bluuebunny/crossref_metadata_2025 huggingface dataset:
Traditional risk factor assessment does not capture the extent of cardiovascular risk in systemic lupus erythematosus
Authors: Lee A. B. , Godfrey T. , Rowley K. G. , Karschimkus C. S. , Dragicevic G. , Romas E. , Clemens L. , Wilson A. M. , Nikpour M. , Prior D. L. , Best J. D. , Jenkins A. J.
Published: March 2006

Background: Systemic lupus erythematosus (SLE) is associated with accelerated atherosclerosis. However, the degree of endothelial dysfunction and its relationship to traditional and novel cardiovascular risk factors have not been examined in SLE.

Methods: In a case–control design, 35 patients with clinically stable SLE and 35 control subjects matched for age, sex, body mass index and smoking status were studied. Arterial elasticity, lipid profile, homocysteine, measures of inflammation and oxidative stress were determined.

Results: Among traditional vascular risk factors, there was a nonsignificant trend towards lower blood pressure in the control subjects, whereas low‐density lipoprotein (LDL) cholesterol levels were significantly lower in the SLE group (2.5 vs 3.3 mmol/L, P < 0.001). Patients with SLE had significantly lower small artery elasticity (SAE; 4.9 vs 7.0 ml/mmHg × 100, P < 0.001) and higher plasma homocysteine (11.4 vs 8.3 mmol/L, P = 0.002) than control subjects. Levels of serum sVCAM‐1 (614 vs 494 ng/mL, P = 0.002), oxidized LDL (144 vs 97, P < 0.001) and CD40 ligand (4385 vs 1373 pg/ml, P = 0.001) were significantly higher in SLE. Oxidized LDL levels, older age at SLE diagnosis and higher disease damage scores correlated inversely with SAE but not traditional risk factors.

Conclusion: Impaired endothelial function as shown by decreased SAE, and an adverse profile of novel proatherogenic and prothrombotic vascular disease risk factors were prevalent in clinically quiescent SLE. These findings show the vulnerability of patients with SLE for atherosclerosis, and emphasize that assessments based on traditional risk factors alone may be inadequate.
On the need for probity when physicians interact with industry
Authors: Scott I. A.
Published: March 2006

Physicians are expected to practice scientifically sound medicine, to be critical of industry claims, and to be immune from making clinical decisions biased by commercial sponsorship and marketing. The reality, as argued in this article, is that much of medical research, in its conduct and reporting, is distorted by commercial interests and that physician decision‐making remains vulnerable to the effects of subliminal commercial promotion which has the potential to create conflicts of interest, or perceptions thereof, and undermine public trust. Research is presented that may encourage physicians to view recently revised Royal Australasian College of Physicians (RACP) guidelines on the ethical relationships between the medical profession and industry as an attempt to deal with such conflicts in protecting our authority and standing within the community.
Does being against euthanasia legislation equate to being anti‐euthanasia?
Authors: Cartwright C. M. , Williams G. M. , Parker M. H. , Steinberg M. A.
Published: March 2006

This study investigated issues raised in qualitative data from our previous studies of health professionals and community members, which suggested that being opposed to euthanasia legislation did not necessarily equate to being anti‐euthanasia per se. A postal survey of 1002 medical practitioners, 1000 nurses and 1200 community members was undertaken. In addition to a direct question on changing the law to allow active voluntary euthanasia (AVE), four statements assessed attitudes to euthanasia with or without a change in legislation. Responses were received from 405 doctors (43%), 429 nurses (45%) and 405 community members (38%). Compared with previous studies there was a slight increase in support for a change in the law from medical practitioners, a slight decrease in support from community members and almost no change among nurses. Different interpretations of the results of the four attitude questions are possible, depending on the perspective of the interpreter.
Cost‐effectiveness of current and optimal treatment for adult asthma
Authors: Simonella L. , Marks G. , Sanderson K. , Andrews G.
Published: March 2006

Background: This article is part of a project to determine the cost‐effectiveness of averting the burden of disease. We used population data to investigate the costs and benefits of allocating resources to optimal treatment for asthma in adults, using a burden of disease framework.

Methods: We calculated the population burden of asthma in the absence of any treatment as years lived with disability (YLD), ignoring the years of life lost. We then estimated the proportion of burden averted with current interventions, the proportion that could be averted with optimally implemented current evidence‐based guidelines and the direct treatment cost‐effectiveness ratio in $A per YLD averted for both current and optimal treatment.

Results: The direct treatment cost of current treatment of adult asthma in Australia was $A452 million and averted 25% of the burden with a cost‐effectiveness ratio of $A14 000/YLD averted. Optimal treatment and optimal compliance would cost $A627 million and avert 69% of the burden with a cost‐effectiveness ratio of $A7000/YLD averted.

Conclusion: Implementation of optimal treatment for asthma is affordable, will be more cost‐effective and will significantly decrease disability.
Rituximab use in systemic lupus erythematosus pneumonitis and a review of current reports
Authors: Lim S. W. , Gillis D. , Smith W. , Hissaria P. , Greville H. , Peh C. A.
Published: March 2006

Rituximab is a chimeric monoclonal antibody specific for human CD20 that causes selective transient depletion of the CD20+ B‐cell subpopulation. We report the first case of systemic lupus erythematosus (SLE) pneumonitis resistant to conventional treatments that responded well to rituximab and review current reports on the use of rituximab in SLE.
A vacuum device for penile elongation: fact or fiction?
Authors: AGHAMIR MOHAMMAD KAZEM , HOSSEINI REZA , ALIZADEH FARSHID
Published: March 2006

OBJECTIVE

To assess the efficacy of a vacuum device as a noninvasive method for penile elongation.

PATIENTS AND METHODS

Between September 2003 and November 2004, 37 sexually active men with a stretched penis length of <10 cm were given vacuum treatment three times a week, for 20 min on each occasion, for 6 months.

RESULTS

After 6 months, the mean penile length had increased from 7.6 cm to 7.9 cm (no significant difference). The efficacy of vacuum treatment was ≈ 10%, and the patient satisfaction rate was 30%. There was one case of haematoma of the penis and one of glans numbness, both resolved spontaneously without any intervention.

CONCLUSION

Vacuum treatment of the penis is not an effective method for penile elongation, but provides psychological satisfaction for some men.
Polymorphisms in the α1A‐adrenoceptor gene do not modify the short‐ and long‐term efficacy of α1‐adrenoceptor antagonists in the treatment of benign prostatic hyperplasia
Authors: MOCHTAR CHAIDIR A. , LAAN WIJNAND , VAN HOUWELINGEN KJELD P. , FRANKE BARBARA , DE LA ROSETTE JEAN J.M.C.H. , SCHALKEN JACK A. , KIEMENEY LAMBERTUS A.L.M.
Published: March 2006

OBJECTIVE

To determine whether a common single nucleotide polymorphism (SNP) in the ADRA1A gene encoding the α1A‐adrenoceptor modifies the short‐ and long‐term efficacy of α1‐adrenoceptor antagonists in the treatment of benign prostatic hyperplasia (BPH).

PATIENTS AND METHODS

For 254 patients with BPH and/or lower urinary tract symptoms who received α1‐adrenergic antagonists for ≥ 3 months, the ADRA1A genotype at position 1475 of the coding region was determined. The patients’ short‐term response to treatment was determined for four outcome measures, i.e. the International Prostate Symptom Score (IPSS), the IPSS quality‐of‐life score, peak urinary flow rate, and obstruction grade, stratified by genotype. Eventual BPH‐related invasive therapy was used as the outcome for assessing the long‐term response to treatment. Genetic variants at positions 834, 896, 898 and 1831 were too rare to be considered in the analysis.

RESULTS

There were no significant differences for the genotype strata in three of the four outcome measures. Patients with the CC genotype responded significantly better in quality‐of‐life perception than patients with the CT or TT genotype. There were also no significant differences in the risk of BPH‐related invasive therapy among the three genotypes.

CONCLUSIONS

The 1475C→T SNP in the ADRA1A gene does not modify the short‐ and long‐term efficacy of α1‐adrenoceptor antagonists for treating BPH. There was a small effect on perceived quality of life but this was not reflected in other variables that measured the treatment response more directly.
Biocompatibility properties of a new braided biodegradable urethral stent: a comparison with a biodegradable spiral and a braided metallic stent in the rabbit urethra
Authors: ISOTALO TAINA M. , NUUTINE JUHA‐PEKKA , VAAJANEN ANU , MARTIKAINEN PAULA M. , LAURILA MARITA , TÖRMÄLÄ PERTTI , TALJA MARTTI , TAMMELA TEUVO L.
Published: March 2006

OBJECTIVE

To compare the biocompatibility properties of a new braided biodegradable self‐reinforced poly‐l‐lactic acid (SR‐PLLA) urethral stent to the former spiral biodegradable SR‐PLLA stent and the stainless steel stent in a rabbit model.

MATERIALS AND METHODS

In all, 54 male New Zealand White rabbits were anaesthetized and stents inserted into the prostatic urethra, three of each kind for each sample time. The rabbits were killed after 1, 3, 6, 9, 12 or 15 months and light microscopy and scanning electron microscopy used to analyse the effects.

RESULTS

The disintegration of the braided SR‐PLLA stent was more closely controlled than that of the spiral SR‐PLLA stent. The metallic stent induced epithelial hyperplasia and polyposis earlier than the biodegradable stents, and in these rabbits the polyposis disappeared after the disintegration process. There were no differences in the histological analyses between the biodegradable stents, whereas the metallic stents caused the strongest inflammatory reactions.

CONCLUSIONS

The braided SR‐PLLA urethral stent functioned well in the rabbit urethra and clinical studies are already planned.
Effect of cyclooxygenase inhibitors on the micturition reflex in rats: correlation with inhibition of cyclooxygenase isozymes
Authors: ANGELICO PATRIZIA , GUARNERI LUCIANO , VELASCO CRISTINA , COVA RITA , LEONARDI AMEDEO , CLARKE DAVID E. , TESTA RODOLFO
Published: March 2006

OBJECTIVE

To investigate the role of cyclooxygenase (COX) isozymes (COX‐1 and ‐2) in the regulation of bladder volume capacity (BVC) in several rat urodynamic models, using a selection of nonsteroidal anti‐inflammatory drugs (NSAIDs), some selective for COX‐2, correlating the potency of the tested compounds in the urodynamic models and their in vitro potency as inhibitors of COX isozymes, to verify the relative importance of the different isozymes.

MATERIALS AND METHODS

The effects of an i.v. administration of several nonselective and selective COX‐2 inhibitors (indomethacin, meloxicam, naproxen, aspirin, paracetamol, flurbiprofen, nimesulide, NS‐398, celecoxib, rofecoxib and L 745337) on bladder filling and voiding were evaluated in conscious and anaesthetized rats by cystometry. The cystometry was done in conscious rats 1 day after catheter implantation, by filling the bladder with dilute acetic acid (0.2%) or saline, and again with saline 5 days after catheterization. Effects on isovolumic bladder contractions in anaesthetized rats were also evaluated.

RESULTS

All the NSAIDs tested dose‐dependently increased BVC; their potency at increasing BVC during infusion of the bladder with acetic acid was similar to that evaluated with saline on cystometry 1 day after catheterization. When a nonselective (naproxen) and a selective (nimesulide) COX‐2 inhibitor were tested in rats with bladders infused with saline 5 days after catheterization, their effects on BVC were significantly lower than those evaluated at 1 day. All tested compounds dose‐dependently inhibited isovolumic bladder contractions in anaesthetized rats. There was a good correlation between the potency in inhibiting the isovolumic bladder contractions in anaesthetized rats and in increasing BVC during cystometry in conscious rats with the bladder infused with acetic acid. The potency of the compounds in the cystometry model with bladders infused with acetic and in the isovolumic bladder voiding contractions correlated well with COX‐2 inhibition, but not COX‐1.

CONCLUSIONS

Both nonselective and COX‐2 selective inhibitors are more active in inhibiting the micturition reflex in rats with bladder overactivity caused by bladder irritation than in normal rats. The potency of the anti‐inflammatory compounds in inhibiting bladder overactivity induced by chemical or surgical irritation, and their activity in a cystometrographic model practically independent of bladder irritation (isovolumic bladder contractions in anaesthetized rats), was related to the potency as inhibitors of COX‐2 isozyme. This suggests that the involvement of prostaglandins in the micturition reflex in rats is mainly mediated by this isozyme.
Bladder wall replacement by tissue engineering and autologous keratinocytes in minipigs
Authors: BREHMER BERNHARD , ROHRMANN DOROTHEA , RAU GÜNTER , JAKSE GERHARD
Published: March 2006

OBJECTIVE

To develop a tissue‐engineered bladder wall replacement with autologous cells and a biodegradable scaffold, as whenever there is a lack of native urological tissue the bladder is reconstructed with different bowel segments, which has inevitable complications.

MATERIAL AND METHODS

Skin biopsies were taken from six minipigs, and primary fibroblast and keratinocyte cell cultures established. A partial resection of the urinary bladder was reconstructed by a cell‐seeded scaffold covered with completely differentiated epithelium and supported by a mucosa‐free pedicled ileum graft. Each pig was assessed urodynamically and by cystography before operation and every month until explantation; the pigs were killed at 1, 2 and 3 months after augmentation. Control groups (of six pigs each) with bladder augmentation with complete or denuded ileum were used. The bladders were assessed histologically and by distensibility measurements

RESULTS

The differentiated keratinocyte epithelium was still present on the reconstructed bladder wall after 3 months. The overall shrinkage rate was 6.5%. The engineered bladder wall had lower distensibility than the native one. The inflammatory reaction present initially had disappeared after 3 months.

CONCLUSIONS

The implanted, tissue‐engineered substitution of the bladder wall is not only a bridging graft, but also a complete reconstruction. With this model, extended bladder wall substitution seems feasible and should be investigated in further studies.
Endoglin (CD105) expression in human renal cell carcinoma
Authors: SANDLUND JOHANNA , HEDBERG YLVA , BERGH ANDERS , GRANKVIST KJELL , LJUNGBERG BÖRJE , RASMUSON TORGNY
Published: March 2006

OBJECTIVE

To evaluate the prognostic potential of endoglin (CD105) expression in human renal cell carcinoma (RCC), as endoglin is a cell membrane glycoprotein expressed in tumour‐associated vascular endothelium and a marker of angiogenesis; intratumoral microvessel density assessed by endoglin staining has prognostic significance in some neoplasms.

PATIENTS AND METHODS

Tumour samples from 210 patients with RCC (168 conventional), diagnosed between 1982 and 1997, were assessed using the tissue microarray technique with immunohistochemical staining for endoglin. The expression of endoglin was related to clinical variables and survival.

RESULTS

Of the tumours, 75% expressed endoglin, and in conventional RCC the expression was inversely correlated to the Tumour‐Node‐Metastasis (TNM) stage (P = 0.008) and nuclear grade (P = 0.01). There was no correlation between endoglin expression and gender, age, tumour size or cell type. Patients with conventional RCC and high endoglin expression had a more favourable prognosis than those with tumours with lower expression (P = 0.04). A multivariate analysis of prognostic factors showed that TNM stage and nuclear grade were independent predictors of prognosis. Endoglin expression did not add further prognostic information.

CONCLUSION

These results indicate that endoglin expression is inversely related to stage and grade in RCC, and that it is associated with prognosis.
Treating renal cell cancer in the elderly
Authors: BERDJIS NAVID , HAKENBERG OLIVER W. , NOVOTNY VLADIMIR , FROEHNER MICHAEL , WIRTH MANFRED P.
Published: March 2006

OBJECTIVE

To determine whether age and comorbidity are predictors of peri‐operative complications and/or mortality in surgery for renal cell cancer in a retrospective study of patients aged >75 years.

PATIENTS AND METHODS

Between 1993 and 2003, 1023 radical nephrectomies or nephron‐sparing surgery for renal cell cancer were performed in 115 consecutive patients aged ≥ 75 years and in 908 consecutive patients aged <75 years. The preoperative American Society of Anesthesiologists (ASA) score was used for risk stratification. Operative mortality and early complications (within 30 days of surgery) were reviewed.

RESULTS

The younger patients had significantly lower ASA scores than the older patients. There were early complications in 31 of the 908 younger patients (3.4%) and in two of the 115 older patients (1.7%). Peri‐operative mortality was higher in the older than in the younger patients (1.7% vs 0.3%; P = 0.29). Overall morbidity and mortality correlated with increasing ASA score but not with age (P < 0.05).

CONCLUSIONS

Despite greater comorbidity in older patients, their morbidity and mortality did not differ significantly from that of younger patients. Advanced age alone should thus not be used as a criterion to deny surgery for renal cell carcinoma. However, older patients should be counselled regarding a tendency for increased comorbidity‐related peri‐operative mortality.
Relationship between serum prostate‐specific antigen and prostate volume in Korean men with benign prostatic hyperplasia: a multicentre study
Authors: CHUNG BYUNG HA , HONG SUNG JOON , CHO JIN SEON , SEONG DO HWAN ,   Severance Urologic Oncologic Group
Published: March 2006

OBJECTIVES

To evaluate the relationship between prostate specific antigen (PSA) and prostate volume (PV) in Korean men, as PV is a key predictor of both disease progression and response to medical therapy in patients with benign prostatic hyperplasia (BPH), and PSA has been suggested as a proxy marker to estimate the total PV, mainly in Caucasians.

PATIENTS AND METHODS

From 1999 to 2004, men aged 50–79 years with lower urinary tract symptoms (LUTS) and BPH were enrolled into this multicentre study. The analyses included 5716 patients presenting to 11 medical centres with LUTS (International Prostate Symptom Score >8, peak urinary flow rate <15 mL/s); they had a mean age of 64.3 years, mean baseline PV of 36.9 mL, and mean baseline PSA level of 2.2 ng/mL. Men with a baseline PSA of >10 ng/mL were excluded, to reduce the likelihood of including occult prostate cancer. A biopsy was taken in those with suspicious findings on a digital rectal examination or serum PSA level of >4 ng/mL, to exclude prostate cancer. Receiver operating characteristic (ROC) curves were constructed to evaluate the ability of serum PSA to predict threshold PV in men with BPH

RESULTS

The PV and serum PSA level had an age‐dependent log‐linear relationship, the strength of which increased with age. The ROC curve analysis showed that PSA had good predictive value for various prostate volume thresholds (30, 40 and 50 mL).

CONCLUSIONS

The PSA‐PV relationship in Korean men is similar to that in Caucasians, but Korean men have a slightly lower PSA level and a smaller PV than Caucasians. The approximate age‐specific criteria for detecting Korean men with a PV of >40 mL were a PSA level of >1.3 ng/mL, >1.7 ng/mL and >2.0 ng/mL for men with BPH in their sixth, seventh and eighth decade, respectively.
Inguinal metastases from testicular cancer
Authors: DAUGAARD GEDSKE , KARAS VLADIMIR , SOMMER PETER
Published: March 2006

OBJECTIVE

To evaluate the incidence of inguinal metastases in patients with testicular cancer and relapse after initial stage I disease.

PATIENTS AND METHODS

Of 695 patients, 14 (2%) with stage I testicular cancer developed inguinal metastases during the follow‐up on a surveillance programme. At orchidectomy, one patient had involvement of the tunica albuginea and one a history of cryptorchidism and development of testicular cancer on the contralateral side. The remaining patients had no history of previous surgery in the inguinal region or in the scrotal area, or any other known risk factors for developing inguinal‐node metastases. Two patients had a seminoma (0.5%) and 12 (4%) a nonseminoma. The histopathological examination showed that the metastases were in lymph nodes in four patients, the remainder having a more diffuse involvement of the tissue in the inguinal region. At relapse, patients were treated by three or four cycles of bleomycin, etoposide and cisplatin, except those with low‐stage seminomas (stage IIa and IIb), who were treated by radiation therapy.

RESULTS

All patients had a complete remission after treatment with chemotherapy or radiotherapy. No patients died or developed a recurrence during the median follow‐up of 72 months.

CONCLUSION

Metastases to the inguinal region are found in ≈ 2% of patients with testicular cancer; about a quarter have lymph‐node metastases, the rest probably having metastases to the spermatic cord with direct invasion into the surrounding tissue. High ligation of the spermatic cord is therefore important. Chemotherapy for patients with nonseminoma and radiotherapy for patients with seminoma gives excellent results.
The use of endoluminal ultrasonography for preventing significant bleeding during endopyelotomy: evaluation of helical computed tomography vs endoluminal ultrasonography for detecting crossing vessels
Authors: HENDRIKX AD J.M. , NADORP SVEN , DE BEER NICOLE A.M. , VAN BEEKUM JOOST B. , GRAVAS STAVROS
Published: March 2006

OBJECTIVE

To evaluate, in a prospective study, the efficiency of helical computed tomography (CT) and endoluminal ultrasonography (ELUS) for detecting significant crossing vessels, a major cause of bleeding complications when treating patients with pelvi‐ureteric junction (PUJ) obstruction, and to compare our results using ELUS with those of an earlier multicentre study (not using ELUS), to see whether the complication rate decreased.

PATIENTS AND METHODS

The study included 27 patients with a PUJ who had isotope renography, intravenous urography, helical CT and ELUS before surgery. Depending on the findings of ELUS, patients were treated with a pure lateral AcuciseTM incision (Applied Medical, Irvine, CA, USA) an Acucise with changed cutting direction, or (later) a laparoscopic pyeloplasty.

RESULTS

ELUS detected 15% more crossing vessels than helical CT; 16 patients had Acucise (seven lateral, nine other cutting direction), eight were treated with a laparoscopic pyeloplasty and three with other procedures. By contrast with earlier reports and as a consequence of using ELUS, there was no bleeding, vs 16% in the study not using ELUS. The success rate of 73% of the endourological approach is comparable with previous reports.

CONCLUSION

ELUS is more sensitive in detecting relevant crossing vessels than helical CT and therefore the use of ELUS can better prevent bleeding complications. ELUS can also improve the success rate by helping in selecting the correct treatment. Because it is minimally invasive and safe, ELUS combined with Acucise (or other possible endourological techniques, like holmium laser incision) should be the first choice of treatment for PUJ stenosis.
Comparison of two α1‐adrenoceptor antagonists, naftopidil and tamsulosin hydrochloride, in the treatment of lower urinary tract symptoms with benign prostatic hyperplasia: a randomized crossover study
Authors: NISHINO YOSHINORI , MASUE TAKAKO , MIWA KOUSEI , TAKAHASHI YOSHITO , ISHIHARA SATOSHI , DEGUCHI TAKASHI
Published: March 2006

OBJECTIVES

To compare the efficacy of two α1‐adrenoceptor antagonists, α1A‐adrenoceptor‐selective tamsulosin hydrochloride and α1D‐adrenoceptor‐selective naftopidil, in the treatment of lower urinary tract symptoms (LUTS) with benign prostatic hyperplasia (BPH).

PATIENTS AND METHODS

Thirty‐four patients (mean age 72.4 years, sd 4.3, range 66–79) with LUTS (International Prostate Symptom Score, IPSS >8) secondary to BPH were enrolled in a randomized crossover study. Seventeen patients were initially prescribed naftopidil 50 mg for 4 weeks, followed by tamsulosin 0.2 mg for 4 weeks (group A); another 17 were initially prescribed tamsulosin 0.2 mg, followed by naftopidil 50 mg (group B). Patients changed to the alternative treatment after a 1‐week washout period. Efficacy criteria were improvement in LUTS (IPSS), quality of life (QoL), uroflowmetry, and pressure‐flow study (PFS) values based on the treatment with each agent.

RESULTS

At baseline there were no significant differences between the groups in IPSS, QoL, uroflowmetry values or PFS values, except for the volume at maximum desire to void. After treatment with each agent, the IPSS and QoL were significantly improved and the reduction in bladder outlet obstruction confirmed by PFS. Naftopidil was significantly more effective than tamsulosin in relieving nocturia. The increases from baseline (before treatment) to the endpoint (after treatment with each agent) in the volume at first desire and maximum desire to void were significantly higher with naftopidil than with tamsulosin. Involuntary contractions disappeared in two patients with relief of nocturia with naftopidil, but not with tamsulosin. The decrease in other symptoms of the IPSS, QoL, increase in uroflowmetry values and changes in other PFS values were similar for both agents.

CONCLUSIONS

The two agents provided similar efficacy in the treatment of LUTS with BPH. However, naftopidil was better than tamsulosin for nocturia. The disappearance of involuntary contraction and the greater increase in first‐desire volume with naftopidil may be associated with the relief of nocturia. The α1D‐adrenoceptor antagonist is effective in alleviating both voiding and storage symptoms. The α1D‐adrenoceptor antagonist may be more effective than the α1A‐adrenoceptor antagonist in LUTS with BPH.
Antegrade scrotal sclerotherapy for treating primary varicocele in children
Authors: ZAUPA PAOLA , MAYR JOHANNES , HÖLLWARTH MICHAEL E.
Published: March 2006

OBJECTIVE

To evaluate the effectiveness and limitations of antegrade sclerotherapy (AS) for the treatment of primary varicocele in childhood.

PATIENTS AND METHODS

From December 1996 to December 2004, 88 patients (mean age 13.3 years, range 9–18) with primary varicocele underwent AS (91 varicocele ablations in all). The indications for surgery were testicular pain (16 boys, 18%), a large varicocele with cosmetic implications, testicular hypotrophy (one) and in 71 (81%) the varicocele was detected incidentally during a routine physical examination; all were left‐sided. According to the classification used by Tauber, 46 (52%) varicoceles were grade II and 42 (48%) grade III. The clinical and ultrasonography (US) results were evaluated over a median (range) follow‐up of 11 (3–60) months, and the operative duration, X‐ray exposure time, persistence rate of varicoceles and complications were compared with those using other techniques.

RESULTS

In 11 patients there was a palpable difference in size between the testicles, but in only five (6%) was testicular hypotrophy (testicular volume (<75% testicular volume vs the normal side) confirmed by US. The mean (sem) operative duration for AS was 33.2 (2.14) min. In 16 (18%) patients it was necessary to expose a second or third vein because the first vein chosen was unsuitable for sclerotherapy. The mean operative radiation exposure was 2.18 (0.21) s. One patient (1%) was treated with a high ligature of the testicular vein (Palomo procedure) after initial unsuccessful AS, and was excluded from the analysis. Eighty‐four (97%) patients were eligible for follow‐up: six (7%) had a persistent varicocele (four grade II, two grade III), four of whom had repeat sclerotherapy successfully (no recurrence at follow‐up). Fourteen (15%) patients had enlarged testicular veins only on US (varicocele grade 0). No patient developed a hydrocele after AS, There were complications after surgery in three (3%) patients (two superficial wound infections, one scrotal haematoma together with focal testicular necrosis).

CONCLUSIONS

AS is an efficient minimally invasive surgical method for correcting varicoceles in older children, although the operative duration is sometimes longer than in adults, and surgery can be more difficult because of the smaller veins. Partial testicular necrosis, despite correct AS, is a very rare but serious complication.
Comparative analysis of the frequency of lower urinary tract dysfunction among institutionalised and non‐institutionalised children
Authors: BARROSO UBIRAJARA , DULTRA ANDERSON , DE BESSA JOSÉ , BARROS DANIELA G. , MARON FABIO , BARROSO DANILO V. , MOREIRA EDSON DUARTE
Published: March 2006

OBJECTIVES

To evaluate the level of symptoms of lower urinary tract dysfunction (LUTD) in orphans in institutions, and compare these data with schoolchildren of the same age group who were not institutionalised, as LUTD in children is related to factors such as social isolation and low self‐esteem, with other psychological changes also being cited, although it is unknown whether these problems are primary or secondary to the symptoms of LUTD.

PATIENTS AND METHODS

Children institutionalised in orphanages with no parental presence and who are isolated from a family environment are probably more sensitive to psychological disturbances. Psychological changes have been associated with symptoms of urgency and urinary incontinence. Thus 89 orphans were compared with 143 schoolchildren not in institutions. A questionnaire was devised and completed by the care‐taking staff in the orphanage, while for the schoolchildren the parents completed the questionnaire. The mean age in the institutionalised children was 7.9 years and that of the control group 7.8 years (P = 0.32). Thirty‐nine (44%) of the orphans were boys, vs 74 (54%) of the control group (P = 0.17).

RESULTS

The incidence of urgency, diurnal urinary incontinence, nocturnal enuresis and constipation in the orphans and in the control group were: 45 (51%) and 57 (40) (P = 0.17), 36 (40%) and 19 (13%) (P < 0.001), 39 (47%) and 38 (27%) (P = 0.002), and 27 (30%) and 43 (30%) (P = 0.76), respectively.

CONCLUSION

Children living in orphanages have a significantly higher level of diurnal urinary incontinence and nocturnal enuresis than those not in an institution.
Extracorporeally induced ablation of renal tissue by high‐intensity focused ultrasound
Authors: HÄCKER AXEL , MICHEL MAURICE S. , MARLINGHAUS ERNST , KÖHRMANN KAI U. , ALKEN PETER
Published: March 2006

Authors from Germany describe the use of percutaneously applied high‐intensity focused ultrasound for non‐invasive tissue ablation. They found that the lessons they learned from the use of this technology in animals could be transferred to its use in humans, both of which are described. They indicate that refinements in the technology are essential before this treatment can be used outside the departmental stage.

The use of endoluminal ultrasonography is discussed by authors from the Netherlands, for preventing significant bleeding during endopyelotomy. In a prospective study, they evaluate this technology against helical CT.

OBJECTIVE

To investigate the safety and the effects on healthy renal tissue of high‐intensity focused ultrasound (HIFU) applied extracorporeally.

PATIENTS, MATERIALS AND METHODS

Ultrasound waves (1.04 MHz) created by a cylindrical piezo‐ceramic element were focused by a parabolic reflector to a physical focus size of 32 × 4 mm (−6 dB). For an in vivo study, HIFU was applied to the healthy tissue of 24 kidneys, monitored by ultrasonography, with a maximum power of 400 W and a spatially averaged intensity (ISAL) in the focus of 1192 W/cm2. Fourteen kidneys were removed immediately after ablation to evaluate the side‐effects and the effects in the focal zone, and 10 kidneys were removed delayed after 1, 7 and 10 days. The clinical study consisted of 19 patients requiring radical nephrectomy for a renal tumour. HIFU was applied to the healthy tissue of 19 kidneys (up to 1600 W, ISAL = 4768 W/cm2) before proceeding with the radical nephrectomy.

RESULTS

There were no major complications after applying HIFU to the 43 kidneys. Side‐effects included skin burns (grade 3) in two patients. During the follow‐up there were no further HIFU‐specific side‐effects. In one case (in vivo study) there was a thermal lesion of the small intestine, which was due to mis‐focusing. HIFU effects in the focal zone immediately after application were: interstitial haemorrhages, fibre rupture, shrinking of the collagen fibres, and coagulation necrosis. These effects occurred sporadically, and their number and size did not correspond to the number of HIFU pulses applied. After 7 and 10 days, there was a well‐demarcated coagulation necrosis in vivo.

CONCLUSION

Using this device, extracorporeally applied HIFU can ablate healthy kidney tissue in vivo in combination with diagnostic online ultrasonography. The technique is safe and resulted only in minor complications (skin burns). Refinements in the technology are essential to establish HIFU as a noninvasive treatment option that allows complete and reliable tissue ablation.
Technical characterization of a new bipolar and multipolar radiofrequency device for minimally invasive treatment of renal tumours
Authors: HÄCKER AXEL , VALLO STEFAN , WEISS CHRISTEL , STEIN THOMAS , ALKEN PETER , KNOLL THOMAS , MICHEL MAURICE STEPHAN
Published: March 2006

OBJECTIVE

To investigate the technical characteristics of a newly developed device for bipolar and multipolar radiofrequency ablation (RFA) of kidney tissue with a resistance‐controlled power output.

MATERIALS AND METHODS

The standardized model of the isolated perfused ex vivo porcine kidney was used. Two different applicators (20 and 30 mm active length) were selected for bipolar RFA, and one pair of applicators (2 × 30 mm active length) for multipolar RFA. RF energy was applied at different power levels (20, 30, 60 W) depending on the total active length of the electrodes. Treatment times were 1, 3, 5 and 9 min. The ablation cycles were recorded in continuous digital real‐time and displayed on a monitor showing pre‐set power, actual applied power, applied energy, tissue resistance, and impedance. Lesion sizes were measured macroscopically. A coagulation coefficient (coagulated tissue volume per applied energy unit) was calculated.

RESULTS

There was a dosage‐effect relationship between the generator power/treatment time and the sizes of the lesions. With increasing treatment time, less tissue volume was coagulated per unit of applied energy. The actual applied energy was lower than that calculated theoretically. The resistance and impedance values for the 30‐W applicator were lower than those of the 20‐W applicator.

CONCLUSIONS

The technical features of this RFA device, with internally cooled bipolar and multipolar applicators and a resistance‐controlled power output, represents an innovative improvement in RF technology. In vivo studies are needed to confirm the expected advantages and the suitability of this device for complete and reliable ablation of renal tumours.
An analysis of deaths related to urological surgery, reviewed by the State Coroner: a case for cardiac vigilance before transurethral prostatectomy
Authors: GYOMBER DENNIS , LAWRENTSCHUK NATHAN , RANSON DAVID L. , BOLTON DAMIEN M.
Published: March 2006

OBJECTIVES

To ascertain the frequency of in‐hospital deaths after urological surgery in a compulsory reporting setting, and to identify the contributing and potentially reversible factors involved in patients who had had transurethral resection of the prostate (TURP).

METHODS

We reviewed all hospital deaths reported to the State Coroner from Coronial Services Victoria (CSV), Australia, in 2000–2002 to identify those instances associated with urological surgery. These cases were then analysed using methods developed by CSV. Resources available included medical records, police reports, government data on operative procedures and autopsy results.

RESULTS

There were 20 in‐hospital deaths after urological surgery identified for the 3‐year period; most related to pre‐existing comorbidities, predominantly ischaemic heart disease. Two episodes of hospital‐acquired infection, two instances of technical complication of surgery contributing to death, and one pulmonary embolus were identified. Numerically the largest group of deaths after surgery was patients having TURP, and these deaths represented 0.05% (nine of 17 044) of all TURPs in this period. Most in this group (eight) had an acute myocardial infarction.

CONCLUSION

Death after urological surgery appears to be uncommon; assessing patients for coronary artery disease before urological surgery, particularly TURP, closer cardiovascular monitoring after surgery, and rapid transfer to a coronary care unit if required, may further reduce mortality.
Genitourinary small cell carcinoma: a retrospective review of treatment and survival patterns at The Ottawa Hospital Regional Cancer Center
Authors: ASMIS TIMOTHY R. , REAUME M. NEIL , DAHROUGE SIMONE , MALONE SHAWN
Published: March 2006

OBJECTIVE

To review patients with genitourinary (GU) small cell carcinoma (SCC) treated at a regional cancer centre, as due to its rarity and aggressive nature, GU SCC remains a therapeutic challenge.

PATIENTS AND METHODS

The charts of patients managed at a regional cancer centre between 1991 and 2002 for any GU diagnosis were manually reviewed to identify GU SCC. Demographic, staging, treatment and outcome data were extracted. The Veterans Administration small cell lung cancer staging classification of ‘limited’ or ‘extensive’ disease was adapted for SCC of the prostate and bladder (with ‘limited’ defined as disease localized to the true and false pelvis, and ‘extensive’ as disease beyond the pelvis).

RESULTS

In all, 555, 858 and 5066 new cases of primary renal, bladder and prostate cancer, respectively, were identified. Of these patients, 22 had GU SCC (12 bladder and 10 prostate; there were no cases of SCC of the kidney). Eight of 12 patients with bladder SCC had limited disease; five of 12 are alive (all with limited disease at diagnosis), and the median survival was 19.8 months. Surviving patients received similar therapy, with transurethral resection of the bladder tumour, platinum‐based chemotherapy, etoposide (4–6 cycles), and radical radiotherapy (56–60 Gy). Two of 10 patients with SCC of the prostate had limited‐stage disease, but all 10 died, the median survival being 9.5 months. Survival by stage for both types combined was 59 months for limited disease and 8 months for extensive disease.

CONCLUSIONS

These results indicate that GU SCC is an aggressive cancer; limited‐stage SCC of the bladder or prostate, when treated with platinum/etoposide chemotherapy and radical radiotherapy, has a more favourable outcome than that of extensive GU SCC.
A survey of help‐seeking and treatment provision in women with stress urinary incontinence
Authors: SHAW CHRISTINE , GUPTA ROBEN DAS , WILLIAMS KATE S. , ASSASSA R. PHILIP , MCGROTHER CATHERINE
Published: March 2006

OBJECTIVE

To establish the prevalence of treatment‐seeking in women with stress urinary incontinence (SUI), the extent and type of treatment provision, and the levels of unmet need in women who have and have not accessed care, as SUI in women is common but only a small proportion seek help, and there are reports suggesting that few women receive appropriate treatment.

SUBJECTS AND METHODS

A cross‐sectional postal survey was conducted in which questionnaires were sent to a random sample of community‐dwelling women aged ≥ 40 years, registered with participating general practitioners (GPs) and living in Leicestershire. The questionnaires addressed urinary symptoms and their impact on quality of life, and service use in the preceding 12 months; 15 359 questionnaires were mailed and 9340 (60.8%) were returned complete.

RESULTS

Of the respondents, 7.7% reported SUI monthly or more often, and 15% of those had sought help. Help‐seekers reported more severe symptoms and greater impact on quality of life. Most (78%) had spoken to their GP, and 77% had received some form of treatment or advice, but only 35% had received recommended treatments. The effects on quality of life were not related to treatment provision.

CONCLUSIONS

Most women with SUI are treated in primary care; access to appropriate treatments is poor and may, in part, be the cause of the high levels of unmet need observed in this study. Health education interventions may aid appropriate help‐seeking and self‐care strategies.
Chemotherapy for high‐risk localized prostate cancer
Authors: NAKABAYASHI MARI , OH WILLIAM K.
Published: March 2006

There are three mini‐reviews in this section, with very different subject material. The first describes the integration of chemotherapy into the overall treatment plan for patients with prostate cancer who are at high risk of recurrence and micrometastasis at initial diagnosis, a concept on which urologists will have a strong opinion. The second controversial subject is that of the use of leuprolide to modify the behaviours of sex offenders. The review deals specifically with the role of the urologist in this sensitive area. Finally, authors from Germany have written a mini‐review on the very important topic of chlamydial infections and prostatitis in men.
A therapeutic method for failed bladder augmentation in children: re‐augmentation
Authors: VAJDA PETER , BUYUKUNAL CENK S.N. , SOYLET YUNUS , DANISMED NUR , JUHASZ ZSOLT , PINTER ANDREW B.
Published: March 2006

OBJECTIVE

To investigate the causes leading to the deterioration of previously successful bladder augmentation and to evaluate the efficacy of re‐augmentation.

PATIENTS AND METHODS

Between 1988 and 2004, 136 bladder augmentations were performed in two paediatric urological units in Hungary and Turkey. Re‐augmentation was necessary in two patients after colocystoplasty and in three after gastrocystoplasty. A secondary augmentation was not required in any patients after ileocystoplasty. The clinical data of these five patients were evaluated.

RESULTS

On the basis of the clinical signs and urodynamic studies, re‐augmentation was performed 2–7 years after the initial augmentation cystoplasties. Anticholinergic therapy given before re‐augmentation did not improve bladder capacity, intravesical pressure and/or bladder compliance. An ileal or sigmoid segment was used for the secondary augmentation. After re‐augmentation, all five patients became continent, and showed marked improvement in their urodynamic parameters at a mean (range) follow‐up of 6.8 (2–10) years.

CONCLUSION

A decreased bladder capacity and/or compliance and increased bladder pressure after successful augmentation cystoplasty might be the result of: (i) impairment of the blood supply to the large bowel or gastric segment used for augmentation; or (ii) bowel mass contractions. Ileocystoplasty seems to be the ‘first‐line’ of choice for primary augmentation. Re‐augmentation with a bowel segment is a suitable treatment if conservative treatment fails. Regular urodynamic investigations are needed for early detection of malfunction of the augmented bladder, and advising therapy.
Determining the success of vasectomy
Authors: DHAR NIVEDITA BHATTA , BHATT AMIT , JONES J. STEPHEN
Published: March 2006

OBJECTIVES

To examine patient compliance, significance of rare nonmotile sperm (RNMS) and to determine the timing and number of semen analyses required to confirm sterility.

PATIENTS AND METHODS

From November 2001 to November 2004, 436 consecutive primary vasectomies were performed by one surgeon. All patients were instructed to submit two initial semen specimens for analysis (2 and 3 months after vasectomy) and additional samples (at 1‐month intervals) if sperm were identified on the initial and subsequent analyses.

RESULTS

A quarter of the patients submitted no semen specimens and only 21% followed the full instructions to provide two consecutive negative semen analyses. Three‐quarters of the patients provided a semen specimen at 8 weeks after vasectomy; of these, 75% were azoospermic and 25% contained sperm. At 12 weeks after vasectomy half the patients provided a semen specimen; of these, 91% were azoospermic and 9% contained sperm. Of the 83 patients with semen containing sperm at 8 weeks, 80 had RNMS and three had rare motile sperm (one of whom subsequently proved to have vasectomy failure). Of the 80 patients with RNMS, at 3, 4, 5, 6, 8, 10 and 11 months, 65, four, three, four, two, one and one, respectively were azoospermic.

CONCLUSIONS

The present results indicate that many patients are not compliant with the protocol after vasectomy. Provided patients have been adequately counselled, we think that one negative semen analysis at 3 months or one with RNMS at 2 months may be adequate to determine the success of vasectomy. This should reduce the number of semen analyses, including reducing the number of men who must undergo repeat testing, without sacrificing the accuracy of determining paternity. Simplifying the follow‐up after vasectomy is important; not only would it be cost‐effective but it may also improve patient compliance.
Self‐Monitoring: Individual Differences in Orientations to the Social World
Authors: Leone Christopher
Published: March 2006

ABSTRACTIn their articles in this special section of theJournal of Personality, the authors have focused their attention on the role of individual differences in self‐monitoring for a variety of interpersonal phenomena. In so doing, the authors have provided an overview of the theoretical and empirical contributions of the psychology of self‐monitoring to the domains of interest: close relationships, consumer behavior, behavior in the workplace, and social interaction. As each of the contributing authors to this special section suggests, much more theoretical and empirical work is in order if the impact of individual differences in self‐monitoring for the phenomena reviewed here is to be fully appreciated. Moreover, the four domains of interest represented in this special section by no means exhaust the areas to which theorists and researchers have applied or can apply the psychology of individual differences in self‐monitoring. Given the large nomological network that currently exists involving the self‐monitoring construct, it is anticipated that the breadth and depth of applications of the psychology of self‐monitoring will only continue to expand as it has in the last 30 years since the appearance of the construct in the literature.
Self‐Monitoring in Social Interaction: The Centrality of Self‐Affect
Authors: Ickes William , Holloway Renee , Stinson Linda L. , Hoodenpyle Tiffany Graham
Published: March 2006

ABSTRACT
In this review, we examine the role of self‐monitoring in social interaction. We first note that the presumed ease with which self‐monitors adapt to new social contexts is more apparent than real, being the self‐conscious outcome of (1) high self‐monitors' preference for clearly defined situations, (2) their use of scripts regarding typical situations, (3) their ability to formulate effective plans of action before social encounters, and (4) their ability to use other people's behavior as a guide. We then examine the strong motive of high self‐monitors to express and evoke high levels of positive affect in their interpersonal relationships. Two recent unstructured dyadic interaction studies lead us to argue that the primary concern of high self‐monitors during social interaction is to regulate their own self‐affect through effective impression management. In this sense, it really is the self that is closely monitored whenever self‐monitoring processes influence social interaction.