bluuebunny/crossref_metadata_2025 huggingface dataset:
Blepharophimosis: a recommendation for early surgery in patients with severe ptosis
Authors: Beckingsale Peter S , Sullivan Timothy J , Wong Vincent A , Oley Christine
Published: December 2004

Purpose: To determine the optimal age for surgical correction of blepharophimosis. Associated features and their effects on incidence of amblyopia were also investigated.

Methods: The study was a retrospective case series of 28 patients with blepharophimosis, ptosis and epicanthus inversus syndrome presenting to a tertiary referral eyelid, lacrimal and orbital clinic.

Results: Amblyopia was present in 39% of patients. Patients with coexistent strabismus had a 64% incidence of amblyopia compared to 24% for those without strabismus. Hypermetropia was present in 43% of patients and 7% were myopic. Significant astigmatism was found in 40% of patients, but these factors did not increase the risk of amblyopia. Patients with severe ptosis had lower rates of amblyopia than those with moderate ptosis but had their ptosis corrected at a median age of 2 years compared to 5 years for those with moderate ptosis. There was an 18% incidence of nasolacrimal drainage problems. A good to excellent cosmetic outcome was achieved in 86% of patients. A positive family history was noted in 75% of patients, usually with paternal inheritance.

Conclusions: Patients with blepharophimosis have a high rate of amblyopia. Co‐existent strabismus doubles the risk of amblyopia. Ptosis alone causes mild to moderate amblyopia only. Patients with severe ptosis should have their ptosis corrected before 3 years of age, and all other patients should undergo surgery before 5 years of age.
Confocal imaging of the human keratocyte network using the vital dye 5‐chloromethylfluorescein diacetate
Authors: Poole C Anthony , Brookes Nigel H , Clover Gillian M
Published: December 2004

Background: The human corneal stroma consists of intercalated layers of collagen and keratocytes. These cells are known to maintain the stroma and aid in repair but it is likely they have other crucial roles throughout the cornea. The complexity of their anatomy is revealed in this study by ex vivo in situ images of the human keratocyte covering a range of ages.

Methods: Human donor corneas of different ages were stained with 5‐chloromethylfluorescein diacetate (CMFDA), a dye that is anchored and retained within the cell cytoplasm. The tissue was fixed, sectioned, mounted, and then imaged using a confocal laser scanning microscope at various magnifications and tissue planes. The digital image sets were transferred to multifunction image processing software for analysis and production of 3‐D stereo images of keratocyte networks throughout the stroma.

Results: High quality images of CMFDA‐stained cells revealed differences in the structure and orientation of keratocytes in the anterior, central and posterior stroma, which did not differ throughout the age‐range studied. This method reveals very fine cell process ramifications not previously visualized, orientated in lateral and antero­posterior directions, and it confirms the potential for multidirectional communication between keratocyte networks.

Conclusions: This qualitative study found consistency of keratocyte morphology in the normal human cornea throughout life. It confirmed differences in keratocyte anatomy, and the potential for rapid cellular communication by multiple interconnecting processes supporting cohesive keratocyte activity. This high‐resolution 3‐D microscopic study should assist in identifying gross deviant cellular behaviour in post‐surgical and disease states.
Five‐year follow‐up study after Helicobacter pylori eradication: Reinfection and peptic ulcer status
Authors: ZHOU Li Ya , LIN San Ren , SHEN Zu Yao , ZHONG Shang Zhi , DING Shi Gang , HUANG Xue Biao , WANG Li Xin , XIA Zhi Wei , JIN Zhu , CAO Shi Zhi
Published: December 2004

OBJECTIVE:  To investigate the prevalence of peptic ulcers and Helicobactor pylori reinfection 5 years after H. pylori eradication.

METHODS:  One thousand and six adults were randomly sampled from the general population in a high‐incidence region of gastric cancer. Of these, 552 subjects were confirmed to be H. pylori‐positive by using both the rapid urease test and the Warthin−Starry stain. All H. pylori‐positive subjects were randomly divided into two groups: (i) the eradication group, who received 1 week of omeprazole‐based triple therapy; and (ii) the control group, who received placebo tablets. Four weeks after the cessation of treatment, 13C‐urea breath tests demonstrated that H. pylori had been successfully eradicated in 88.9% of patients in the eradication group, whereas 96.4% of patients remained H. pylori positive in the control group. Subjects in both groups were followed up using endoscopy at the end of the first and fifth year after treatment. The H. pylori infection status was determined by using the rapid urease test and Warthin−Starry staining.

RESULTS:  The response rates to endoscopy at the end of the first and fifth year were 89.3 and 83.11%, respectively. The prevalence of peptic ulcers in the eradication group and control group were 9.87 and 7.61% before treatment, 3.70 and 12.58% 1 year after treatment (P < 0.05), and 5.86 and 14.93% 5 years after treatment (P < 0.05), respectively. The recurrence rates of peptic ulcers in the eradication group and the control group were 3.70 and 38.10% 1 year after treatment, and 14.81 and 42.86% 5 years after treatment, respectively. The rates of H. pylori infection 1 and 5 years after treatment in the eradication group were 13.58, and 19.82%, respectively. In the control group, the rates of H. pylori infection were 91.97 and 83.26% 1 and 5 years after treatment, respectively.

CONCLUSIONS:  The prevalence of peptic ulcers decreased significantly after the eradication of H. pylori. The reinfection rate after H. pylori eradication was 4−5% per year. Helicobacter pylori infection status remained constant in almost 85% of cases.
Management of severe acute pancreatitis: The Peking Union Medical College Hospital experience from 1984 to 2001
Authors: DENG Rui Xue , LU Xing Hua , LIU Da Wei , ZHONG Shou Xian , ZHAO Yu Pei
Published: December 2004

OBJECTIVE:  To discuss recent advances in diagnostic techniques for severe acute pancreatitis. To discuss recent changes in the treatment of severe acute pan­creatitis, and to evaluate their effects.

METHODS:  Sixty‐two patients who were admitted to Peking Union Medical College Hospital with severe acute pancreatitis between April 1984 and June 2001 were reviewed.

RESULTS:  From 1984 to 1993, the main treatment was early surgical débridement, and the mortality rate was 38.5% (15/39). Since 1994 computed tomo‐graphy has been used as a diagnostic tool, and treatment has shifted to aggressive intensive medical care, with specific criteria for operative and non‐operative interventions. The mortality rate during this period was 17.4% (4/23).

CONCLUSIONS:  The prognosis of patients with severe acute pancreatitis has improved greatly because of advances in diagnosis and treatment. Computed tomography is an important and effective non‐invasive diagnostic technique.
Iron‐deficiency anaemia and delay in the diagnosis of colorectal cancer
Authors: Acher P. L. , Al‐Mishlab T. , Rahman M. , Bates T.
Published: December 2004

Aims  Iron‐deficiency anaemia (IDA) is a recognized complication of colorectal cancer (CRC) especially with right‐sided tumours, and failure to investigate the anaemia in older patients may lead to a delay in diagnosis. The aims of this study were to establish the proportion of patients with CRC shown to have an IDA for more than six months before diagnosis and to establish the proportion of patients with IDA who subsequently prove to have CRC.

Methods  All patients presenting with confirmed CRC in a health district (catchment population 280000) in the 4 years 1996–9 were identified from the pathology database after ethical approval. The criteria for IDA were haemoglobin (Hb) < 10.1 g/dl plus mean corpuscular volume < 78 fl and/or mean corpuscular Hb concentration < 32 g/dl.

The haematology data‐base serving the same population was searched for evidence of: 1. IDA at diagnosis of CRC; 2. IDA more than 6 months and more than one year before the diagnosis of CRC; 3. The number of haematology referrals per annum in women over 55 and men over 50 years of age meeting the criteria for IDA.

Results  Of 440 patients with colorectal cancer, 166 (38%) had IDA at diagnosis and of the latter 54 (12%) were known to have IDA for more than six months before diagnosis and 26 (6%) had IDA more than one year before diagnosis. IDA was more common in right sided tumours (65%) than in those arising in the left side of the colon and rectum (26%). The annual incidence of IDA in the sampled population was 1366 in the stated age group.

Conclusion  The investigation of iron‐deficiency anaemia in older patients is important but in order to detect 26 patients with colorectal cancer a year earlier, the investigation of approximately 5000 patients would be required – a detection rate of less than 1%.
Local excision of rectal carcinoma not‐exceeding the muscularis layer
Authors: Kosciñski T. , Malinger S. , Drews M.
Published: December 2004

Aim  The aim of the study was to compare the results of treatment by local excision of two different clinical stages of the rectal cancer.

Material and methods  Fifty‐eight patients with early rectal carcinoma were operated on during the last 26 years using different methods of local exscision. The carcinomas were initially assessed as not‐exceeding the muscularis layer of the rectal wall. The tumours, localized up to 12 cm from the anal margin, were removed by means of ‘parachute’ excision (47 patients). In 6 patients, carcinoma localized in the central part of rectum, was excised by means of the Localio method. Transanal endoscopic microsurgery was applied in 5 cases of carcinoma localized on the depth of 5–20 cm from the anal margin.

Results  After local excision the patients were divided into two groups: I, tumours of low degree of malignancy, not exceeding submucosal layer (26 patients); II, tumours of low or median degree of malignancy with infiltration of muscularis layer (32 patients). There was a significant difference in cancer relapses between groups I and II. One patient in group I and 9 in group II developed local recurrences (P < 0.05) and 5 patients in group II had neoplastic dissemination (15.6%).

Conclusions  Best results were obtained in patients with carcinoma not exceeding submucosal membrane. In cases of rectal muscular layer infiltrations, the risk of carcinoma relapses was markedly higher. The use of transanal endoscopic microsurgery has permited removal of tumours from the upper rectum.
Colorectal transport in normal defaecation
Authors: Krogh K. , Olsen N. , Christensen P. , Madsen J. L. , Laurberg S.
Published: December 2004

Objective  Colorectal luminal transport during defaecation can be assessed by means of scintigraphy. However, normal values remain to be established and inter‐ and intra‐subjective variation is unknown. The aim of the study was to describe colorectal transport during normal defaecation by means of a new method for colorectal scintigraphy and to determine inter‐ and intrasubjective variation.

Methods  Thirty healthy volunteers (18 men and 12 women, age 22–46 years; median 31) took 2 MBq 111In on two consecutive days (days 0 and 1). On days 1 and 2 an abdominal scintigraphy was done before and after defaecation. Changes in colorectal contents were computed in two ways: firstly, assuming ordered evacuation, the extent of colorectal emptying was computed; secondly, antegrade and retrograde transport within the colorectum was computed for each colorectal segment.

Results  Median colorectal emptying during normal defaecation was 99% of the rectosigmoid (range: 60% of the rectosigmoid to complete emptying of the rectosigmoid, descending colon, transverse colon and 19% of the caecum/ascending colon). There was no difference between men (median 99% of the rectosigmoid) and women (98% of the rectosigmoid). Day to day variation was large (dispersion = 52%) with a trend towards larger defaecation on day 2 than on day 1 (P = 0.09). Large antegrade and retrograde movements of colorectal contents were observed within the colorectum during defaecation. Antegrade transport involved the rectosigmoid (median 99%), the descending colon (median 53%), the transverse colon (median 46%), and the caecum/ascending colon (median 11%). Retrograde transport was mainly from the transverse colon and the descending colon. Colorectal emptying was significantly correlated to the subjective description (P < 0.01) but not to total gastrointestinal or segmental colorectal transit times determined by means of radioopaque markers.

Conclusions  Colorectal scintigraphy before and after defaecation provides detailed information about colorectal emptying and intracolonic antegrade or retrograde transport during defaecation. Inter‐ and intraindividual variations are large and antegrade and retrograde transport within the colorectum is common.
Effects of intraperitoneal 4% icodextrin solution on the healing of bowel anastomoses and laparotomy incisions in rabbits
Authors: Rodgers K. E. , Verco S. J. S. , DiZerega G. S.
Published: December 2004

Objective  Peri‐operative lavage and postoperative instillation of a 4% icodextrin solution reduces de novo formation and reformation of peritoneal adhesions following abdominal surgery. This experimental study evaluated the effects of 4% icodextrin treatment on the healing of bowel anastomoses and laparotomy incisions.

Materials and methods  Female New Zealand White rabbits (weight 2.21–2.77 kg) were randomised by ascending weight to one of 3 surgical treatments, each with 2 termination points (6 groups of 8 animals). The treatments were anastomotic bowel surgery alone or with lavage and postoperative instillation of either 4% icodextrin solution or Lactated Ringer's Solution (LRS). The solutions were coded A and B by the supplier, so that the study personnel were blinded to their identity. After the abdomen was opened, 30 ml of solution A or B was instilled and removed by aspiration prior to surgery. The ascending colon was then transected 5 cm aboral to the ileocaecal junction and the ends anastomosed. During surgery, 5 ml of the solution was applied 4 times at the surgical site, and a further 30 ml was administered and aspirated as a postoperative lavage. Just prior to closure of the abdominal wall, 50 ml of the solution was administered as a postoperative instillate. Duplicate treatment groups were terminated 7 and 21 days after surgery and the anastomotic sites inspected for adhesion and/or abscess formation. In 6 animals per group, an 8–12 cm length of colon including the anastomotic site was removed for measurement of bursting pressure, and a section of the abdominal wall including the incision line was tested for breaking strength. The other 2 animals per group provided tissue for histological analysis of wound healing at the bowel and incision sites.

Results  There was no significant difference between the 3 treatment groups for any parameter (P > 0.05). Compared with the surgical control at either day 7 or 21 after surgery, the administration of solutions A or B did not affect the formation of abscesses or adhesions, the bursting strength of the bowel, or the tear strength of the abdominal wall incision. Histological assessment of the quality of wound healing showed no differences between treatment groups in inflammatory cell infiltration, fibroblast density, blood vessel formation or collagen maturity.

Conclusions  The use of a 4% icodextrin solution for peri‐operative lavage and postoperative instillation in a rabbit model of bowel anastomotic healing did not result in any difference from either LRS treated or untreated surgical controls.
Short‐term pre‐operative smoking cessation intervention does not affect postoperative complications in colorectal surgery: a randomized clinical trial
Authors: Sørensen Lars Tue , Jørgensen Torben
Published: December 2004

Background  Smokers have a higher risk of complicated tissue and wound healing after surgery than nonsmokers. We tested the hypothesis that short‐term pre‐operative cessation of smoking in colorectal surgery decreases the incidence of postoperative tissue and wound complications.

Methods  From February 1998 to March 2001, 60 patients, who smoked daily, undergoing colorectal resection were randomly assigned 2–3 weeks before scheduled surgery to either abstinence from smoking, counselling and nicotine replacement therapy or maintenance of daily smoking habits. Postoperative tissue and wound complications necessitating surgical or medical treatment were evaluated at discharge and 30 days after surgery by blinded outcome assessment.

Results  In the pre‐operative period of 15 days (8–24) (median, interquartile range (IQR)), 89% of the patients in the intervention group vs. 13% in the control group abstained from smoking or reduced by more than half (P < 0.05). In the postoperative period of 11 days (10–13), the corresponding figures were 92% and 50%, respectively (P < 0.05). Postoperative tissue and wound complications occurred in 33% (9 of 27) of the patients in the intervention group compared to 27% (8 of 30) in the control group (NS). Likewise, no difference in overall postoperative complication rate was found between the groups.

Conclusion  Short‐term cessation of smoking does not reduce the risk of complicated tissue and wound healing or other complications in colorectal surgery.
Angiogenesis in anal warts, anal intraepithelial neoplasia and anal squamous cell carcinoma
Authors: Mullerat J. , Wong Te Fong L. F. , Davies S. E. , Winslet M. C. , Perrett C. W.
Published: December 2004

Introduction  Most cases of anal carcinoma seem to develop from high grade anal intraepithelial neoplasia (AIN) caused by persistent anal warts. Similar pre‐invasive epithelial genital lesions (e.g. those of the cervix and vulva) have been shown to be associated with increased angiogenesis. In this study we examined biopsies of anal lesions ranging from warts to invasive anal carcinoma, with the aim of assessing the degree of angiogenesis in pre‐invasive anal lesions.

Method  Samples from 70 patients (51 male) who had undergone excision biopsy or resection of anal wart lesions (20), low grade AIN (12), high grade AIN (27) and anal squamous cell carcinoma (SCC) (11) were studied. Samples (6) from normal HIV‐anal skin were used as controls. The samples were stained for von Willebrand factor, a specific marker of endothelial cells. Angiogenesis was measured by microvessel density (MVD) analysis, quantifying the microvessels in the stroma adjacent to the epithelial lesion.

Results  There was a statistically significant (P < 0.001) progressive increase in MVD between low grade AIN, high grade AIN and anal SCC. The difference in MVD between normal skin, warts and low grade AIN was not statistically significant.

Conclusion  There are progressive abnormal patterns of angiogenesis in highly dysplastic lesions, similar to those found in cervical and vulvar pathology. These findings may have biological, prognostic and therapeutic implications.
Chronic idiopathic slow transit constipation: pathophysiology and management
Authors: El‐Salhy M.
Published: December 2004

Objective  Patients with idiopathic slow‐transit constipation comprise a small proportion of the total population complaining of constipation. The purpose of this review is to present an update of pathophysiology of this disorder and its application in clinical management.

Methods  Medline was used to search English language articles published up to the end of September 2002 on the subject of slow‐transit constipation.

Results and conclusions  Patients with idiopathic slow‐transit constipation can be divided into 2 subgroups: 1. patients with normal proximal gastrointestinal motility and with onset of constipation in connection with childbirth or pelvic surgery. This subgroup may benefit from consideration of surgical treatment; 2. patients who have a dysfunctional enteric nervous/neuroendocrine system and exhibit colonic dysmotility as part of a generalised gastrointestinal dysmotility. Surgical approach in this subgroup seems to be unhelpful and medical treatment appears to be a better approach.
Health‐related quality of life after radical cystectomy for bladder cancer: a comparison of ileal conduit and orthotopic bladder replacement
Authors: Hara I. , Miyake H. , Hara S. , Gotoh A. , Nakamura I. , Okada H. , Arakawa S. , Kamidono S.
Published: December 2004

Objective To compare the health‐related quality of life (HRQoL) after radical cystectomy in patients with an ileal conduit or an orthotopic neobladder.

Patients and methods The study included 85 men who underwent radical cystectomy for bladder cancer, comprising 48 with an orthotopic neobladder (26 with an ileal and 22 with a colon neobladder) and 37 with an ileal conduit. HRQoL was evaluated using the Short Form‐36 survey containing 36 questions assessing eight aspects, including physical functioning, role‐physical functioning, bodily pain, general health, vitality, social functioning, role‐emotional functioning and mental health.

Results The mean follow‐up periods for patients with a neobladder (ileal and sigmoid) and with an ileal conduit was 45.9 (38.2 and 53.1, respectively) and 130.9 months, respectively. Scale scores were not affected by the duration of follow‐up in either group. There was no significant difference in any scale scores between the neobladder and ileal conduit groups. However, general health and social functioning in both the neobladder and ileal conduit groups appeared to be significantly lower than those in the general population in the USA. Furthermore, patients with a colon neobladder had a significantly higher score for role‐emotional functioning than those with an ileal neobladder, while there was no significant difference in the remaining seven scores between patients with ileal and colon neobladders.

Conclusions Six of the eight scales of HRQoL were favourable in both patients with a neobladder or an ileal conduit, and there was no significant difference between these groups. In addition, the HRQoL of patients with an orthotopic neobladder (except for role‐emotional functioning) was unaffected by the segment of the intestine used for neobladder construction. Therefore, patients with both types of urinary diversion were generally satisfied with their overall health and quality of life.
Extraordinarily high rates of male circumcision in South Korea: history and underlying causes
Authors: Pang M.G. , Kim D.S.
Published: December 2004

Objective To investigate the high circumcision rate in South Korea and its rapid increase in the short period since its introduction.

Subjects and methods From January to December 2000, 5434 South Korean males (or their parents) aged 0–92 years were interviewed in detail about their circumcision status, their age at circumcision, and the possible effect of circumcision on their sexuality. In addition, 267 practising medical doctors were surveyed about their basic understanding of circumcision and phimosis.

Results Currently the circumcision rate for high‐school boys is > 90% and for those > 70 years old is < 10%. The circumcision rate in 1945 was < 0.1%. When averaged over the whole population, the present South Korean circumcision rate is ≈ 60%; the rate has increased dramatically with time and particularly in the past 20 years, when the estimated number of male circumcisions has exceeded the number of male births. Although circumcision in South Korea has been strongly influenced by American culture, it has never been predominantly neonatal. The age at circumcision has continued to decrease and boys are now circumcised at ≈ 12 years old. Of those who were circumcised long after they had been sexually active, > 80% reported no noticeable difference in sexuality, but a man was twice as likely to have experienced diminished sexuality than improved sexuality. Of the doctors who were surveyed, 41% carried out circumcision but, unlike in America, gynaecologists and paediatricians rarely did so. Among the doctors, basic knowledge on circumcision and phimosis was generally lacking, regardless of whether they practised circumcision or not. Amongst the factors contributing to the high circumcision rate was the mistaken notion held by both doctors and the general public that circumcision is directly correlated with industrialization and general progress of living standards. Many doctors believe the out‐dated and sometimes controversial benefits of circumcision, i.e. prevention of cervical cancer and sexually transmitted diseases, and improved sexuality. Thus the vast majority of doctors recommend circumcision regardless of the patient's age. Peer pressure was also an important contributing factor.

Conclusion South Korea has an unusual history of circumcision. The mistaken and out‐dated notions about circumcision and lack of knowledge of phimosis by physicians seem to be a leading contributory factor to the extraordinarily high circumcision rate.
Prevalence and risk factors of urinary incontinence in young and middle‐aged women
Authors: Peyrat L. , Haillot O. , Bruyere F. , Boutin J.M. , Bertrand P. , Lanson Y.
Published: December 2004

Objective To assess the prevalence of and risk factors for urinary incontinence (UI) in young and middle‐aged women.

Subjects and methods During 1998 the prevalence of overall, stress, urge and mixed UI was assessed in women working in a French academic hospital. Women (2800) received a questionnaire at the same time as their yearly interview with a staff physician in occupational medicine. The usual risk factors for constitutional events, i.e. increasing age, obesity (defined as a body mass index of 25), obstetric events (pregnancy, previous Caesarean delivery, previous vaginal delivery, postpartum incontinence) and gynaecological events (hysterectomy) were evaluated.

Results Of the 1700 women (mean age 40.0 years) who returned the questionnaire, 467 (27.5%, 95% confidence interval, CI, 25.4–29.7) reported UI, comprising 210 (12.4%, 10.8–14.0) with stress UI, 28 (1.6%, 1.1–2.4) with urge UI and 229 (13.5%, 11.9–15.2) with mixed UI. Thirty‐eight women (8.1%) had frequent urinary leakage, comprising one (0.5%), four (14.3%) and 33 (14.4%) with stress, urge and mixed UI. The prevalence of UI increased significantly with age 40 years, with a relative risk (95% CI) of 2.16 (1.86–2.57), and with pregnancy (2.22, 1.71–2.87), previous vaginal delivery (2.15, 1.72–2.69), postpartum incontinence (2.57, 2.22–2.97), and hysterectomy (1.52, 1.11–2.08). Obesity (1.14, 0.99–1.32) and previous Caesarean delivery (2.15, 1.72–2.69) did not significantly increase the risk of UI. The risk factors for stress UI were age  40 years, pregnancy, previous vaginal delivery, postpartum incontinence and hysterectomy, but there was no relationship between stress UI and obesity or previous Caesarean delivery.

Conclusion There was a high prevalence of UI among young adult and middle‐aged women hospital workers who had easy access to medical resources. Gynaecological and obstetric events (pregnancy, particularly previous vaginal delivery and hysterectomy) were the most prominent risk factors, especially for stress UI.
Outcome of hypospadias fistula repair
Authors: Shankar K.R. , Losty P.D. , Hopper M. , Wong L. , Rickwood A.M.K.
Published: December 2004

Objectives  To examine the long‐term results of hypospadias fistula repair, the factors involved in recurrence and the outcome in cases where this has occurred.

Patients and methods  The study comprised 113 children undergoing urethrocutaneous fistula repair between 1984 and 1996. Most of the fistulae were closed in two to three layers, with or without a transpositional skin flap. Tunica vaginalis or a scrotal dartos flap was used in patients with inadequate vascularized tissue adjacent to the fistula. Success rates were calculated for each attempt at fistula repair until the patient was cured.

Results
 The median (range) age at primary fistula repair was 40 (18–169) months and the median follow‐up after the most recent repair 7.5 (2.3–17) years. The overall success rate of primary fistula repair was 71%. Fistulae which were >2 mm (11 of 21, 52%) were more likely to recur than were those 2 mm (22 of 92, 24%). Recurrence did not relate to the initial form of hypospadias repair, to the means of skin closure nor, with the exception of multiple lesions, to the location of the fistula. The success rates of subsequent repairs were 70% at the second and 50% at the third, fourth and fifth repairs. One child was cured at the sixth attempt. The use of tunica vaginalis or scrotal dartos as a ‘waterproofing’ layer was limited to the third or subsequent repairs and was successful in five of six cases.

Conclusion  A simple layered closure with or with no transpositional skin flap is effective in 71% of repairs. For recurrent fistulae, tissues from an unscarred area (tunica vaginalis or scrotal dartos layer) should be used to cover the fistula.
Over‐expression of apoptosis‐related proteins contributes to muscular damage in the obstructed ureter of the rat
Authors: Chuang Y.‐H. , Chuang W.‐L. , Huang S.‐P. , Huang C.‐H.
Published: December 2004

Objective To determine the role of apoptosis‐related proteins (Myc, Bax, Bcl‐2, and Bcl‐XL) in muscular damage in obstructed rat ureters.

Materials and methods The in situ end‐labelling of DNA fragments and the expression of apoptosis‐related proteins were assessed, using immunohistochemistry, in 54 female Sprague‐Dawley rats in which unilateral ureteric obstruction was caused by ureteric ligation.

Results The severity of ureteric damage increased during the period of obstruction. Apoptotic cells and the expression of Bax were detected in the smooth muscle layer from 14 days after ligation. The percentage of apoptotic cells and the expression of Bax in the smooth muscle layer increased and reached a peak 21 days after ligation, and then declined. The expression of Myc was also detected in the smooth muscle layer 14 days after ligation but reached a peak at 28 days. The expressions of Bcl‐2 and Bcl‐XL in the smooth muscle layer were only detected 21 and 28 days after ligation. The numbers of apoptotic cells in the smooth muscle layer correlated significantly with the expressions of Myc and Bax (r = 0.7360 and 0.7432, respectively; both P < 0.005), and with the expression index of Bax/Bcl‐2 and Bax/Bcl‐XL (r = 0.8909 and 0.8592, respectively; both P < 0.001).

Conclusions Apoptosis‐related proteins might be important in regulating cell apoptosis in ureteric damage during the development of obstructive uropathy.
Improving prostate cancer detection with an extended‐core transrectal ultrasonography‐guided prostate biopsy protocol
Authors: Durkan G.C. , Sheikh N. , Johnson P. , Hildreth A.J. , Greene D.R.
Published: December 2004

Objective To investigate whether taking two transition zone (TZ) and four lateral peripheral zone (PZ) biopsies in addition to routine parasaggital sextant biopsies would improve detection rates in men with suspected prostate cancer.

Patients and methods The study included 493 consecutive men (mean age 68.7 years, sd 8.2) with elevated serum prostate‐specific antigen (PSA) levels and/or abnormal findings on a digital rectal examination who underwent transrectal ultrasonography‐guided prostate biopsy. In addition to sextant biopsies, six further biopsies were obtained, two from the TZ (mid‐gland) and four from the lateral PZ (base and mid‐gland). Pathological findings for the additional biopsies were compared with those of the sextant regions.

Results Prostatic adenocarcinoma was diagnosed in 164 of the 493 (33%) men biopsied. Men with cancer were older, had smaller prostates and higher median PSA levels than men with negative biopsies. Sextant biopsies were positive for cancer in 133 of 164 (81%) men. All three sets of biopsies were positive in 53 (32%) cases. In 50 (30%) men both the sextant and lateral PZ biopsies were positive, while in six (4%) men, both sextant and TZ biopsies were positive. Thirty‐one (19%) tumours were not detected by sextant biopsies, 10 (6%) where the lateral PZ biopsies alone were positive, 17 (10%) where the TZ biopsies alone were positive and four (3%) where both the TZ and lateral PZ together were positive. There were no differences in median PSA concentration, total prostate volume or TZ volume between men with an isolated TZ cancer and men with cancer elsewhere in the prostate. However, 77% of men with TZ cancer had a PSA of > 10 ng/mL, compared with 60% of men with cancer at other sites within the prostate (P = 0.015).

Conclusion An extended‐core biopsy protocol significantly improves the detection rate for prostate cancer when compared with the standard sextant biopsy protocol alone. Routine TZ biopsies should be considered for men with serum PSA levels of >10 ng/mL.
The migration of Proteus mirabilis and other urinary tract pathogens over Foley catheters
Authors: Sabbuba N. , Hughes G. , Stickler D.J.
Published: December 2004

Objective To examine the ability of organisms that infect the catheterized urinary tract to migrate over the surfaces of Foley catheters.

Materials and methods In a simple laboratory model, organisms were challenged to migrate across sections of hydrogel‐coated latex, hydrogel/silver‐coated latex, silicone‐coated latex and all‐silicone catheters. The sections (1 cm long) were placed as bridges in channels between blocks of agar and the test organisms inoculated onto the agar adjacent to one side of each bridge. The plates were incubated at 37 °C for 24 h and examined for growth of the test organisms on the agar on the other side of the bridges. A collection of swarming, swimming and nonmotile species were tested in the model. The relative mobilities of the test organisms were expressed as migration indices, calculated as the percentage of tests in which bacterial migration was observed over each type of catheter bridge.

Results The swarmer cells of Proteus mirabilis and P. vulgaris migrated successfully (migration indices of 73–100) over all four types of catheter. The migration index of Serratia marcescens swarmers was reduced to 33 over the silver‐coated catheters, but these cells crossed over the other catheter surfaces with ease (indices of 100). Pseudomonas aeruginosa was the most mobile of the swimming, non‐swarming organisms with indices of 70–22, but this group was less capable of migration than the swarmers. Indices were 0–33 for nonmotile organisms. The mean migration indices for the nine species for each type of catheter were 57 (hydrogel‐coated latex), 49 (silver/hydrogel‐coated latex), 41 (silicone‐coated latex) and 35 (all‐silicone). The swarmer cells of P. mirabilis moved through populations of Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Enterococcus faecalis, and then migrated over sections of hydrogel‐coated latex catheters with little or no reduction in migration index. They were also capable of transporting the nonmotile cells of K. pneumoniae and S. aureus over the catheters. The migration index of P. mirabilis swarmers was substantially reduced in the presence of Ps. aeruginosa and S. marcescens.

Conclusions Hydrogel coatings facilitate the migration of urinary tract pathogens over catheter surfaces. With the exception of S. marcescens, the incorporation of silver into the hydrogel did not inhibit migration. Swarmer cells were particularly effective at moving over catheters and P. mirabilis swarmers were also capable of transporting other species. This suggests that inhibitors of swarming could be useful in controlling catheter‐associated infection and the complications resulting from the spread of bacterial biofilm over catheters.
Prediction of stone disease by discriminant analysis and artificial neural networks in genetic polymorphisms: a new method
Authors: Chiang D. , Chiang H.‐C. , Chen W.‐C. , Tsai F.‐J.
Published: December 2004

OBJECTIVE

To use information from genetic polymorphisms and from patients (drinking/exercise habits) to identify their association with stone disease, the main analytical and predictive tools being discriminant analysis (DA) and artificial neural networks (ANNs).

PATIENTS, SUBJECTS AND METHODS

Urinary stone disease is common in Taiwan; the formation of calcium oxalate stone is reportedly associated with genetic polymorphisms but there are many of these. Genotyping requires many individuals and markers because of the complexity of gene‐gene and gene‐environmental factor interactions. With the development of artificial intelligence, data‐mining tools like ANNs can be used to derive more from patient data in predicting disease. Thus we compared 151 patients with calcium oxalate stones and 105 healthy controls for the presence of four genetic polymorphisms; cytochrome p450c17, E‐cadherin, urokinase and vascular endothelial growth factor (VEGF). Information about environmental factors, e.g. water, milk and coffee consumption, and outdoor activities, was also collected. Stepwise DA and ANNs were used as classification methods to obtain an effective discriminant model.

RESULTS

With only the genetic variables, DA successfully classified 64% of the participants, but when all related factors (gene and environmental factors) were considered simultaneously, stepwise DA was successful in classifying 74%. The results for DA were best when six variables (sex, VEGF, stone number, coffee, milk, outdoor activities), found by iterative selection, were used. The ANN successfully classified 89% of participants and was better than DA when considering all factors in the model. A sensitivity analysis of the input parameters for ANN was conducted after the ANN program was trained; the most important inputs affecting stone disease were genetic (VEGF), while the second and third were water and milk consumption.

CONCLUSIONS

While data‐mining tools such as DA and ANN both provide accurate results for assessing genetic markers of calcium stone disease, the ANN provides a better prediction than the DA, especially when considering all (genetic and environmental) related factors simultaneously. This model provides a new way to study stone disease in combination with genetic polymorphisms and environmental factors.
Effects of benzalkonium chloride treatment on the intramural innervation of the upper urinary tract
Authors: Rolle U. , Chertin B. , Puri P.
Published: December 2004

OBJECTIVE

To establish a model for investigating the pathophysiology of pelvi‐ureteric junction (PUJ) obstruction, using benzalkonium chloride (BCI) treatment of the upper urinary tract of rabbits, and thus further elucidate the pathophysiology of PUJ obstruction, the most common urinary tract obstruction in children.

MATERIALS AND METHODS

Although various histological abnormalities have been described, PUJ obstruction may be functional. Defective innervation in PUJ has been suggested to be a major factor in the failure to transmit peristaltic waves across the PUJ. Previously established animal models of hydronephrosis deal mostly with surgical obstruction of the PUJ, which does not correlate with human congenital hydronephrosis. BCl has been used to ablate selectively neurones of the gastrointestinal myenteric plexus, which generated spastic segments with impaired peristalsis. Thus 12 rabbits were treated with BCl at the PUJ; the right upper urinary tract was dissected extraperitoneally and treated with a local application of 0.1% or 0.5% BCl (six each) for 15 min. The controls were four sham‐operated animals treated with saline. The animals were assessed by intravenous urography (IVU) at 4 and 8 weeks after treatment, after which the animals were killed, the upper urinary tracts removed and whole‐mounts prepared. Acetylcholinesterase (AChE) histochemistry, and neurofilament and tyrosine hydroxylase (TH) single‐enzyme immunohistochemistry were used to detect the intrinsic innervation.

RESULTS

None of the animals had hydronephrosis on the IVU or at death. AChE histochemistry, TH and neurofilament immunohistochemistry showed no or very few nerve fibres within the BCl‐treated PUJs in both (0.1% and 0.5%) groups. After saline treatment there was normal development of the neuronal plexus within the submucosal, muscular and adventitial layers of the upper urinary tract.

CONCLUSION

These results suggest that treatment with BCl is useful for ablating the intrinsic innervation in the upper urinary tract. Defective intrinsic innervation of the upper urinary tract did not lead to clinically or radiologically evident hydronephrosis. Further physiological studies using this model are needed to further elucidate the neuronal and myogenic influence on the development of PUJ obstruction.
Endourethral injection of bulking agents for urinary incontinence in children
Authors: Godbole P. , Bryant R. , MacKinnon A.E. , Roberts J.P.
Published: December 2004

Objective

To assess the early and late outcome of endourethral injection with bulking agents in children with urinary incontinence (a neuropathic bladder or exstrophy‐epispadias complex), by reviewing our experience over a 5‐year period.

Patients and methods

The records of 15 children (10 boys) were reviewed retrospectively; 10 had spina bifida and a neurogenic bladder, four had a neurogenic bladder from other causes and one had epispadias. All children had a stable low‐pressure detrusor and a compliant bladder with sphincteric weakness on preoperative urodynamic testing. Four children had undergone previous enterocystoplasty with a Mitrofanoff stoma, with concomitant urethral lengthening in two and a Goretex™ bladder neck sling in two. Three children voided spontaneously while 12 depended on intermittent catheterization. The agent was injected under general anaesthesia in all patients but one, with an endourethral submucosal injection of the bulking agent into four or more points at the junction of the bladder neck and proximal urethra, aiming to obtain visual occlusion of the urethra. The median (range) number of injections was 2 (1–3); five children had one injection, seven had two and three had three. There were no procedure‐related complications and most were day‐case procedures. Initially PTFE paste was used as the bulking agent, being replaced by bovine collagen or polydimethylsiloxane in the latter half of the series.

Results

At a median (range) follow‐up of 28 (11–65) months three children were completely dry after a single injection; there was no change in four and a short‐term improvement (median 25 months, range 4 days to 37 months) in eight. After this period all children deteriorated to their original incontinence grade; hence the overall cure rate was three of 15.

Conclusion

This experience with a long‐term follow‐up differs from previously reported high success rates for the endourethral injection of bulking agents for urinary incontinence in children. Despite a short‐term benefit, in the long‐term this technique was unreliable and often ineffective. Patients and their carers should be given a realistic and guarded prognosis.
The role of thoracotomy in managing postchemotherapy residual thoracic masses in patients with nonseminomatous germ cell tumours
Authors: McGuire M.S. , Rabbani F. , Mohseni H. , Bains M. , Motzer R. , Sheinfeld J.
Published: December 2004

The role of thoracotomy in patients with metastatic testicular cancer is explored by the group from Memorial Sloan‐Kettering Cancer Center. This is a controversial area, and they evaluate the outcome and establish prognostic variables in patients having this procedure after chemotherapy. They found it to be therapeutic for most patients with teratoma, and many with residual viable cancer.

The group from the University of Miami evaluated the use of cell‐saver in patients undergoing radical prostatectomy and reassure the reader that its use does not influence the recurrence of cancer. In another interesting study from Hamburg, the authors show that there are important differences in the biopsy features between prostate cancers located in the transition and peripheral zones. In a detailed study, authors from Poitiers show in a case‐control study that obesity was not significantly associated with prostate cancer when compared to controls with BPH, but obese men had a higher risk of having prostate cancer.

Objective

To evaluate the clinical outcome and identify prognostic variables in patients with nonseminomatous germ cell tumours undergoing postchemotherapy thoracotomy for residual masses, as the role of this procedure is controversial.

Patients and methods

Of 385 patients who underwent postchemotherapy retroperitoneal lymph node dissections between 1988 and 1998, 105 also had 130 thoracotomies. The clinical presentation, chemotherapy regimens, marker status, primary tumour histology, pathology of all resected masses, and clinical outcome of these 105 patients were analysed.

Results

The overall discordance rate for synchronous thoracic and retroperitoneal masses was 28%; that for asynchronous thoracic and retroperitoneal masses was 57%. Independent prognostic factors for residual thoracic teratoma or cancer were teratoma (mature or immature) in the primary tumour or retroperitoneal teratoma or cancer. Although three of 12 patients with residual thoracic cancer remained with no evidence of disease, residual thoracic cancer is an independent prognostic factor (P < 0.001) against disease‐free survival.

Conclusion

Postchemotherapy thoracotomy yields important prognostic information, and is therapeutic for most patients with teratoma and a subset with residual viable cancer. The prognostic criteria predictive of fibrosis are not sufficiently accurate to omit resection of residual thoracic masses.
Obesity in relation to prostate cancer risk: comparison with a population having benign prostatic hyperplasia
Authors: Irani J. , Lefebvre O. , Murat F. , Dahmani L. , Doré B.
Published: December 2004

Objective

To analyse the relationship between obesity and prostate cancer, when compared with men with benign prostatic hyperplasia (BPH).

Patients and methods

The records were reviewed of consecutive patients with histologically confirmed prostate cancer admitted for prostate surgery between January 1993 and February 1999. Controls were selected from patients who were hospitalized at the same time for the surgical treatment of BPH. One control was matched to each case by age. Obesity was defined as a body mass index (BMI) of> 29 kg/m2.

Results

The study included 194 cases and 194 controls; their median (range) age at operation was 69.5 (50–88) years in both groups, and the BMI 26.1 (16.6–38.1) kg/m2 in the cancer and 25.7 (15.1–36.8) kg/m2 in the BPH group. The difference between the groups was not significant (P = 0.06). Obesity was significantly associated with prostate cancer, with an odds ratio (95% confidence interval) of 2.47 (1.41–4.34). Cases with advanced disease had a higher BMI than those with localized disease, but when age was considered the difference was not significant.

Conclusion

In general the BMI was not significantly associated with prostate cancer when compared with men having BPH. However, obese men had 2.5 times the risk of having prostate cancer.