bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in prostatic thickness and the location of ejaculatory ducts in autopsy prostates
Authors: Suzuki T. , Kurokawa K. , Takahashi O. , Yajima H. , Ito H. , Yamanaka H.
Published: November 2008

Objective To measure prostatic thickness and the depth of ejaculatory ducts from the urethral surface to prevent ejaculatory duct damage during transurethral balloon laser thermotherapy.

Materials and methods In 47 prostates obtained at autopsy, the prostatic thickness and the depth of ejaculatory ducts from the urethral surface were measured in eight directions from the centre of the urethra.

Results The depth of ejaculatory ducts was approximately 6 mm from the urethral surface regardless of prostatic weight. Increase in prostatic weight was associated with increase in the thickness in all directions except the posterior one; the thickness ranged from 9 to 20 mm. The posterior thickness at the level of the transition zone was 10 mm regardless of prostatic weight.

Conclusion When benign prostatic hypertrophy is treated transurethrally, using laser or microwave equipment, care should be taken to avoid heating the posterior region of the prostate.
The effect of age, ethnicity and geographical location on impotence and quality of life
Authors: Jonler M. , Moon T. , Brannan W. , Stone N.N. , Heisey D. , Bruskewitz R.C.
Published: November 2008

Objective To estimate the prevalence of impotence in men over 40 years of age and correlate impotence to age, geographical location, ethnicity and quality of life.

Subjects and methods While attending ‘The Prostate Cancer Awareness Week’ in Madison, WI, USA, New Orleans, LA, USA and New York, NY, USA, 1680 men were asked to complete a questionnaire regarding impotence, age, geographical location, ethnicity and quality of life.

Results Impotence was found to be significantly associated with age, was less associated with geographical location but independent of ethnicity. Men living in Madison reported a lower potency score compared with men living in New Orleans and New York.

However, potency score for men living in Madison did not appear to decline as rapidly with age when compared with men living in New Orleans and New York. Impotence and quality of life were also found to be associated even when the quality of life estimates were adjusted for age, geographical location, and age by geographical location.

Conclusion This study indicates that impotent men have a lower quality of life than potent men and has confirmed previous findings that age is associated with impotence. Surprisingly, answers to impotence questions were also associated with geographical location.
Scarring following renal trauma in children
Authors: Surana R. , Khan A. , Fitzgerald R.J.
Published: November 2008

Objective To assess factors relating to renal scarring following kidney injury.

Patients and methods A total of 25 children who had documented renal injury between 1981 and 1988 were included in the study and 19 were followed up for 1 month to 12 years (mean 5.5 years) and the development of hypertension and renal scars assessed using ultrasonography and radionuclide scans (dimer‐capto‐succinic acid, DMSA).

Results Of the 19 children 13 had renal contusions, four had renal lacerations and two sustained severe renal injury, one of whom had pelvi‐ureteric disruption. Eighteen patients presented with macroscopic or microscopic haematuria except the patient with pelvi‐ureteric junction disruption who presented 3 weeks later with abdominal distension, vomiting and hypertension. All the patients were managed without an operation except the latter patient who required neph‐rectomy. Renal scarring was demonstrated in four children at a mean follow‐up of 3.5 years, one following renal contusion (5% scarring), two after renal laceration (50% scarring) and one after rupture of the kidney (100% scarring). In one patient intravenous pyelography did not reveal a renal scar but a radionuclide scan performed 5 years later demonstrated a scar. Transient hypertension was noted in only two patients but peripheral plasma renin levels were normal.

Conclusion Renal scars developed in four of 19 patients with renal trauma and more than half of the patients with severe renal injury. Long‐term follow‐up including a radionuclide scan is therefore necessary in patients with renal injury. Although no sustained hypertension was noted in any patients in this study, long‐term blood pressure assessments would seem prudent.
Bile acid dysfunction after clam enterocystoplasty
Authors: BARRINGTON J.W. , FERN‐DAVIES H. , ADAMS R.J. , EVANS W.D. , WOODCOCK J.P. , STEPHENSON T.P.
Published: November 2008

Objective To determine if the bowel dysfunction that develops in approximately 12% of patients after a clam enterocystoplasty is due to disruption of the enterohepatic circulation of bile acids.

Patients and methods Fourteen symptomatic patients (mean age 36 years, range 21–65) who had undergone clam enterocystoplasty were investigated by bowel frequency charts, hydrogen breath tests of expired air and the retention of radioactive 75Selabelled homocholic acid‐taurine (SeHCAT), a synthetic bile acid. Patients with abnormal results were commenced on anion‐exchange resins and the symptoms evaluated 6 weeks later.

Results The interruption of bile acid circulation, as estimated by SeHCAT, occurred in most of the patients studied and was due to surgical resection of the terminal ileum. All hydrogen breath tests were normal, excluding bacterial overgrowth as a cause of diarrhoea. Bowel frequency correlated well with the percentage of SeHCAT retained. Anion‐exchange resins were successful in relieving the symptoms if patients complied well with the treatment.

Conclusions After clam enterocystoplasty, some patients have bowel dysfunction caused by the interruption of the enterohepatic circulation of bile acids. These patients can be identified using bowel frequency charts and treated by anion‐exchange resins.
Substitution cystoplasty for intractable interstitial cystitis
Authors: HUGHES O.D.M. , KYNASTON H.G. , JENKINS B.J. , STEPHENSON T.P. , VAUGHTON K.C.
Published: November 2008

Objective To assess the results of substitution cystoplasty for the treatment of intractable interstitial cystitis (IC).

Patients and methods Thirty‐two patients (29 women and three men; mean age 58 years, range 24–74) with intractable IC resistant to conservative therapy who had undergone substitution cystoplasty between 1983 and 1992 were reviewed. Their bladder capacities were measured pre‐operatively and related to the outcome of treatment.

Results All but two of the 22 women with a bladder capacity of < 250 mL under anaesthetic were improved (five) or cured (15) of their symptoms. The results in women with larger bladder capacities were much less reliable, with only two of seven being cured of their symptoms. The three men all had a good result. Those who had undergone supratrigonal cystectomy were more likely to void spontaneously, but four patients developed pyelonephritis from associated reflux. Subtotal cystectomy reduced the likelihood of reflux and, although there were too few patients for statistical significance, probably increased the chance of cure at the expense of increasing the need for intermittent self‐catheterization (ISC).

Conclusions Pre‐operative bladder capacity under anaesthetic is the most reliable predictor of outcome of substitution cystoplasty for treating intractable IC in women. It is contra‐indicated if bladder capacity is >250 mL. Supratrigonal cystectomy is a quick and easy operation and is preferable in the older patient. Subtotal cystectomy with reimplantation of the ureters is preferable in the younger patient, even though it may increase the need for ISC.
Intermittent catheterization following enterocystoplasty
Authors: SINGH G. , THOMAS D.G.
Published: November 2008

Objective To assess the segment of bowel used in enterocystoplasty and the need to perform intermittent self‐catheterization (ISC) after enterocystoplasty for the treatment of incontinence.

Patients and methods Of 123 patients undergoing enterocystoplasty, 77 (mean age 29.5 years, range 13–61) had neurogenic disease (NB group) and 46 (mean age 45.7 years, range 16–74) had non‐neuropathic bladders (NNB group). The success of enterocystoplasty, with respect to the segment of bowel used and the need for ISC, was assessed during a follow‐up of 6–125 rhonths.

Results Ileum was used in 84 (63.8%), ileum and caecum in 19 (15.4%) and sigmoid in 20 (16.3%) patients. In the NB group, more patients had a sigmoid cystoplasty (24.7 vs 2.2%) and less (67 vs 80 %) had an ileo‐cystoplasty than in the NNB group. A total of 87 (71%) patients required ISC; 63 (82%) of the NB group and 24 (52%) of the NNB group. The influence of the intestinal segment was conspicuous in the NB group, with 82% and 95% of patients with ileocaecal and sigmoid cystoplasty needing ISC against 77% of those patients with ileal cystoplasty. The difference was not so evident in the NNB group.

Conclusions A social continence rate of 93.6% in the NB and 84.8% in the NNB patients was achieved, partly due to the patients' success with ISC, a necessary skill to be mastered by all patients before undergoing enterocystoplasty.
Are transrectal ultrasonically guided biopsies required for the accurate diagnosis of carcinoma of the prostate? Can digitally guided systematic biopsies offer an acceptable alternative?
Authors: FIGUEIREDO A.J.C. , SEENI K. , ANSON K.M. , FURTADO A.J.L. , MILLER R.A.
Published: November 2008

Objective To compare the diagnostic yield of ultrasonically guided and digitally guided systematic biopsies of the prostate.

Patients and methods Fifty two patients with suspected but unproven carcinoma of the prostate underwent simultaneous transrectal ultrasonography (TRUS)‐guided and digitally guided systematic biopsies of the prostate. A mean of 12 cores was obtained from each patient. On average more cores were obtained with TRUS guidance (mean 6.7) than with digital guidance (mean 5.3).

Results Cancer was detected in 19 patients and the diagnosis was made by both techniques in 16. Two patients had tumour detected only with TRUS guidance and one only with digital guidance. No complications occurred.

Conclusion This study indicates that there is no significant difference between TRUS guidance and digital guidance to direct systematic biopsies of the prostate. The use of routine TRUS in screening programmes is now in doubt.
Long‐term results with M‐VAC for advanced urothelial cancer: high relapse rate and low survival in patients with a complete response
Authors: IGAWA M. , URAKAMI S. , SHIINA H. , ISHIBE T. , KADENA H. , USUI T.
Published: November 2008

Objective To describe the long‐term results of treating patients with advanced urothelial cancer using a combination of methotrexate, vinblastine, doxorubicin and cisplatin (M‐VAC).

Patients and methods Fifty‐one patients (37 men and 14 women, median age 66 years, range 41–82) with inoperable or metastatic carcinoma of the bladder, ureter or renal pelvis were treated with M‐VAC and their responses evaluated for up to 7 years. Relative dose intensity (RDI) was calculated by dividing the actual dose intensity by the projected total dose intensity and related to outcome. Overall survival was assessed from the date of initiation of treatment with M‐VAC, using the Kaplan‐Meier method.

Results Of the 51 patients, 10 (20%) had a complete and 18 (35%) had a partial response, giving an overall response rate of 55% (95% CI, 41–68%). There was no significant difference in the median values of RDIs with response to the M‐VAC regimen. The median duration of response was 11.9 months for the 10 patients with a complete response and of these, eight relapsed at a median of 10 months after treatment and died at a median of 8.5 months from the time of disease recurrence. Survival of patients with a complete response differed significantly from those with no response at 1 year after the start of treatment, but not subsequently.

Conclusion Long‐term follow‐up revealed a high relapse rate and poor prognosis in patients with a complete response who received the M‐VAC as induction therapy. Therefore, new adjunctive therapies are needed for patients with locally unresectable or metastatic urothelial cancer.
Maternal serum human chorionic gonadotrophin during early pregnancy resulting in boys with hypospadias or cryptorchidism
Authors: KIELY E.A. , CHAPMAN R.S. , BAJORIA S.K. , HOLLYER J.S. , HURLEY R.
Published: November 2008

Objective To compare maternal serum human chorionic gonadotrophin (hCG) samples before 18 weeks gestation in mothers of boys with cryptorchidism or hypospadias with that in mothers of normal boys. The effect of season on maternal hCG was also assessed.

Subjects and methods Stored serum samples from mothers of singleton male fetuses born between January 1988 and December 1992 were assayed for total hCG, using a Delfia assay. There were 153 eligible samples from 96 mothers of normal boys, 31 of those with cryptorchidism, and 26 of those with hypospadias.

Results The data from mothers of normal boys were used to construct a time‐specific reference range for hCG. Plotting the hCG levels of the other groups and superimposing the reference range showed no significant difference between them (P= 0.09). Maternal hCG was not significantly different between cryptorchid boys requiring orchidopexy and those experiencing early spontaneous descent. An analysis of covariance allowing for gestational age showed that maternal hCG is significantly higher during the peak summer than peak winter months (P= 0.046).

Conclusion While a seasonal effect on maternal hCG was demonstrated our data does not suggest this to be the sole cause for cryptorchidism or hypospadias or to account for the observation that both have a seasonal frequency.
Cutting the cost of catheterization for acute retention—a hospital or domiciliary procedure?
Authors: WEBB V.J. , BOOTH C.M.
Published: November 2008

Objective To report the views of General Practitioners (GPs) and patients on the most appropriate place and person to catheterize patients in acute urinary retention.

Patients and methods Two separate questionnaires were sent to 50 local GPs and 100 patients who had recently been referred with acute urinary retention. The questionnaires were designed to ascertain the most appropriate place and person to catheterize these patients. They also established the number of hospital admissions due to acute retention, the use of ambulances and the uptake of the district nurse services.

Results Whilst 54% of GPs advocated domiciliary catheterization, only 20% of emergency catheterizations were carried out in the home. Nearly half the patients catheterized in the Accident and Emergency Department were admitted acutely and 41% of patients had travelled to hospital by ambulance. Patients were equally divided about where they would prefer to be catheterized, but 70% of patients stated that they were happy to be catheterized by a trained nurse; no GP opposed this concept.

Conclusion The cost/benefit analysis of these results strongly supports the case for establishing best‐practice guidelines to promote an emergency domiciliary service led by GPs and trained district nurses and thus hasten the emergency care of acute retention and cut costs.
Long‐needle bladder neck suspension for genuine stress incontinence—does endoscopy influence results? A structured overview
Authors: JARVIS G.J.
Published: November 2008

Objective To assess the hypothesis that the use of an endoscope to aid suture placement in long‐needle suspension procedures is more likely to be lead to improved results.

Materials and methods A literature survey of 15 journals yielded 77 evaluable publications which provided data to compare the subjective and objective outcomes following a Pereyra procedure (2259 and 301 patients, respectively) or a Stamey procedure (2029 and 456 patients, respectively).

Results There was no statistically significant difference in the mean percentage continence rates, based on subjective assessment of continence, following either the Pereyra or the Stamey procedure. Approximately 7% of patients subjectively claimed to be continent yet were not so upon some form of objective measurement.

Conclusion The analysis detected no improvement in the likelihood of continence after long‐needle suspension procedures whether or not they were performed under endoscopic control to aid suture placement. This conclusion applied to primary procedures whether outcome was judged subjectively or objectively, and to subjective outcome after previously failed surgery. This study suggests that those surgeons who report their results are sufficiently skilled in judging suture placement as accurately as is needed without the benefit of a cystoscope.
The role of urodynamic studies in the evaluation of patients with augmentation cystoplasties
Authors: McINERNEY P.D. , DeSOUZA N. , THOMAS P.J. , MUNDYM A.R.
Published: November 2008

Objective To assess the role and value of videouro‐dynamic studies (VUD) in the post‐operative evaluation of 100 patients who were continent following augmentation (clam) enterocystoplasty.

Patients and methods Fifty patients had non‐neuropathic detrusor instability and 50 had neuropathic bladder dysfunction. All underwent standard dual channel medium fill cystometry and synchronous video screening before and at 6 months and 2 years after a clam ileocystoplasty.

Results Pre‐operative capacity was variable in non‐neuropathic patients but post‐operative capacity in this group, and both pre‐and post‐operative capacity in the neuropathic group, were more reproducible. Of non‐neuropathic patients, 88% became stable and 83% became normally compliant, compared with only 38 and 50% respectively of neuropathic patients. More surprisingly, two of eight neuropathic patients previously stable became unstable and four of 12 of those previously normally compliant became poorly compliant. In all patients voiding spontaneously there was a tendency for capacity to increase and voiding efficiency to decrease with time.

Conclusions From these results, standard VUD studies contributed little to the post‐operative assessment of patients with clam cystoplasties beyond that which could be obtained by ultrasonography of the bladder before and after voiding. The effect or lack of effect of augmentation cystoplasty on compliance in the neuropathic bladder suggests a neuropathic effect on bowel contractility and warrants further investigation. The meaning and significance of ‘urodynamic’ observations when bowel is incorporated into the bladder also needs careful investigation.
Neomycin‐induced perception deafness following bladder irrigation in patients with end‐stage renal disease
Authors: GERHARZ E.W. , WEINGÄRTNER K. , MELEKOS M.D. , VARGA S. , FEIBER H. , RIEDMILLER H.
Published: November 2008

Objective To report a serious side‐effect of intravesical instillations of neomycin in patients with end‐stage renal disease.

Patients and methods Three patients (two men and a woman, aged 51,71 and 54 respectively) with end‐stage renal disease who had undergone bladder irrigation with neomycin sulphate solution suffered complete irreversible deafness, which was assessed by audiogram.

Results All three patients developed complete perception deafness after 3, 4 and 10 months, with characteristic changes in the audiogram. The severe progressive hearing loss was maximal in the high‐frequency range. A high‐pitched tinnitus was the first sign of impending hearing difficulty and two patients developed a spontaneous nystagmus.

Conclusion In view of the doubtful efficacy and, most importantly, the risk of severe disabling side‐effects such as ototoxicity, we recommend the avoidance of intravesical instillation with neomycin whenever possible.
Serum granulocyte colony‐stimulating factor levels in patients with urinary bladder tumour and various urological malignancies
Authors: MIZUTANI Y. , OKADA Y. , TERACHI T. , KAKEHI Y. , YOSHIDA O.
Published: November 2008

Objectives To measure the serum levels of granulocyte colony‐stimulating factor (G‐CSF) in patients with urinary bladder tumour (UBT) or various urological malignant tumours, and to assess G‐CSF production by tumour cells.

Patients and methods Peripheral blood was obtained, before operation or anti‐cancer therapy, from 141 patients with UBT, 37 patients with other urological malignant tumours (21 with renal cell carcinoma, nine with renal pelvic or ureteric tumours, five with prostatic cancer, and two with testicular cancer), 38 patients with benign urological diseases (21 with benign prostatic hypertrophy, 11 with urolithiasis and six with a varicocele), and from 15 healthy donors. The serum G‐CSF levels were quantified using an enzyme immunoassay.

Results Of 141 patients with UBT, 13 showed elevated serum G‐CSF levels above the sensitivity of the assay (30 pg/mL) with a mean value of 328 pg/mL. The serum levels in normal healthy donors and in patients with prostatic cancer, testicular cancer or varicocele were < 30 pg/mL, while the levels were > 30 pg/mL in two of nine patients with renal pelvic or ureteric tumour (mean 754 pg/mL) and in one of 21 patients with renal cell carcinoma (40 pg/mL). The levels of serum G‐CSF in several patients with benign prostatic hypertrophy or urolithiasis were also elevated, but the mean levels were low. The serum G‐CSF levels in patients with UBT correlated with the increase of grade and the progression of the stage of UBT. Furthermore, patients with UBT and an undetectable level of serum G‐CSF had higher disease‐specific survival rates at the 5‐year follow‐up when compared with those with an elevated level of serum G‐CSF. There was a positive correlation between serum G‐CSF levels and white blood cell counts. T24 and J82 UBT cell lines and freshly separated tumour cells derived from the patient whose serum G‐CSF level was high produced G‐CSF.

Conclusion These results suggest that elevated serum G‐CSF level might be associated with a poor prognosis in patients with UBT and be due to the production of G‐CSF by UBT cells
The burden of prostate cancer from diagnosis until death
Authors: OTNES B. , HARVEI S. , FOSSÅ S.D.
Published: November 2008

Objective To quantify the need for treatment and care in patients with conservatively treated prostate cancer.

Patients and methods All men who had been diagnosed with prostate cancer in a defined geographical area and who died within the period 1987–91 were identified. Patients treated with curative intent were excluded. Medical records from hospitals, nursing homes and community nurses for the period from diagnosis until death were scrutinized for the remaining 174 patients.

Results Of the 174 patients, 95% were symptomatic at diagnosis and 62% died from prostate cancer. All but two patients were hospitalized for prostate cancer, for a mean of 1 month. Thirty‐six per cent needed regular nursing in nursing homes or by community nurses at home. Complications requiring hospitalization or long‐term catheterization occurred in 49%. Prostatic surgery was performed in 66% and androgen ablation in 76% of the patients; palliative irradiation was given to 16% and 50% received analgesics regularly, including opiates or equivalents in 37%. Prednisone was given to 29%, after the failure of androgen ablation.

Conclusion Our findings demonstrate the considerable burden imposed both on patients and health‐care resources by symptomatic prostate cancer, conservatively treated. There are few data available for comparison.
Is day‐case prostatectomy feasible?
Authors: KEOGHANE S.R. , MILLAR J.M. , CRANSTON D.W.
Published: November 2008

Objective To assess the possibility of discharging patients, catheter‐free, on the same day that they undergo contact‐laser prostatectomy.

Patients and methods Ten patients underwent contact vaporization of the prostate using the SLT (Surgical Laser Technologies, Oaks, PA, USA) Nd:YAG laser with an MTRL10 6 mm tip. Patients were selected in the out‐patient clinic for day‐case surgery on the basis of their good general health and clinically small glands. All patients had pre‐operative urodynamic assessment and were proven obstructed and stable. Contact vaporization was carried out under general anaesthesia. Both intra‐operative blood loss and irrigant absorption were assessed. The follow‐up at 3 and 6 months included American Urological Association (AUA‐7) symptom scores and the measurement of urinary flow rates.

Results The mean operating time was 25.2 min, with a mean application of 43.05 kJ of laser energy. The mean absorption of irrigant fluid was 30 mL and the mean intra‐operative blood loss was 31 mL. Nine patients were discharged on the day of treatment. Two patients went into clot retention following discharge and had a suprapubic catheter sited, and two failed to void once discharged, necessitating catheterization for 2 weeks. At 3 and 6 months, there was a substantial decrease in the AUA symptom score and an improvement in urinary flow rate.

Conclusion Day‐case laser prostatectomy is possible, but the patients must be selected carefully and, perhaps more importantly, a specialist day‐case anaesthetist must be available.
Targeting of bladder cancer with monoclonal antibody NCRC48—a possible approach for intravesical therapy
Authors: KUNKLER R.B. , BISHOP M.C. , GREEN D.J. , PIMM M.V. , PRICE M.R. , FRIER M.
Published: November 2008

Objective To determine the localization of the anti‐MUCl mucin monoclonal antibody (mAb) NCRC48 to bladder cancer following intravesical administration.

Patients and methods mAb NCRC48 (330–500 μg) radiolabeled with 111indium (11–17 MBq) was administered intravesically to 12 unselected patients with radiological evidence of bladder cancer. Tumour localization was assessed by gamma‐camera imaging and by tissue biodistribution studies on biopsies obtained at cystoscopy at about 2 or 24 h after the procedure. After 24 h, whole blood radioactivity was measured and 3 weeks after the procedure the serum level of human anti‐mouse antibodies was estimated using an ELISA method.

Results Eleven patients had tumours confirmed at cystoscopy (grades 1–3, stages pTa‐pT2). The mean uptake of NCRC48 by tumour and by normal uro‐thelium (expressed as the percentage of the instilled dose/g × 103± SD) at 2h was 3.42 ± 3.68 and 0.41 ± 0.77 (P < 0.05). After 24 h, the values for tumour and normal urothelium were 1.17 ± 1.18 and 0.17 ± 0.11, respectively. Areas of increased activity on the scintigrams were consistent with the position of the tumours at cystoscopy. No radioactivity was detected in blood at 24 h and there was no evidence of a human anti‐mouse antibody response.

Conclusion The MUC1 mucin may be a suitable antigen to study the potential of therapeutic strategies based on monoclonal antibody targeting of superficial bladder cancer and may allow the development of more effective agents in the treatment of this condition.
Hydration monitoring in the prevention of recurrent idiopathic urinary tract infections in pre‐menopausal women
Authors: ECKFORD S.D. , KEANE D.P. , LAMOND E. , JACKSON S.R. , ABRAMS P.
Published: November 2008

Objective To assess whether the use of simple hydration monitoring can encourage adequate hydration and reduce urinary osmolality and the incidence of urinary tract infections (UTIs) in a population of susceptible pre‐menopausal women with recurrent idiopathic urinary infections.

Subjects and methods The study included 28 premenopausal women who had at least two idiopathic UTIs in the previous 6 months. Urinary osmolality was assessed by the patients at each void by a simple hand‐held probe, and the readings over 4 months compared. Monthly urine culture was compared between successive 4‐month periods in which the probe was or was not used.

Results The study was completed by 17 women. There was a significant shift towards urine of lower osmolality over the 4‐month period using the probe (Pearson's χ2 < 0.001). Significantly fewer urinary tract infections developed during the 4 months using the probe (McNemar's χ2= 0.046).

Conclusions The use of the osmolality probe encouraged the subject to maintain adequate hydration. The resulting augmentation of the natural urethral washout mechanism led to lower osmolality urine and a reduction in the incidence of UTIs.
Alfuzosin attenuates erectile dysfunction in rats with partial bladder outlet obstruction
Authors: Gur Serap , Sikka Suresh C. , Chandra Surabhi , Koka Padma Sandeep , Agrawal Krishna C. , Kadowitz Philip J. , Hellstrom Wayne J.G.
Published: November 2008

OBJECTIVE

To determine how partial bladder outlet obstruction (PBOO) in a rat model affects erectile function, and whether an uroselective α1‐adrenoceptor antagonist, alfuzosin (Sanofi‐Aventis, Paris, France) attenuates any erectile dysfunction (ED).

MATERIALS AND METHODS

Adult male Sprague‐Dawley rats (120) were randomized into four groups: 1, sham‐operated; 2, alfuzosin‐treated; 3, PBOO; and 4, alfuzosin‐treated with PBOO. Groups 3 and 4 were subjected to PBOO for 6 weeks by ligation of the urethra, while groups 2 and 4 rats received daily oral alfuzosin (10 mg/day) for 6 weeks. In vivo erectile responses were monitored by evaluating ratios of intracavernosal pressure (ICP)/mean arterial pressure, and total ICP (area under the curve). Organ‐bath studies were performed on corpus cavernosum smooth muscle (CCSM) strips. Nitric oxide synthase (NOS) expression was determined immunohistochemically (IHC) for neuronal (n)NOS and by Western blot analysis for endothelial (e) and inducible (i) NOS protein.

RESULTS

Rats with PBOO showed lower erectile responses than controls. Maximum

electrical field stimulation‐mediated and endothelium‐dependent acetylcholine‐induced relaxations and contractile responses to phenylephrine were significantly reduced in CCSM strips from the PBOO group. The NO donor sodium nitroprusside completely relaxed CCSM from rats in all groups. IHC analyses showed decreased expression of nNOS in PBOO groups compared with controls; by contrast, protein expression of eNOS and iNOS was increased. Alfuzosin‐treatment partially attenuated functional and molecular changes in penises of PBOO rats.

CONCLUSION

Rats with PBOO show ED, most likely due to altered NOS expression and NO bioavailability. The α‐adrenoreceptor antagonist alfuzosin reversed this ED by altering sympathetic tone, increasing NO‐induced relaxation and augmenting blood flow in the penis. This study suggests a rationale for further clinical trials using combinations of α‐adrenoceptor antagonists and phosphodiesterase‐5 inhibitors in patients with ED and lower urinary tract symptoms.
Haemostatic sealants in nephron‐sparing surgery: what surgeons need to know
Authors: Dalpiaz Orietta , Neururer Richard , Bartsch Georg , Peschel Reinhard
Published: November 2008

Surgical haemostatic agents have been increasingly applied for the control of bleeding, and have excellent potential in laparoscopy. Several factors are important when evaluating the use of sealants. We present a brief overview of the history, composition and mechanism of action of sealants, together with a report on experimental studies and clinical experience with haemostatic sealants. We searched for reports on haemostatic agents and their use in renal parenchymal haemostasis; 15 animal models studies and 11 papers on clinical experience were included. The development of haemostatic agents and instruments is allowing the wider diffusion of challenging procedures. Several experimental animal studies have shown the efficacy and safety of sealants for haemostasis during nephron‐sparing surgery. Clinical studies confirm the effectiveness of synthetic or fibrin glue, in particular during laparoscopic surgery. Sealants are effective and safe topical agents to control bleeding during nephron‐sparing surgery. They should not be viewed as an alternative, but as complementary agents to be used to improve surgical outcomes. Further prospective studies are necessary to validate their role in relation to other haemostatic support techniques.
FINANCE AND THE POOR
Authors: LEVINE ROSS
Published: November 2008

The operation of the formal financial system is profoundly important for the poor. Financial development influences the degree to which economic opportunities are shaped by talent rather than by parental wealth. Considerably more research is needed on which formal financial sector policies boost aggregate economic efficiency, while simultaneously expanding the economic prospects of the poor.
MEAN–VARIANCE VERSUS FULL‐SCALE OPTIMIZATION: BROAD EVIDENCE FOR THE UK
Authors: HAGSTRÖMER BJÖRN , ANDERSON RICHARD G. , BINNER JANE M. , ELGER THOMAS , NILSSON BIRGER
Published: November 2008

Portfolio choice by full‐scale optimization applies the empirical return distribution to a parameterized utility function, and the maximum is found through numerical optimization. Using a portfolio choice setting of three UK equity indices we identify several utility functions featuring loss aversion and prospect theory, under which full‐scale optimization is a substantially better approach than the mean–variance approach. As the equity indices have return distributions with small deviations from normality, the findings indicate much broader usefulness of full‐scale optimization than has earlier been shown. The results hold in‐ and out‐of‐sample, and the performance improvements are given in terms of utility as well as certainty equivalents.
Promoting patient–practitioner partnership in clinical training: a critical evaluation
Authors: Gale Nicola Kay
Published: November 2008

This study provides a critical assessment of the application of the ‘partnership’ model of clinical interaction in an educational context, in the light of ethnographic research on education in complementary and alternative medicine (CAM). The concept of ‘partnership’ in healthcare practice is central to current health policy developments in the UK and the sense of patient empowerment in a more equitable practitioner–patient relationship is often cited as a reason why people are turning to CAM in ever greater numbers. After locating the concept of partnership in its policy and theoretical context (comparing it with traditional and consumer models), the study draws on ethnographic research with student osteopaths and homeopaths to explore the extent to which partnership can be achieved in clinical training situations. The implications for a working concept of professional expertise are subsequently discussed. I argue that the partnership model of clinical interaction is a useful point of departure for critically exploring issues in the patient–practitioner relationship in an educational context.
Just deserts? Developing practice in youth justice
Authors: Kubiak Chris , Hester Richard
Published: November 2008

This paper considers the issues involved in developing a programme for youth justice practitioners. Contemporary youth justice practice occurs in an increasingly managerialist and punitive context raising questions about how best to develop effective practitioners. It is argued that youth justice practice involves a recurring challenge of meeting situations of high complexity that must be dealt with on a case‐by‐case basis, guided by a clear understanding of how offending behaviour is constituted. The Professional Certificate in Effective Practice is reviewed and it is argued that education must emphasize reflective understanding. A critique of competency‐based education in relation to the Diploma in Probation Studies is also presented arguing that such an approach renders invisible important aspects of practice. Recommendations are made for a curriculum for a youth justice programme which stresses humanism, reflective understanding of context and history, criminology, sociology and psychology, social exclusion, social control, risk, victimology and comparative youth justice.
Evaluation of two soil conditioners for limiting post‐fire erosion as part of a soil conservation strategy
Authors: Darboux F. , Robin J.‐G. , Fox D.
Published: November 2008

Soil conservation is a major concern for catchments affected by forest fires. The lack of vegetation cover and the development of soil water repellency increase the risk of topsoil erosion. This paper evaluates two soil conditioners (a wetting agent and a polyvinyl acetate) for limiting overland flow and erosion in inter‐rill areas. Unburned and burned soil samples were treated with one or both soil conditioners. The effects of these treatments on run‐off, water retention, erosion and plant growth were assessed using laboratory rainfall simulations. Polyvinyl acetate had little impact on water retention but was effective in reducing soil loss. The surfactant had little impact on water run‐off or soil loss but substantially improved water retention and plant biomass production. Application of soil conditioners on post‐fire areas could be a valuable technique in a soil conservation strategy. To maximize their benefits, soil conditioners could be applied with seeding using hydroseeding techniques and be limited to particular areas, such as paths and roadsides. Laboratory results indicate that field testing should also be carried out.
Effect of Left Ventricular Lead Concordance to the Delayed Contraction Segment on Echocardiographic and Clinical Outcomes after Cardiac Resynchronization Therapy
Authors: FUNG JEFFREY W.H. , LAM YAT‐YIN , ZHANG QING , YIP GABRIEL W.K. , CHAN WINNIE W.L. , CHAN GARY C.P. , CHAN JOSEPH Y.S. , YU CHEUK‐MAN
Published: November 2008

Introduction: The optimal left ventricular (LV) pacing site for cardiac resynchronization therapy (CRT) is unclear. The current study aims to explore the clinical significance of LV lead concordance to delayed contraction segment in CRT.

Methods and Results: Concordant LV lead position was defined as the lead tip located by fluoroscopy at or immediately adjacent to the LV segment with latest contraction determined by tissue Doppler imaging. Echocardiographic and clinical outcomes among 101 consecutive patients with or without concordant LV lead positions were compared. There was no significant difference in changes in LV volumes and clinical parameters between patients with concordant (n = 46) or nonconcordant (n = 55) LV lead positions at 3 and 6 months. In multivariate analysis, the baseline asynchrony index (β= 1.092, 95% CI: 1.050–1.114; P < 0.001), but not LV lead concordance, was the only independent predictor of LV reverse remodeling. By Cox regression analysis, ischemic etiology, and LV reverse remodeling, but not LV lead concordance, were independent predictors of mortality (β= 2.475, 95% CI: 1.183–5.178; P = 0.016, and β= 0.272, 95% CI: 0.130–0.567; P < 0.001, respectively), cardiovascular hospitalization (β= 1.551, 95% CI: 1.032–2.333; P = 0.035, and β= 0.460, 95% CI: 0.298–0.708; P < 0.001, respectively), and heart failure hospitalization (β= 0.486, 95% CI: 0.320–0.738; P = 0.001 for LV reverse remodeling).

Conclusion: LV lead concordance to the delayed contraction segment may not be a major determining factor for favorable echocardiographic and clinical outcomes after CRT.
Radiofrequency Catheter Selection Based on Cavotricuspid Angiography Compared with a Control Group with an Externally Cooled‐Tip Catheter: A Randomized Pilot Study
Authors: DA COSTA ANTOINE , ROMEYER‐BOUCHARD CÉCILE , JAMON YANN , BISCH LAURENCE , ISAAZ KARL
Published: November 2008

Background: Radiofrequency ablation (RFA) of cavotricuspid isthmus (CTI)‐dependent atrial flutter (AFL) can be performed using either externally cooled‐tip RFA catheters or large‐tip (8 mm) catheters. However, experimental and clinical studies suggest that the efficacy of both catheters may vary with CTI anatomy and catheters orientation.

Objectives: The aim of this prospective study was to evaluate: a RFA catheter selection based on CTI angiography compared with a control group with an externally cooled‐tip catheter together with the risk of an expensive crossover catheter in both groups.

Method: Over a period of 16 months, 119 patients were included and randomized.

Results: When comparing the angiographic group (n = 56) and the externally cooled‐tip RFA catheter group (n = 63), the duration of application time with a median of 7 min (interquartile range 4.5–11) versus a median of 10 min (interquartile range 6–20; P = 0.008) and the duration of X‐ray exposure with a median of 7 min (interquartile range 4–10) versus a median of 10 min (interquartile range 5–15; P = 0.025) were significantly lower in the angiographic group versus externally cooled‐tip catheter group. Furthermore, the number of catheters crossover was significantly higher in the angiographic group versus externally cooled‐tip catheter group I (27% vs 7%; P = 0.007).

Conclusions: This study shows that a strategy with a catheter selection based on a CTI angiographic evaluation is superior to an empirical use of an externally cooled‐tip catheter during CTI RFA. Thus, angiographic isthmus evaluation predicts the effectiveness of a RFA catheter and the risk of an expensive catheter crossover.
Formation of a Nanocrystalline Layer on the Surface of Stone Wool Fibers
Authors: Yue Yuanzheng , Korsgaard Martin , Kirkegaard Lise Frank , Heide Gerhard
Published: November 2008

In the present paper, we report a simple approach for creating a nanocrystalline layer on the surface of stone wool fibers (SWFs) with a basalt‐like composition. The approach is based on a preoxidation process of the SWFs in atmospheric air at a temperature around the glass transition temperature (Tg) for various durations. During preoxidation, the network‐modifying ions diffuse from the interior toward the surface of SWFs and react with oxygen on the surface to form oxides. This diffusion process is accompanied by an inward diffusion of electron holes via the oxidation process of Fe2+ to Fe3+. It is found that the diffusion of Mg2+ is dominant in the overall diffusion process. The main phase of the nanocrystalline layer is identified to be periclase (MgO) crystals. The thickness of the nanocrystalline layer can be varied by adjusting the temperature and the duration of preoxidation. The nanocrystalline layer plays a significant role in enhancing the high‐temperature stability of the SWFs.
Improved Microwave Dielectric Properties of Ba6Ti1−xSnxNb4O18 Ceramics
Authors: Zhang Hui , Fang Liang , Su Heping , Yu Qian , Wu Bolin
Published: November 2008

Single‐phase polycrystalline microwave dielectric ceramics Ba6Ti1−xSnxNb4O18, with x changing from 0 to 1, were synthesized by the solid‐state reaction method. All the solid solutions fitted well with A6B5O18 cation‐deficient hexagonal perovskite structure. The substitution of Sn for Ti effectively enhanced the quality factor and controlled τf. With increasing Sn content, the dielectric constant decreased from ∼47 to ∼32, and the Q×f value increased significantly from 11 530 to 28 496 GHz, with τf varying from 64 to 0 ppm/°C. A zero τf was realized when Sn was fully replaced by Ti with the composition Ba6SnNb4O18.
Quantifying structural variation in contour feathers to address functional variation and life history trade‐offs
Authors: Butler Luke K. , Rohwer Sievert , Speidel Markus G.
Published: November 2008

Body feathers are important to many interactions birds have with their physical and social environments, such as streamlining the body for flight, thermoregulation, and social signaling. Birds differ dramatically in the texture of their body plumage depending on species and age class, likely reflecting different functional demands and age‐related trade‐offs in feather production. Despite the important insights potentially offered by studying variation in the structure of body feathers, there is no clear system for quantifying this variation. We present methods for quantifying age and species differences in the structure of body feathers. Most variation in our measures is due to species and age‐class differences, with little variance attributable to individual birds or to differences among feathers sampled from the same bird. We use our measures to test the hypothesis that the loosely‐textured plumage characteristic of many juvenile passerines reflects a trade‐off between investment in feather quality and rapid body growth that promotes early fledging. The structure of juvenile feathers was negatively correlated with duration of the nestling period among ten species of New World warblers (Parulidae), suggesting a trade‐off between investment in feathers and investment in rapid somatic development promoting fledging. Systematic studies of variation in the structure of body feathers will likely offer numerous other insights into avian biology.
Marriage Following Adolescent Parenthood: Relationship to Adult Well‐being
Authors: Gillmore Mary Rogers , Lee Jungeun , Morrison Diane M. , Lindhorst Taryn
Published: November 2008

Research suggests that adult marriages confer benefits. Does marriage following a teenage birth confer benefits similar to those observed for adults? Longitudinal data from a community sample of 235 young women who gave birth as unmarried adolescents were used to examine this question. Controlling for socioeconomic status and preexisting “benefits,” we found that marriage conferred small, though statistically significant, benefits with regard to less economic adversity and less marijuana and polydrug use but no observable benefits with regard to alcohol or other drug use, poverty, psychological well‐being, or high school completion, in contrast to prior findings. We conclude that in addition to the marriage benefits observed, stable intimate relationships, whether marital or not, appear to confer psychological benefits in this sample.
Mother and Grandmother Parenting in Low‐Income Three‐Generation Rural Households
Authors: Barnett Melissa A. ,   The Family Life Project Key Investigators
Published: November 2008

This study draws data from the Family Life Project to examine parenting behaviors observed for 105 mothers and grandmothers raising an infant in rural low‐income multigenerational households. Multilevel models are used to examine the relationships between maternal age and psychological distress and parenting of the infant by both generations. The findings indicate that young maternal age is a risk factor for less sensitive parenting in the presence of other risks, including psychological distress. Further, young maternal age is associated with negative parenting behaviors by grandmothers only. Grandmothers and mothers displayed similar levels of negative intrusive parenting, but different factors were linked to the observed parenting of each generation. These findings contribute to understanding the benefits and risks of three‐generation households.
Braving Jim Crow to Save Willie McGee: Bella Abzug, the Legal Left, and Civil Rights Innovation, 1948–1951
Authors: Zarnow Leandra
Published: November 2008

This article considers the role of Bella Abzug, lead counsel for Willie McGee from 1948–1951, in shaping the defense of this Cold War era Mississippi rape case. Representing McGee left an indelible mark on Abzug: she made her first trip south, wrote her first Supreme Court petition, and faced her first death threat. Participation in the Left legal bar—especially the National Lawyers Guild and Left feminist circles—shaped Abzug's legal consciousness as she redirected the McGee defense significantly in 1950. By joining race and sex, Abzug's legal argument zeroed in on the taboo of interracial sexual relations at the heart of Southern rape cases, thereby exposing the innermost sexual color line. She urged the courts and cause lawyers—albeit unsuccessfully—to pursue a more radical civil rights agenda than outlawing public segregation, as ultimately achieved inBrown v. Board of Education(1954), and typically recognized in Cold War civil rights scholarship.