bluuebunny/crossref_metadata_2025 huggingface dataset:
Decreased nocturnal melatonin secretion in patients with Klinefelter's syndrome
Authors: Luboshitzky Rafael , Wagner Oded , Lavi Schachar , Herer Paula , Lavie Peretz
Published: November 2003

OBJECTIVE We have recently demonstrated that GnRH deficient male patients have increased nocturnal melatonin secretion which decreases to normal levels during testosterone treatment. The results suggested that sex steroids, rather than LH, modulate pineal melatonin in an inverse fashion. The purpose of this study was to characterize circulating melatonin levels in untreated males with hypergonadotrophic hypogonadism due to Klinefelter’s syndrome (KS).

DESIGNS Prospective, controlled.

SUBJECTS Eleven patients with Klinefelter’s syndrome and seven controls. Patients were subdivided into two groups: (1) with low testosterone, and (2) with normal testosterone levels.

MEASUREMENTS Serum samples for melatonin concentrations were obtained every 15 minutes from 1900 to 0700 h in a controlled light–dark environment.

RESULTS All patients had elevated FSH, LH and oestradiol (E2) levels. Mean (±SD) dark time nocturnal melatonin levels were significantly lower in low testosterone KS (92±19 pmol/l) compared with 146±42 pmol/l in normal testosterone KS and 179±59 pmol/l in controls (P<0.02). A similar pattern was observed for the mean (±SD) peak melatonin levels (165±41, 236±59 and 293±89 pmol/l) in low testosterone KS, normal testosterone KS and controls, respectively (P<0.01). Integrated nocturnal melatonin secretion values (AUC) were also lower in low testosterone KS (64±13) compared with 96±26 in normal testosterone KS and 116±39 pmol/min l×103 in controls (P<0.02).

The time of melatonin peak and the time of the nocturnal melatonin rise as well as the light‐time mean (±SD) serum melatonin levels were similar in all three groups.

No correlations were found between melatonin and LH, FSH, or E2 levels.

CONCLUSIONS Melatonin secretion is decreased in male patients with low testosterone hypergonadotrophic hypogonadism whereas in normal testosterone Klinefelter's syndrome patients, melatonin secretory profiles are normal.

The results suggest that the suppression of melatonin secretion in these patients is mediated by GnRH (either directly or indirectly) and/or oestradiol.
Growth hormone and the maintenance of adult bone mineral density
Authors: Inzucchi S. E. , Robbins R. J.
Published: November 2003

Growth hormone serves many important functions in man. It influences carbohydrate, lipid and protein metabolism, regulates the secretion and action of a variety of other hormones, and interacts with the immune system. Its most studied role, however, as its name implies, is the orchestration of longitudinal growth, which occurs predominantly at the epiphyseal plate. Here, GH acts both directly and indirectly, through the systemic and local production of IGF‐I (Isaksson et al., 1987). A separate role for the GH/IGF‐I axis in the maintenance of normal bone mineral density (BMD) after epiphyseal closure is also apparent and is an area of active clinical investigation. In this review, we examine the effects of GH on mature bone, summarize the findings of studies on the skeletal effects of GH in adults, and consider the potential use of GH as an anabolic agent in the treatment of osteoporosis.
Aromatic amino‐acid residues at the active and peripheral anionic sites control the binding of E2020 (Aricept®) to cholinesterases
Authors: Saxena Ashima , Fedorko James M. , Vinayaka C. R. , Medhekar Rohit , Radić Zoran , Taylor Palmer , Lockridge Oksana , Doctor Bhupendra P.
Published: November 2003

E2020 (R,S)‐1‐benzyl‐4‐[(5,6‐dimethoxy‐1‐indanon)‐2‐yl]methyl)piperidine hydrochloride is a piperidine‐based acetylcholinesterase (AChE) inhibitor that was approved for the treatment of Alzheimer's disease in the United States. Structure‐activity studies of this class of inhibitors have indicated that both the benzoyl containing functionality and the N‐benzylpiperidine moiety are the key features for binding and inhibition of AChE. In the present study, the interaction of E2020 with cholinesterases (ChEs) with known sequence differences, was examined in more detail by measuring the inhibition constants with Torpedo AChE, fetal bovine serum AChE, human butyrylcholinesterase (BChE), and equine BChE. The basis for particular residues conferring selectivity was then confirmed by using site‐specific mutants of the implicated residue in two template enzymes. Differences in the reactivity of E2020 toward AChE and BChE (200‐ to 400‐fold) show that residues at the peripheral anionic site such as Asp74(72), Tyr72(70), Tyr124(121), and Trp286(279) in mammalian AChE may be important in the binding of E2020 to AChE. Site‐directed mutagenesis studies using mouse AChE showed that these residues contribute to the stabilization energy for the AChE–E2020 complex. However, replacement of Ala277(Trp279) with Trp in human BChE does not affect the binding of E2020 to BChE. Molecular modeling studies suggest that E2020 interacts with the active‐site and the peripheral anionic site in AChE, but in the case of BChE, as the gorge is larger, E2020 cannot simultaneously interact at both sites. The observation that the KI value for mutant AChE in which Ala replaced Trp286 is similar to that for wild‐type BChE, further confirms our hypothesis.
The propeptide in the precursor form of carboxypeptidase Y ensures cooperative unfolding and the carbohydrate moiety exerts a protective effect against heat and pressure
Authors: Kato Michiko , Sato Yasuhiro , Shirai Kumiko , Hayashi Rikimaru , Balny Claude , Lange Reinhard
Published: November 2003

The heat‐ and pressure‐induced unfolding of the glycosylated and unglycosylated forms of mature carboxypeptidase Y and the precursor procarboxypeptidase Y were analysed by differential scanning calorimetry and/or by their intrinsic fluorescence in the temperature range of 20–75 °C or the pressure range of 0.1–700 MPa. Under all conditions, the precursor form showed a clear two‐state transition from a folded to an unfolded state, regardless of the presence of the carbohydrate moiety. In contrast, the mature form, which lacks the propeptide composed of 91 amino acid residues, showed more complex behaviour: differential scanning calorimetry and pressure‐induced changes in fluorescence were consistent with a three‐step transition. These results show that carboxypeptidase Y is composed of two structural domains, which unfold independently but that procarboxypeptidase Y behaves as a single domain, thus ensuring cooperative unfolding. The carbohydrate moiety has a slightly protective role in heat‐induced unfolding and a highly protective role in pressure‐induced unfolding.
EFFECTS OF TRAPIDIL ON THE HEALING OF COLONIC ANASTOMOSES IN AN EXPERIMENTAL RAT MODEL
Authors: Colak Tahsin , Nayci Ali , Polat Gurbuz , Polat Ayse , Comelekoglu Ulku , Kanik Arzu , Turkmenoglu Ozgur , Aydin Suha
Published: November 2003

Background:  Trapidil has various properties including vasodilatation, inhibition of lipid peroxidation and platelet aggregation as well as, and reduction of, the inflammatory response to injury. The aim of the present study was to investigate the effects of trapidil on dexamethasone‐impaired colonic anastomotic healing in an experimental rat model.

Methods:  Twenty‐four Wistar rats underwent colonic transsection and primary anastomosis. Rats were divided into four groups of six: group 1 (G1), control; group 2 (G2) trapidil, 8 mg/kg per day intravenously; group 3 (G3) dexamethasone, 0.1 mg/kg per day intramuscularly; and group 4 (G4) dexamethasone 0.1 mg/kg intramuscularly and trapidil 8 mg/kg intravenously per day, for 1 week. Anastomotic bursting pressure, hydroxyproline level, histopathological grading, malondialdehyde and nitrite/nitrate levels were determined.

Results:  Dexamethasone‐impaired anastomotic healing was found to be improved by trapidil administration in terms of anastomotic bursting pressure and hydroxyproline content (P = 0.026, and P = 0.017). In addition, histopathological examination revealed an increase in fibroblast proliferation and collagen deposition (P = 0.004, and P = 0.015) and a decrease in leucocyte infiltration (P = 0.004). Moreover, serum nitrite/nitrate and malondialdehyde levels decreased when G3 was compared to G4 (P < 0.001, P= 0.38).

Conclusions:  Trapidil may improve the dexamethasone‐impaired anastomotic healing due to its preventive effects on inflammatory response and lipid peroxidation in rats.
ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY: IMPLICATIONS OF PROLONGED WAITING TIMES FOR SURGERY
Authors: Lawrentschuk Nathan , Hewitt Peter M. , Pritchard Michael G.
Published: November 2003

Background:  The aim of the present study was to assess the impact of surgical waiting times on patients scheduled for elective laparoscopic cholecystectomy (LC), with emphasis on morbidity and costs incurred.

Methods:  A retrospective review of all patients who underwent cholecystectomy at the Launceston General Hospital between 1 January 1999 and 31 December 2001 was performed.

Results: A total of 322 LCs was performed during the study period. Median time on the waiting list was 130 (1−1481) days. While awaiting surgery, 44/322 patients (14%) re‐presented to the emergency department with biliary symptoms (89 separate presentations); 21 patients (6%) were admitted (28 admissions), of whom 18 (86%) were on the waiting list for biliary colic symptoms only. Reasons for emergency admission included pancreatitis (1), cholangitis (3), choledocholithiasis (7), cholecystitis (7), and exacerbation of symptoms (10). Median hospital stay was 4 days (1−14 days) (total cost of 124 hospital days, excluding subsequent admission for cholecystectomy, $A128 712 according to average bed day costs), and 11 patients required endoscopic retrograde cholangiopancreatography (13 procedures). Mean (median) time on the surgical waiting list for patients who developed complications was 238 (203) days versus 185 (126) days for patients who had LC without interval complications. A total of 198 cancellations occurred in 124/322 patients (39%) before surgery.

Conclusions:  Prolonged waiting times for elective LC are associated with morbidity in 14% of patients at the Launceston General Hospital. This, combined with frequent cancellation of elective surgery, may result in significant costs to the health‐care sector.
DOES NECK EXTENSION ELEVATE THE THYROID GLAND CEPHALAD TO POTENTIALLY IMPROVE ACCESS DURING THYROIDECTOMY?
Authors: Serpell Jonathan W. , Grodski Simon F. A. , O'Donell Christopher
Published: November 2003

Background:  Patients undergoing thyroidectomy are positioned with the neck extended to facilitate exposure of the neck. Computed tomography (CT) scanning of the thyroid, without i.v. contrast, is often used preoperatively to investigate the extent of large goitres. Currently, patients are scanned in the neutral position rather than the surgical position of neck extension. The aim of the present study was to determine the degree, if any, of movement of the thyroid, as measured by CT, achieved by neck extension.

Methods:  A trial was designed using CT scanning of the neck. Fourteen patients were studied. Patients attended for the usual CT thyroid. In addition, they were then rescanned with their neck extended. The position of the inferior aspect of the gland in relation to the sternal notch was measured in both positions. The degree of neck extension was measured and correlated with the extent of thyroid gland movement. The data were analysed with the Wilcoxon signed rank test and Spearman correlation coefficients.

Results:  Results showed a median difference between the two positions of 5 mm (P = 0.0002).

Conclusion:  The minimal cephalad movement of the thyroid achieved by neck extension, although statistically significant, is of doubtful clinical use, and overextension of the neck should be avoided because of its associated risks of pain, vomiting and spinal damage.
Methods for crack opening load and crack tip shielding determination: a review
Authors: STOYCHEV and S. , KUJAWSKI D.
Published: November 2003

In this paper a review of the literature on crack closure/opening load and crack tip shielding effects determination methods is presented. Commonly used ‘subjective’ (visual) and ‘non‐subjective’ approaches have been included. Procedures associated with the determination of an effective crack driving force for both Elber type and that of partial (or incremental) crack closure models have been covered. Comparison among different methods of analyses based on compliance and fatigue crack growth rate measurements is discussed together with their implications and difficulties in fatigue crack growth correlations.
Identification of patients requiring out‐patient follow‐up after transurethral prostatectomy: is there a role for nurse‐led screening of post‐operative outcomes by telephone?
Authors: Brough R. J. , Pidd H. , O'Flynn K. J. , Payne S. R.
Published: November 2003

Objective To determine the most efficient method to follow patients after transurethral prostatectomy (TURP) such that only those patients suffering significant post‐operative problems are reviewed.

Patients and methods The study comprised two parts: (1) a retrospective review of the case notes of 100 consecutive patients who underwent TURP under one consultant to determine whether any factors could be identified pre‐ or post‐operatively by which those patients most likely to require clinic review could be selected and; (2) a prospective review of the succeeding 100 patients undergoing TURP, using a telephone ‘screening’ call made by the urological research nurse 3 months after the operation. Patients who requested follow‐up and those patients with malignancy or admitted in high‐pressure chronic retention were reviewed in the out‐patient department.

Results In the first part, 17 patients (17%) required an out‐patient review for malignancy. Only nine patients (11%) with benign histology required further treatment after TURP; this subgroup could not be identified on the basis of their pre‐ or post‐operative symptoms. In the second part, 23 patients were not reviewed by telephone; 14 had carcinoma of the prostate, eight had no telephone and one could not be contacted after seven attempts. Of the remaining 77 contacted by ‘phone, 61 (79%) declined further clinic review and 16 (21%) requested follow‐up for persistent problems. A mean of two calls was made per patient and the mean duration of each call was 6.3 min.

Conclusions Based on pre‐ or post‐operative symptoms at the time of discharge, there is no reliable method of identifying those patients who have a poor result after TURP. Telephone screening of patients at 3 months identified successfully those patients who required an out‐patient review and enabled resources to be targeted towards this difficult group of patients.
Urethral injury in girls with fractured pelvis following blunt abdominal trauma
Authors: Ahmed S. , Neel K.F.
Published: November 2003

Objective To review the management of major urethral injury in three girls with fractured pelvis following blunt abdominal trauma.

Patients and methods Three girls aged 5 years, 1 year and 3 years sustained major urethral injury in association with fractured pelvis following blunt abdominal trauma. Initial management was undertaken elsewhere. Two girls, with complete loss of the urethra and a closed bladder base, were managed by construction of a neourethra using a flipped anterior bladder‐wall tube. The third patient with extensive perineal soft‐tissue loss and rupture of the bladder neck and urethra had a modified Young‐Dees‐Leadbetter bladder neck reconstruction. All three had an associated vaginal injury which did not require a specific surgical procedure.

Results The two girls who underwent construction of a neourethra using a flipped anterior bladder‐wall tube are continent. The first voids normally and the second is managed by clean intermittent catheterization. The patient who underwent bladder neck reconstruction is incontinent and further surgery, possibly a continent diversion, may be necessary.

Conclusion Pelvic fracture following blunt abdominal trauma in girls may be associated with major urethral injury, usually with an associated vaginal injury. Surgical ingenuity is required to repair such injuries successfully. In those with complete loss of the urethra, a flipped anterior bladder‐wall tube neourethra is suitable.
The value of multiple free‐flow studies in men with lower urinary tract symptoms
Authors: Reynard J.M. , Peters T.J. , Lim C. , Abrams P.
Published: November 2003

Objective To assess the variability of free‐flow studies in men presenting with lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO) and to determine the sensitivity, specificity and predictive values of consecutive measurements of maximum flow rate for the presence of bladder outlet obstruction (BOO) at several threshold values.

Patients and methods The value of multiple free‐flow studies was assessed in 165 men presenting with LUTS suggestive of BPO. Each patient was requested to void four times into a uroflowmeter and the voided volume and post‐void residual urine volume (PVR) were also measured. The variability of the maximum flow rate (Qmax ), voided volume and PVR between consecutive voids was assessed. In addition, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of various thresholds of Qmax for the presence of BOO were calculated for each consecutive void.

Results The mean Qmax on void 1 was 10.2 mL/s and the mean maximum value for Qmax between voids 1 and 2 was 12.5 mL/s. For voids 1, 2 and 3, the mean maximum Qmax was 13.9 mL/s and for voids 1 to 4 it was 15.2 mL/s. There were no significant changes in PVR among any of these voids. There was a statistically significant, although small, decrease in voided volume between voids 1 to 3 and voids 1 to 4. The specificity and PPV of Qmax for BOO increased with each subsequent void, such that using a threshold value for Qmax of 10 mL/s on the fourth void, the specificity and PPV for BOO were 96% and 93%, respectively.

Conclusions There was a significant increase in Qmax with each successive void when men with LUTS suggestive of BPO performed multiple free‐flow measurements and consequently, single free‐flow measurements substantially underestimated the maximum Qmax that these patients achieved. The specificity and PPV of Qmax for BOO can be improved considerably by performing multiple free‐flow studies and by carefully selecting an appropriate threshold value (although whether pressure‐flow studies are unnecessary will depend on what level of specificity and PPV is deemed acceptable in clinical practice). These findings should be considered if free‐flow studies are to be used as the basis for deciding the clinical management of men with LUTS and may be particularly useful for urologists with limited facilities for pressure‐flow studies.
The holmium:YAG laser for ureteric stones
Authors: Shroff S. , Watson G.M. , Parikh A. , Thomas R. , Soonawalla P.F. , Pope A.
Published: November 2003

Objective To assess the efficacy of the pulsed holmium:YAG laser for the fragmentation of ureteric stones.

Patients and methods One hundred patients (72 males and 28 females, age range 14 months–85 years) underwent 114 ureteroscopic procedures using either a 7.2 F semi‐rigid or 9.5 F flexible ureteroscope. A holmium:YAG laser (Sunrise Technologies, Fremont, Ca, USA) was used for laser lithotripsy at a maximum energy of 1.0 J/pulse at 5 Hz. Most of the stones (46%) were located in the upper third of the ureter. The mean size of the stones was 9×8 mm and the mean duration of the procedure was 73 min (including anaesthesia) with a mean hospital stay of 2.7 days.

Results All the stones were accessed successfully using miniaturized endoscopes either retrogradely or antegradely. The holmium laser effectively fragmented all types of stones. Total clearance of all stones fragments was achieved in 87% of cases, with the best results obtained for stones in the lower third of the ureter (96%). The complications attributed directly to the laser included three strictures and three perforations of the ureteric wall.

Conclusion The holmium:YAG laser was effective in fragmenting ureteric stones irrespective of their hardness. However, it has the potential to damage the ureteric wall and must be used with caution.
Open versus closed epididymal sperm retrieval in men with secondarily obstructed vasal systems—a preliminary report
Authors: Collins G.N. , Critchlow J.D. , Lau M.W.M. , Payne S.R.
Published: November 2003

Objective To evaluate and compare sperm quality and suitability for intracytoplasmic sperm injection (ICSI) from open and percutaneous epididymal aspiration in men with obstructive azoospermia, and to determine the relevance of epididymal morphology.

Patients and methods A series of 20 men undergoing vasectomy reversal were evaluated by percutaneous (PESA) and open epididymal sperm aspiration (MESA) before undergoing surgery for reversal. Two samples were taken with PESA, one with the needle in situ (PESA1) and the second while withdrawing the needle (PESA2). Epididymal morphology was graded as normal, distended and grossly distended. Five men undergoing vasectomy served as a control, non‐obstructed group for percutaneous aspiration. Analysis of the aspirates was performed immediately after operation with no knowledge of the treatment, and aspiration was considered successful if sperm suitable for ICSI were retrieved.

Results In the obstructed group, 15 of 20 men had successful PESA and 13 of these also had successful MESA. PESA was successful bilaterally eight times compared with MESA on five occasions; two men with successful PESA had no success with MESA. PESA2 was five times more successful than PESA1. Only one PESA in the non‐obstructed group was suitable for ICSI. PESA was successful in 21 of 25 distended or grossly distended epididymi compared with only three of 21 non‐distended systems.

Conclusion PESA is a viable alternative to MESA in patients with obstructive azoospermia, particularly when associated with clinically distended epididymi.
Quality of life in patients undergoing bacille Calmette‐Guérin therapy for superficial bladder cancer
Authors: Mack D. , Frick J.
Published: November 2003

Objective To determine the impact of post‐operative education about bladder cancer and topical immunotherapy on the physical, psychological and social well‐being of patients with superficial bladder cancer.

Patients and methods Eighty‐five patients (mean age 59 years, range 26–85, 64 men and 21 women) receiving topical immunotherapy were questioned during the initial cycle of treatment and during maintenance therapy with bacille Calmette‐Guérin (BCG). Patients completed a questionnaire on their quality of life when they commenced treatment and twice more during maintenance therapy.

Results Psychological distress and physical symptoms were intense when the diagnosis of bladder cancer was revealed to the patients, despite the knowledge that this cancer is usually curable. The overall quality of life, condition of health and sexual activity were mostly only moderate, were poor during initial therapy and better during 3‐monthly maintenance therapy.

Conclusion In general, the quality of life of these patients is characterized by the disruption of their lifestyle and marked by change in their circumstances. It is the responsibility of the urologist to take the necessary time to educate, comfort and motivate such patients with superficial bladder cancer.
The role of an advanced thermotherapy device in prostatic voiding dysfunction
Authors: Javlé P. , Blair M. , Palmer M. , Jenkins S.A. , Parsons K.F.
Published: November 2003

Objectives To investigate the efficacy of an advanced transurethral thermotherapy (TUMT) device (T3, Urologix) using urodynamic analysis in addition to the standard evaluation protocol in patients with symptomatic benign prostatic hyperplasia (BPH).

Patients and methods Fifty men with symptomatic BPH were assessed using the AUA symptom score, uroflowmetry and ultrasonography (to determine prostatic volume and residual urinary volume) before and 6 weeks, 3, 6 and 12 months after thermotherapy. TUMT was delivered using a focused microwave energy system for 1 h in each patient, treated on an out‐patient basis. Video pressure flow studies with advanced urodynamic analysis were also performed before and 3 months after treatment.

Results The mean AUA symptom score decreased by 63%, the mean peak flow rate increased by 64% and the post‐void residual volume decreased by 30% 3 months after treatment; this improvement was maintained at one year after treatment. Advanced urodynamic analysis showed that 52% of the patients had a decreased severity of obstruction. Furthermore, the efficiency of detrusor contraction improved in 86% of the patients. The improvement in the symptom score, flow rate and residual urine was significantly better in patients with marginal obstruction than in patients with unequivocal obstruction.

Conclusion Urodynamic analysis can predict the treatment outcome of TUMT and the results of thermotherapy are significantly better in patients with marginal prostatic bladder outflow obstruction.
The effect of heparan sulphate on the crystallization of calcium oxalate in undiluted, ultrafiltered human urine
Authors: Suzuki K. , Ryall R.L.
Published: November 2003

Objective To determine the effect of physiological concentrations of heparan sulphate (HS) on the crystallization of CaOx in undiluted, ultrafiltered human urine.

Subjects and methods Urine was collected from normal male volunteers and ultrafiltered at a nominal molecular weight threshold of 10 kDa. Calcium oxalate (CaOx) crystallization was induced by the addition of a standard load of oxalate above an experimentally determined metastable limit and the effect of added HS tested at concentrations of 0, 1, 2 and 10 μg/mL using a Coulter Counter particle analyser and scanning electron microscopy.

Results The metastable limit of the urine for CaOx was unaffected by HS at any concentration, as was the total volume of crystalline material deposited. However, HS strongly inhibited the formation of crystal aggregates with a response dependent on the dose and completely prevented the formation of crystal aggregates at a final concentration of 10 μg/mL. These findings were confirmed by scanning electron microscopy.

Conclusion HS is a potent inhibitor of CaOx crystallization in human urine and may protect against CaOx stone formation by reducing the degree of aggregation and thereby, the size of particles precipitated in the urinary tract.
Bladder replacement by ileocystoplasty after cystectomy for cancer: comparison of two techniques
Authors: Hendry W.F.
Published: November 2003

Objective To compare two methods of connecting the ureters to an ileocystoplasty.

Patients and methods Eighteen men with bladder cancer underwent radical cystoprostatectomy and a further two had a subtotal cystectomy, all with immediate orthotopic bladder replacement by ileocystoplasty. In 10 patients, the ureters were connected to the neobladder by a length of ileum with an inverted nipple valve, while in the other 10 the ureters were implanted directly using a serosal tunnel. Post‐operatively, the upper tracts were examined by intravenous urography and the neobladder by cystography before removel of the catheter.

Results The direct implantation technique used 15 cm less ileum and took a mean of 1 h less operating time to complete. The kidneys and ureters remained normal in all patients except one, who had a subtotal cystectomy and developed severe hydronephrosis and hydroureter with acute renal failure when the inverted nipple valve became everted.

Conclusions Whilst both techniques gave satisfactory results, direct implantation is more economical in the length of ileum used and in operating time.
Neuromodulation of detrusor hyper‐reflexia by functional magnetic stimulation of the sacral roots
Authors: Sheriff M.K.M. , Shah P.J.R. , Fowler C. , Mundy A.R. , Craggs M.D.
Published: November 2003

Objective To investigate the acute effects of functional magnetic stimulation (FMS) on detrusor hyper‐reflexia using a multi‐pulse magnetic stimulator.

Patients and methods Seven male patients with established and intractable detrusor hyper‐reflexia following spinal cord injury were studied. No patient was on medication and none had had previous surgery for detrusor hyper‐reflexia. After optimization of magnetic stimulation of S2–S4 sacral anterior roots by recording toe flexor electromyograms, unstable detrusor activity was provoked during cystometry by rapid infusion of fluid into the bladder. The provocation test produced consistent and predictable detrusor hyper‐reflexia. On some provocations, supramaximal FMS at 20 pulses/s for 5 s was applied at detrusor pressures which were >15 cmH20.

Results Following FMS there was an obvious acute suppression of detrusor hyper‐reflexia. There was a profound reduction in detrusor contraction, as assessed by the area under the curves of detrusor pressure with time.

Conclusions Functional magnetic stimulation applied over the sacrum can profoundly suppress detrusor hyper‐reflexia in man. It may provide a non‐invasive method of assessing patients for implantable electrical neuromodulation devices and as a therapeutic option in its own right.
Indapamide (Natrilix): the agent of choice in the treatment of recurrent renal calculi associated with idiopathic hypercalciuria
Authors: Martins M.C. , Meyers A.M. , Whalley N.A. , Margolius L.P. , Buys M.E.
Published: November 2003

Objective

 To compare the hypocalciuric and potential side‐effects of hydrochlorothiazide (HCT) to indapamide (IND; a thiazide‐like drug) in patients with idiopathic hypercalciuria.

Patients, subjects and methods

Twelve patients with recurrent renal calculi and renal hypercalciuria were studied using a randomized double‐blind cross‐over protocol. In addition, because the side‐effects of HCT are attenuated using small doses, the hypocalciuric effect of 12.5, 25 and 50 mg daily was assessed in six normal subjects.

Results

 There was a significant reduction in urinary calcium excretion using both agents, with a mean (sd) of 6.06 (2.68) and 3.37 (2.00) mmol/24 h using IND, and 5.58 (1.98) and 3.93 (2.35) mmol/24 h using HCT, before and after treatment (P<0.05). The treatment was not sufficiently prolonged to assess adequately all the side‐effects of either agent but both produced a similar decrease in serum potassium, whilst HCT significantly increased the mean (sd) serum urate levels, from 0.34 (0.09) to 0.43 (0.08) mmol/L (P<0.01). There was also a significant decrease in mean (sd) urinary citrate excretion in those receiving HCT, from 1.41 (1.05) to 1.00 (0.71) mmol/24 h (P<0.001), but not in those receiving IND, from 1.19 (0.71) to 1.18 (0.79) mmol/24 h. Although there was a hypocalciuric effect with doses of 12.5 and 25 mg HCT, it was sub‐therapeutic when compared with the dose of 50 mg.

Conclusion

 At a daily dose of 2.5 mg, IND is at least as effective as 50 mg HCT in controlling hypercalciuria. Because of its safety profile and lack of effects on urinary citrate excretion, this agent should be the preferred therapy for patients with idiopathic hypercalciuria and recurrent renal calculi.
Continence after bladder‐neck reconstruction in patients with bladder exstrophy and pubic diastasis
Authors: Ahmed S. , Fouda‐Neel K. , Borghol M.
Published: November 2003

Objective To review the results of bladder‐neck reconstruction in patients with repaired bladder exstrophy and pubic diastasis.

Patients and methods Nine girls (mean age 7 years, range 4–17) and four boys (mean age 9 years, range 5–15) underwent a modified Young‐Dees‐Leadbetter bladder‐neck reconstruction with augmentation cystoplasty (YDL‐C). The patients were reviewed retrospectively (follow‐up, 1–6 years) to assess continence, particularly in relation to the degree of pubic diastasis measured on an appropriate abdominal radiograph.

Results Ten patients were continent; seven girls and one boy are managed by clean intermittent catheterization (CIC) and one girl and one boy void normally. One girl who would not allow CIC and one boy in whom CIC was not possible are incontinent and are scheduled for construction of a continent diversion. One incontinent boy who also would not allow CIC was lost to follow‐up. Pubic diastasis had no bearing on the surgical results, the 10 continent patients having diastasis ranging from 4 to 9 cm (mean 5.5 cm) and the incontinent patients a diastasis of 3, 4 and 6.5 cm (mean 4.5 cm).

Conclusion Young‐Dees‐Leadbetter bladder‐neck reconstruction with augmentation cystoplasty is a satisfactory operation in patients with bladder exstrophy. We believe that the rate of continence reflected a competent tubularization with an adequate bladder capacity and assured bladder emptying. A closed pelvis with approximated pubic bones is not necessary to achieve this objective.
Genomic heterogeneity in bladder cancer as detected by fluorescence in situ hybridization
Authors: Yokogi H. , Wada Y. , Moriyama‐Gonda N. , Igawa M. , Ishibe T.
Published: November 2003

Objective To investigate the relationship between genomic heterogeneity and tumour grade, stage and DNA content in 30 transitional cell carcinomas (TCCs) of the urinary bladder.

Materials and methods Tissue specimens from 30 patients (25 men and five women) with newly diagnosed TCC of the urinary bladder were examined for genomic heterogeneity using fluorescence in situ hybridization (FISH) with chromosome‐specific DNA probes; the copy number of pericentromeric sequences on chromosomes 7, 9 and 17 was detected within interphase nuclei in contact preparations from the tumour specimens.

Results The aneusomy of chromosomes 7, 9 and 17 was significantly higher in aneuploid than in diploid tumours (P<0.001). Tumour grade and stage were strongly associated with aneusomy for chromosome 17 (P<0.01, P<0.001, respectively). The aneusomy of chromosomes 7 and 9 were significantly correlated with increasing tumour stage (P < 0.001), but not with tumour grade.

Conclusion These results suggest that the measurement of aneusomy using FISH, especially for chromosome 17, in bladder cancer may offer a new objective and quantitative assay of the biological potential of individual tumours.
Significant telomere reduction in human superficial transitional cell carcinoma
Authors: Kamata S. , Kageyama Y. , Yonese J. , Oshima H.
Published: November 2003

Objective To investigate telomere reduction and telomerase activity in human transitional cell carcinomas (TCCs) of the bladder, using primary tissue preparations, and their relationship to the clinicopathological properties of the TCC.

Materials and methods Tumour tissues were obtained from 21 patients together with apparently normal urothelia as controls. The mean telomere length of each sample was determined using southern blot analysis with an oligonucleotide probe (TTAGGG)4 and telomerase activity was semi‐quantified using a polymerase chain reaction based assay.

Results The mean (se) telomere length was 6.6 (0.7) kb in tumour tissues and 11.5 (0.4) kb in apparently normal urothelia adjacent to the tumour (P<0.001). Furthermore, it was 8.9 (1.4) kb and 3.4 (0.9) kb in superficial and invasive tumours (P=0.002), respectively. Telomerase activity was detected in all 13 of the tumour tissues examined, with no relationship to telomere reduction, while it was undetectable in any of the control tissues.

Conclusions In human TCCs, telomere length was reduced in tumour tissue, more so in superficial than in invasive tumours. Telomerase was detectable only in tumour tissues and its activity was unrelated to telomere reduction.
Microscopic haematuria: urological investigation using a standard protocol
Authors: Sultana S. R. , Goodman C.M. , Byrne D.J. , Baxby K.
Published: November 2003

Objective To determine which patients with asymptomatic microscopic haematuria (AMH) should be investigated to exclude significant urological pathology.

Patients and methods The study comprised a prospective audit of a standard protocol for investigating all patients referred with haematuria over one year in a haematuria clinic in the urology department serving Tayside, Scotland. Investigations included urine culture and cytology, flexible cystoscopy, and upper tract imaging which consisted of both excretory urography and renal ultrasonography in many of the patients.

Results A total of 381 patients with microscopic haematuria was investigated. No malignancy was found in any <50 years of age (n=131); in patients aged >50 years the overall incidence of malignancy was 7.5% (19/250). The asymptomatic patients in this group had a lower incidence (5%, 6/126) of malignancy than the symptomatic patients (10.5%, 13/124) but this difference did not reach statistical significance. There was no statistically significant difference in the incidence of urological malignancy between men and in women with microscopic haematuria. During the same period, 233 patients were referred with frank haematuria; in these patients, those aged <50 years had a 10% incidence of malignancy (6/60), while in those aged >50 years the incidence was 34.5% (60/173). A total of 18 patients (4.7%) with microscopic haematuria had upper tract calculi, comprising 5.3% (7/131) of patients aged <50 years and 4.4% (11/250) of those >50 years with microscopic haematuria.

Conclusions The investigation of older patients with microscopic haematuria (and all those with frank haematuria) is well justified, as malignancy will be found in a significant proportion even if they are asymptomatic. The benefit of a full urological investigation of younger patients with microscopic haematuria is debatable.
Multiple use of fibres in the visual laser ablation of the prostate
Authors: Gilbert H.W. , O'Boyle P.J. , McLoughlin J. , Speakman M.J.
Published: November 2003

Objective To investigate the possibility of re‐using laser fibres for the visual laser ablation of the prostate (VLAP).

Patients and methods Thirty‐four patients, each with a mean maximum urinary flow rate of <14.0 mL/s and an American Urological Association symptom score of >19, were evaluated. All underwent VLAP; laser energy, generated by a Neodymium:YAG system, was delivered with a side‐firing fibre. The laser generator was fitted with a custom‐built power meter that measured the energy delivered by the fibre. Fibres were re‐used until the energy output fell below 60 W despite increases in laser generator power. Each patient was followed for at least 12 months.

Results A total of seven fibres was used to treat the 34 patients; between one and nine patients were treated with each fibre. The outcome obtained with the first use of a fibre compared well with those obtained with each subsequent use. After 12 months, 25 patients (74%) expressed satisfaction with the results of their operation. Five patients (15%) had urinary tract infections. As each fibre costs about £650, multiple use saved a mean of £516 for each patient treated.

Conclusion This evaluation implies that there is no justification for the single use of laser fibres on the basis of efficacy, provided that a power meter is used to monitor the efficiency of the delivery device.
Paroxetine in the treatment of premature ejaculation
Authors: Ludovico G.M. , Corvasce A. , Pagliarulo G. , Cirillo‐Marucco E. , Marano A. , Pagliarulo A.
Published: November 2003

Objective To test the efficacy and the adverse effects of a new anti‐depressant drug (paroxetine) in the treatment of premature ejaculation.

Patients and methods The study comprised 32 men (mean age 28 years) with premature ejaculation (14 of whom ejaculated before penetration) who were treated with paroxetine (20 mg orally each evening for 2 months). The study group excluded those with neurological and psychiatric disorders, urinary tract infections and drug or alcohol abuse.

Results After about 14 days, the patients' symptoms improved and all patients reported a longer interval before ejaculation. The adverse effects were sleepiness in 19 patients (61%) and mild sensory confusion in 21 (68%), but only one had to withdraw from therapy. Three weeks after the end of therapy, the premature ejaculation recurred in 28 (90%) of the patients.

Conclusions These results indicate that paroxetine is an effective therapy for premature ejaculation. Further studies with different dosages are necessary to decrease the adverse effects and to prolong the efficacy.
Alterations in pulmonary function after retroperitoneoscopic surgery
Authors: Chung H‐J , Chiu A.W. , Chen K‐K , Huang J.S. , Hsu Y‐S , Chang L.S.
Published: November 2003

Objective To evaluate and compare changes in pulmonary function after retroperitoneoscopic and open surgery.

Patients and methods From June 1994 to October 1995, 11 patients (five men and six women, mean age 44.7 years, range 29–69) underwent retroperitoneoscopic procedures (Group 1) and 11 patients (eight men and three women, mean age 57.5 years, range 22–73) underwent flank‐incision procedures (Group 2). The surgery comprised eight adrenalectomies and one each of nephroureterectomy, nephrectomy and pyelolithotomy in Group 1, and five adrenalectomies, four nephroureterectomies, one ureterolithotomy and one excision of a retroperitoneal tumour in Group 2. Pulmonary function tests (PFTs) were performed before and 3 days after surgery; the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1 ), forced expiratory volume at 25% (FEV25% ), FEV1 /FVC, vital capacity (VC), total lung capacity (TLC), residual lung volume (RV) and functional residual capacity (FRC) were compared between the groups. The post‐operative changes in the PFTs were assessed using a paired t‐test and the degree of change in both groups compared using the Mann–Whitney U‐test. Other factors possibly influencing PFT were analysed using multiple regression.

Results Pulmonary function was impaired in both groups on the third day after surgery. In Group 2, the FVC, FEV1 , FEV25% , VC and TLC had declined significantly (all P<0.05) from the pre‐operative value. In Group 1, only the FVC and VC decreased significantly (P<0.05). Post‐operative pulmonary complications occurred in two patients in Group 2 but in none of those in Group 1, showing that pulmonary function was generally less affected in Group 1 than in Group 2.

Conclusion Although pulmonary function was impaired 3 days after surgery in both groups, retroperitoneoscopic surgery, by eliminating a large flank incision, caused less post‐operative pulmonary dysfunction than open surgery.
Varicocele testis and testicular temperature
Authors: Lund L. , Nielsen K.T.
Published: November 2003

Objective To evaluate whether there is an association between scrotal skin temperature and impaired semen quality in patients with varicocele testis.

Subjects and methods Two groups of men (all newly enlisted soldiers), 39 with an asymptomatic varicocele testis and 38 normal control subjects, were compared for semen quality and scrotal skin temperature.

Results The semen quality in the men with varicocele was significantly lower than that in the control subjects; however, there was no significant difference in scrotal skin temperature between the groups.

Conclusion This study confirmed previous observations showing a possible relationship between varicocele testis and impaired sperm quality, but there was no apparent difference in scrotal skin temperature in men with or without a varicocele.
Hydrolysis of cyclic guanosine monophosphate and cyclic adenosine monophosphate by the penis and aorta of the diabetic rat
Authors: Miller M.A.W. , Morgan R.J. , Thompson C.S. , Mikhailidis D.P. , Jeremy J.Y.
Published: November 2003

Objective

 To investigate the hydrolysis of adenosine 3′5′‐cyclic monophosphate (cAMP) and guanosine 3′5′‐cyclic monophosphate (cGMP) by specific phosphodiesterases (PDEs) in the penis and aorta of diabetic rats.

Materials and methods

 Non‐ketonuric diabetes mellitus was induced in 10 Sprague‐Dawley rats with streptozotocin. After 2 months, the rats were killed and their penises and aortae excised. The tissues were incubated with [3H]‐cAMP and [3H]‐cGMP and the degree of hydrolysis was assessed by separating [3H]‐cAMP and [3H]‐cGMP from [3H]‐AMP and [3H]‐GMP, respectively, in the incubation supernatants using thin layer chromatography (polyethyleneimine cellulose developed in 50 mmol/L KCl).

Results

 The hydrolysis of cAMP and cGMP was significantly reduced in penile and aortic tissue from diabetic rats compared to that of seven age‐matched controls.

Conclusions

 Such a reduction of PDE activity would result in increased intracellular cyclic nucleotide levels (and thus corporeal smooth muscle relaxation and erection). Consequently, the altered activity of PDE enzyme systems is not related aetiologically to the pathogenesis of diabetic erectile dysfunction. Furthermore, these data consolidate the concept that enhanced cyclic nucleotide synthesis and decreased degradation constitute an adaptive response to counteract the deleterious effects of diabetes mellitus on erectogenic mechanisms. The pathophysiology and therapeutic implications of these findings warrant further investigation.
‘Double toxicity’ of glycine solution in the mouse
Authors: Zhang W.B. , Hahn R.G.
Published: November 2003

Objective To study whether glycine, which may contribute to the symptoms of the transurethral resection syndrome promotes death in a mouse model and whether a modification of the glycine concentration offers a better chance of survival.

Materials and methods Mortality was determined in 120 mice after an intravenous infusion of increasing volumes and concentrations of glycine solution. The animals were divided into groups of 10 and given 150, 180, 200 or 220 mL/kg body weight of 1.1, 1.5 or 2.2% glycine solution. As a control, 220 mL/kg of a 5% mannitol solution was given to 12 mice.

Results After receiving an isosmotic (2.2%) glycine solution 70% of the animals died, while the overall death rate for 1.5% glycine was only 20%. When 1.1% glycine was used, the mortality was 10% after infusion of 150 and 180 mL/kg and 80% after infusion of ≥200 mL/kg. Logistic regression analysis showed that the outcome for the two highest glycine concentrations was directly related to the dose of glycine and not to the water load. Of 12 mice receiving the isosmotic 5% mannitol solution, three died.

Conclusions A 1.5% glycine solution offered the best chance of survival. The mortality was governed both by the glycine dose (2.2 and 1.5%) and the tendency of the solution to produce overhydration of the cells (1.1%). Glycine toxicity was most important when small volumes were infused.