatic disease.

Conclusion The effect of nephrectomy was to decrease the inflammatory response and increase immune activation. Various defects in NK cell activity and LAK cell generation were demonstrated pre‐surgery which slowly improved once the primary tumour had been removed and it is suggested that such defects could have contributed to tumour growth and development due to an ineffective immune response.
The clinical application of dorsal penile nerve cerebral‐evoked response recording in the investigation of impotence
Authors: PICKARD R.S. , POWELL P. H. , SCHOFIELD I.S.
Published: November 2008

To determine whether recording of penile cerberal‐evoked response (CER) is useful in the assessment of men with impotence.

Patients and mehtods A total of 280 impotent men underwent CER recording as part of an assessment for a complaint of importance. They were categorized from findings in the history and examination as having non‐neurogenic impotence (n=106), impotence related to existing neurological disturbance (n = 67), type I diabetes (n = 49) or type II diabetes (n = 58). Increased period of latency or absence of first positive peak (P1) on CER were used as the criteria for an abnormal response with reference to an age‐matched control group of potent men (n = 34).

Results Overall, impotent men with diabetes or a history of neurological disturbance had significantly longer P1 latencies and lower response amplitudes compared with the control group. In contrast the CER recorded from men with non‐neurogenic impotence was similar to the control group. Individual results showed an increased period of latency or absence of P1 in 100 (36%) impotent men, 72 (72%) of whom were diabetic or had a history of neurological dysfunction. CER abnormalities were associated with neurological signs on physical or cystometrographic examination in 40 (40%) individuals.

Conclusion Although technically satisfactory, the clinical usefulness of CER recording is limited by the poor discriminatory value of response latencies. Most abnormal results could be predicted by the presence of diabetes or pre‐existing neurological dysfunction, or by evidence of neurological deficit on physical examination. The test is not therefore suitable for routine clinical assessment of impotence but may be worthwhile if objective evidence of penile sensory dysfunction is required.
Experience with the second generation Urolume prostatic stent
Authors: Bajoria S. , Agarwal S.A. , White R. , Zafar F. , Williams G.
Published: November 2008

Objective To assess the efficacy of the new, second generation UroLume (American Medical Systems) prostatic stent.

Patients and methods Forty‐seven men with symptomatic and objective evidence of bladder outflow obstruction who were fit for a transurethral resection accepted, as an alternative, the insertion of a new prostatic stent which shortens less than its predecessor.

Results It was possible to insert the stent into 44 of the 47 men. All patients voided spontaneously following stent insertion. Thirty‐three patients had their stent inserted either as a day case or with an overnight stay. Six patients were lost to follow‐up and two died. Of the remaining 36 patients 22 have now been followed for 2 years, with a mean obstructive score of 1.6 (range 0–12), a mean irritative score of 2.5 (range 0–10) and a mean peak flow of 16.8 mL/s (range 3–31). Fourteen stents had to be removed; in the majority of cases this was because of stent migration or the development of epithelial hyperplasia within the lumen of the stent.

Conclusion Because of the development of epithelial hyperplasia and stent migration in approximately one‐third of men in this study, a third generation stent has now been developed. Before permanently implanted stents can be recommended for widespread use, the efficacy of new stents should be assessed in specialist units with large numbers of patients and adequate facilities for follow‐up.