bluuebunny/crossref_metadata_2025 huggingface dataset:
Ultrasonic Detection of Non‐palpable Seminal Vesicle Invasion: A Clinicopathological Study
Authors: OHORI M. , SHINOHARA K. , WHEELER T. M. , AIHARA M. , WESSELS E. C. , CARTER S. ST C. , SCARDINO P.T.
Published: November 2008

Summary In an effort to identify reliable criteria for detecting seminal vesicle invasion (SVI) with transrectal ultrasonography (TRUS) in patients with clinically localised prostate cancer, we reviewed the pre‐operative sonograms in 230 patients who underwent radical retropubic prostatectomy; 49 patients (21%) had pathologically confirmed SVI. Conventional sonographic criteria for SVI (asymmetry, distension, atrophy, abnormal echogenicity and irregularity in outline) were present in 58 patients, but only 16 (28%) had pathologically confirmed SVI.

On the basis of the results of a preliminary comparison of radical prostatectomy specimens and TRUS, we had revised our criteria for the recognition of SVI: (1) a hypoechoic lesion at the base of the prostate (within 10 mm of the seminal vesicle); (2) an “adhesion sign” resulting from the loss of the echo reflections from the normal fat plane between the prostate and the seminal vesicle; (3) “posterior convexity” of the seminal vesicles. When we reviewed the 230 sonograms retrospectively, we found a hypoechoic tumour at the base in 70 patients, of whom 37 had SVI (positive predictive value (PPV) 53%). An adhesion sign was found in 16 patients, 12 of whom had SVI (PPV 75%). Posterior convexity was present in 4 patients, all of whom had SVI. If any one of our sonographic signs was present, the overall accuracy (83%), sensitivity (90%) and positive predictive value (51%) were significantly better than with any one of the conventional criteria. Patients with SVI were also more likely to have a high serum prostate specific antigen (PSA) level. The PPV for SVI of a PSA level ≤ 10 ng/ml was 38%. If the PSA was > 10 ng/ml and TRUS was positive (≤ 1 of our sonographic criteria), 16 (62%) of 26 patients had SVI. If the PSA was < 10 ng/ml and TRUS was negative, only 3 (3%) of 86 patients had SVI.

It was concluded that the conventional criteria for detecting SVI on ultrasonography are not accurate in patients with early stage prostate cancer. There are, however, reliable criteria that predict SVI with reasonable accuracy and these criteria, combined with the serum PSA levels, can stratify patients into those with a low risk and those with a high risk of SVI.
Correlation between the Extent of Nodal Involvement and Survival following Groin Dissection for Carcinoma of the Penis
Authors: RAVI R.
Published: November 2008

Summary Between 1962 and 1986, 208 inguinal and 143 ilio‐inguinal lymphadenectomies were performed on 201 patients with carcinoma of the penis. The crude 5‐year survival rate was 95% for patients with negative nodes, 76% when only inguinal nodes were positive, and 0% when the pelvic nodes were positive. The adverse prognostic factors were (1) involvement of > 3 inguinal nodes, (2) perinodal infiltration in the inguinal area, and (3) pelvic node involvement.
Comparison of Nephrostomy Drainage Systems
Authors: McLOUGHLIN J. , FARAH N. , WILLIAMS GORDON
Published: November 2008

Summary Forty patients undergoing nephrostomy insertion were randomised into 2 groups: those maintained on intermittently closed and those on permanently closed drainage systems. The average cost of managing a patient in the former group was one‐eighth that of the latter and was not associated with any increase in morbidity.
Long‐term Outcome in Renal Transplantation with Terminal Cutaneous Ureterostomy
Authors: PRIETO M. , SIERRA M. , DE FRANCISCO A. L. M. , ZUBIMENDI J. A. , MONTESINOS M. G. , DE LATORRIENTE J. , ARIAS M.
Published: November 2008

Summary We have reviewed the complications and follow‐up in 6 patients who underwent kidney transplantation with cutaneous ureterostomy. Four patients had tuberculosis, 1 myelomeningocele and another congenital stenosis of the posterior urethra. Cutaneous ureterostomy was performed by suturing the edges of the distal end of the ureter to the skin. The mean follow‐up was 40.6 months (range 2–105). The patient and graft survival rates were 83.3% and 66.6% respectively during the 249 months of total follow‐up. Significant bacteriuria and leukocyturia were constantly present and the incidence of urinary infection was 3.1 episodes/patient/year. The early complications of the stoma were partial necrosis in 1 case and haematoma in another. The most frequent late complication was stomal stenosis requiring periodic dilatation. A plasma creatinine of 61.88 to 114.92 µmol/l reflected good long‐term graft function in the remaining patients. Terminal cutaneous ureterostomy is a simple technique with good long‐term results.
Characterisation of Detrusor Contractile Function in Relation to Old Age
Authors: MALONE‐LEE J. , WAHEDNA I.
Published: November 2008

Summary This report describes an age‐related clinical study of detrusor muscle function using urodynamic data obtained from 1391 women and 324 men of different age groups who were free from overt neurological disease and diabetes. Isometric detrusor function during unstable activity was assessed by integrating the calculated force of unstable detrusor activity during filling of the bladder. Isotonic voiding activity was measured by calculating the velocity constant Q*, which reflects the speed of detrusor muscle shortening. In addition, the change in detrusor pressure on initiation of voiding and the post‐micturition residual urine volume were recorded. Older patients of both sexes had higher residual urine volumes. Older women showed lower detrusor shortening velocities. There were no age‐related differences in isometric detrusor function. Older women showed a tendency for the detrusor contraction to fail on initiation of voiding, whereas older men did not demonstrate this difference. Voiding dysfunction in late life was more marked amongst women and seemed to be related to a failure of isotonic detrusor function with no related changes in isometric function.
Alpha‐blocking Treatment with Alfuzosin in Symptomatic Benign Prostatic Hyperplasia: Comparative Study with Prazosin
Authors: BUZELIN J. M. , HEBERT M. , BLONDIN P. , Group PRAZALF
Published: November 2008

Summary Alfuzosin, a selective alpha1 ‐adrenoceptor antagonist which is effective in the symptomatic treatment of benign prostatic hyperplasia (BPH), was compared with prazosin, another drug commonly used for the same purpose. After a 1‐week placebo run‐in period, 103 patients with day‐time frequency 7 or nocturia 2 and peak flow rate < 15 ml/s were randomised to receive either alfuzosin (2.5 mg tid) or prazosin (2 mg bid) for 3 weeks, with a gradual dose increase during the first week, in a double‐blind, parallel group, multicentre study. Voiding symptoms, assessed on the basis of the Boyarsky scale and a micturition diary, were significantly improved in both groups, as were urinary flow rates. However, neither the clinical improvement nor the increase in flow rates differed significantly between the 2 groups. The peak flow rate increased similarly with alfuzosin (2.6 ± 0.6 ml/s) and prazosin (2.9 ± 0.7 ml/s); the mean flow rate and voided volume increase tended to be more marked with alfuzosin (30 and 22.2% respectively) than with prazosin (20.6 and 6.5%). Clinical safety was good in both groups. All 4 adverse events in the prazosin group but only 1 of the 4 adverse events in the alfuzosin group were related to a decrease in blood pressure. It was concluded that alfuzosin was at least as effective as prazosin in the treatment of symptomatic patients with BPH and the incidence of adverse events related to their vasodilatory properties was lower with alfuzosin.
Benign Urethral Polyps
Authors: WALSH I. K. , KEANE P. F. , HERRON B.
Published: November 2008

Summary Ten male patients presented between 1985 and 1991 with benign urethral polyps. This lesion is believed to represent a developmental error in the invagination process of the submucous glandular material of the inner zone of the prostate. The clinicopathological features of the condition are discussed and the literature is reviewed.
Cryptorchism with a Large Abdominal Mass‐A Challenge
Authors: CHENG C. , CHAN P. S. F.
Published: November 2008

Summary ‐The undescended testis is associated with an increased incidence of testicular malignancy. The position of the undescended testis is related to the likelihood of carcinogenesis, with the intra‐abdominal testis having the highest malignant potential. We present 3 patients to illustrate this tendency and to highlight the unusual presentation as an “acute abdomen”.
Endoscopic Treatment of Vesicoureteric Reflux with Collagen Five Years' Experience
Authors: LIPSKY H. , WÜRNSCHIMMEL E.
Published: November 2008

Summary Submucosal injections of bovine collagen (Zyplast) were administered to 67 children and 7 adults with 115 refluxing ureters. Reflux was grade I in 14 ureters, grade II in 54, grade III in 38 and grade IV in 9. All patients had a history of recurrent urinary infection. One year after treatment 70 ureters showed no reflux, 20 were grade I and 25 showed a complete recurrence. The cure rate was 81% if grade I recurrence is included. In all, 68 ureters were followed up for 2 to 4 years. In 19 ureters a second injection was given, 47 showed no reflux, 19 had grade I reflux and 2 had a recurrence. In 5 ureters reflux grade I disappeared without a second injection. The cure rate was 97%. Renal scarring was seen in 4 kidneys. Collagen injections are an adequate method of treatment for reflux grades I‐III.
The effects of acute and chronic JJ stent placement on upper urinary tract motility and calculus transit
Authors: RYAN P.C. , LENNON G.M. , McLEAN P.A. , FITZPATRICK J.M.
Published: November 2008

Objective To determine the pathophysiological changes in upper urinary tract motility and calculus transit which may occur following JJ stent insertion.

Materials and methods The acute and chronic effects of JJ stent placement were studied in 24 canine renal units. Intrarenal and intraureteric pressures and motility were measured, in addition to transit times for complete passage of synthetic calculi from the upper ureter into the bladder.

Results Acute effects included raised renal intrapelvic pressure, reduced pelvic and ureteric motility and delayed calculus transit time. Prolonged JJ stent placement was associated with return of intrapelvic pressure to normal but persistent changes in both renal and ureteric motility and also calculus transit time.

Conclusion In situ JJ stents impair upper urinary tract motility and experimental calculus transit time and may delay passage of ureteric calculi or calculus fragments following extracorporeal shock wave lithotripsy.
The Mitrofanoff principle: expanding upon a versatile technique
Authors: WOODHOUSE C.R.J. , MACNEILY A.E.
Published: November 2008

Objective To illustrate how the original principle of an appendicovesicostomy can be expanded upon and applied successfully to numerous urological conditions utilizing a variety of surgical techniques.

Materials and methods Over the 8‐year period 1985‐1993 the Mitrofanoff principle was utilized 105 times in 100 consecutive patients. Seven different types of catheterizing conduit were constructed in conjunction with six varieties of urinary reservoir for patients falling into one of seven different categories of uropathy.

Results At a median follow‐up of 30 months, the continence rate for patients was 91%. The re‐operation rate for conduit complications was 33%. Neither continence rates nor complications specific to the Mitrofanoff were related to the underlying uropathy, the type of conduit constructed, the urinary reservoir employed, and the patient's age at surgery.

Conclusion The Mitrofanoff principle of continent urinary diversion is a versatile technique with a predictable success rate applicable to a wide variety of urological conditions. Patients and surgeons should be aware of the significant rates of revision required on the catheterizing conduit to enable continence to be ultimately achieved.
Steroid abuse in athletes, prostatic enlargement and bladder outflow obstruction – is there a relationship?
Authors: WEMYSS‐HOLDEN S.A. , HAMDY F.C. , HASTIE K.J.
Published: November 2008

Objective To evaluate the effects of exogenous andro‐genic‐anabolic steroids on the human prostate gland.

Subject and methods A white male athlete, who was routinely using anabolic steroids, volunteered for the study. He was studied during a 15‐week period of steroid self‐administration. Both objective and subjective parameters were measured, including: prostatic volume (transrectal ultrasound), digital rectal examination, urine flow rate, serum acid phosphatase and prostate specific antigen, symptom scoring for bladder outflow obstruction and other associated symptoms.

Results During the period of steroid self‐administration, prostatic volume increased and urine flow rate decreased. The man also noticed an increase in nocturnal urinary frequency, libido and aggression.

Conclusion In this pilot study, the administration of exogenous androgenic‐anabolic steroids has been demonstrated to have profound effects on the human prostate gland, including an increase in prostatic volume, reduction in urine flow rate and an alteration in voiding patterns. These findings warrant further investigation.
Congenital and acquired curvature of the penis treated surgically by plication of the tunica albuginea
Authors: KLEVMARK B. , ANDERSEN M. , SCHULTZ A. , TALSETH T.
Published: November 2008

Objective To evaluate the effectiveness of plication surgery for patients with congenital and acquired curvature of the penis.

Patients and methods Forty‐eight patients with congenital curvature of the penis and 57 with induratio penis plastica were treated by plication of the tunica albuginea. Their average age was 23 and 56 years, respectively. The operation was performed under local anaesthesia, using 2/0 Prolene arid a specially designed suture. The average observation time in the two groups was 24 and 20 months, respectively.

Results Nineteen per cent of patients in the first group and 8% in the second group reported normal intercourse pre‐operatively. Post‐operatively, the numbers increased to 81% and 82%, respectively, and all were able to perform intercourse. Although 18–19% experienced slight discomfort, mostly related to the cut ends of the suture, this minor problem was accepted by all. Five patients needed more than one operation. No impotence was recorded post‐operatively and no patient complained of reduced sensibility of the skin.

Conclusion Satisfactory results were obtained with the plication technique in the first 105 patients. Since the follow‐up study was completed more than 2 years ago, another 70 patients have been treated by the same procedure.
The preventive role of chemical sympathectomy on contralateral testicular hypoxic parameters encountered during unilateral testicular torsion
Authors: KARAGÜZEL G. , TANYEL F.C. , KILINC K. , BUYUKPAMUKCU N. , HICSONMEZ A.
Published: November 2008

ObjectiveTo evaluate the effect of chemical sympathectomy on lactic acid and hypoxanthine concentrations in both testes during unilateral testicular torsion in a rat experimental model.

Materials and methodsFour groups, comprising 10 rats each, were studied. Group I was the control group, Group II rats received a placebo and underwent unilateral testicular torsion, Groups III and IV received guanethidine monosulphate and 6‐OH‐dopamine hydrobromide respectively, and underwent unilateral testicular torsion. The levels of lactic acid and hypoxanthine in both testes were measured.

ResultsIn rats in Group II the levels of lactic acid and hypoxanthine in both testes were significantly elevated when compared to the control group. In the groups of rats that had undergone chemical sympathectomy, the levels of lactic acid and hypoxanthine were significantly decreased in the contralateral testes compared to rats in Groups I andII.

ConclusionChemical sympathectomy prevents the elevation of lactic acid and hypoxanthine levels in the contralateral testis of rats with unilateral testicular torsion. Therefore, we conclude that contralateral testicular damage during unilateral testicular torsion may result through a reflex activating sympathetic system.
The radionuclide assessment of pre‐natally diagnosed hydronephrosis
Authors: UPSDELL S. M. , GUPTA S. , GOUGH D.C.S.
Published: November 2008

Objective To determine if a pre‐operative non‐invasive radionuclide study can predict the results on surgery in infants with pre‐natally diagnosed hydronephrosis.

Patients and methods Eight male infants with prenatally diagnosed hydronephrosis were treated by pyeloplasty within the first 4 months of life. All infants underwent a pre‐operative diuresis renogram and a dimercapto‐succinic acid (DMSA) scan, followed by a further renogram 6 months after surgery to assess renal function an drainage.

Results There was a significant difference between the resutls of the relative renal function estimates obtained by the pre‐operative renogram and the pre‐operative DMSA scan (P=0.001). In all patients the recovery in renal function following surgery was accurately predicted by the pre‐operative DMSA scan.

Conclusion The results of this preliminary study suggest that a pre‐operative DMSA scan could replace the use of invasive nephrostomy drainage to assess the potential for recovery in the poorly functioning neonatal kidney and give an indication of those kidneys most likely to benefit from recontructive surgery.
Altered saccharide sequences in two groups of patients with metastatic prostatic carcinoma
Authors: McMAHON R.F.T. , McWILLIAM L.J. , CLARKE N.W. , GEORGE N.J.R.
Published: November 2008

Objective To investigate the hypothesis that primary prostatic carcinomas with metastases to different sites (lymph nodes or bone) show varying expression of cell surface and cytoplasmic glycoconjugates.

Patients and methods A group of 14 patients with primary prostatic carcinoma with lymph node metastases but no bone metastases has previously been shown to have an increased survival time. This group was compared with a control group of 14 patients with lymph node‐negative, bone metastasis‐positive primary prostatic carcinoma using a panel of biotinylated lectins revealed by the avidin‐biotin peroxidase complex method. The results were analysed semiquantitatively and differences in binding patterns between the two groups were sought.

Results No significant differences were seen using the LCA, LTA, UEA‐1, WFA, VVA or SBA lectins. The group with bone metastases but no lymph node involvement showed significantly increased binding for the ECA and AHA lectins, both before and after neuraminidase pre‐treatment, compared with the lymph node‐positive group.

Conclusions These results suggest that tumours lacking or having a reduced affinity for binding sites for both Galβl‐3GalNac (Type I oligosaccharide structures‐ AHA) and Galβl‐4GlcNac (Type I1 oligosaccharide structures‐ECA) sequences are more likely to develop lymph node metastases and less likely to develop bone metastases and thereby increasing the patient's chances of survival. This is further evidence that the metastatic potential of tumours per se and the ultimate site of distal metastases from such tumours is affected in part by the glycoconjugates expressed on their cell surfaces and indicates that metastatic phenotypes for prostatic carcinoma exists.
The effect of pharmacological stimulation and blockade of autonomic receptors and of pudendal blockade on urethral stress relaxation in healthy women
Authors: THIND P. , LOSE G. , COLSTRUP H. , ANDERSSON K.‐E.
Published: November 2008

Objective To examine the influence of autonomic receptor stimulation and blockade (noradrenaline, prazosin, terbutaline, propranolol, carbachol and atropine), and of pudendal nerve blockade on urethral stress relaxation.

Subjects and methods Forty healthy women were evaluated. The stress relaxation parameter was defined as the relative rate of pressure decrease during a fixed period of time following a rapid dilatation of the urethra. The dilatation was performed by waterinfusion into a small rubber cylinder placed in the urethra.

Results The drugs did not affect stress relaxation significantly, whereas the pudendal blockade produced a significant change along the length of the urethra characterized by a faster pressure decay following dilatation.

Conclusion In women, stress relaxation in the urethra relies significantly on the pudendal nerve‐innervated striated muscles.
Ureteric stricture formation following ureteric instrumentation in patients with a nephrostomy drain in place
Authors: O'SULLIVAN D. C. , LEMBERGER R. J. , BISHOP M. C. , BATES C. P. , DUNN M.
Published: November 2008

Objective To determine what effect the presence of a nephrostomy, left on free drainage, might have on the rate of occurrence of ureteric strictures after ureteric instrumentation.

Patients and methods Eighteen patients were identified in this unit who had had ureteric instrumentation while a nephrostomy was in place.

Results Eight of 11 patients in whom the nephrostomy was left open developed ureteric strictures. None of seven patients in whom the lumen was maintained by stenting and and/or clamping of the nephrostomy developed strictures. The strictures needed dilatation and stenting in seven patients and ureter had to be reimplanted in the other.

Conclusion In patients in whom a nephrostomy is in place, the opening should be occluded after ureteric instrumentation or a stent should be inserted if it is to be left on free drainage.
A prospective randomized trial comparing a modified needle suspension procedure with the vagindobturator shelf procedure for genuine stress incontinence
Authors: GERMAN K.A. , KYNASTON H. , WEIGHT S. , STEPHENSON T.P.
Published: November 2008

Objective To compare two procedures for the treatment of genuine stress incontinence in patients selected randomly.

Patients and methods Fifty patients with proven genuine stress incontinence were randomized prospectively over a 3 year period to be treated either by a modified needle suspension (MNS) (n=26) or by a vagina/obturator shelf (VOS) (n= 24) procedure.

Results In patients who had not undergone previous surgery for incontinence, the VOS procedure was superior with 12 of 14 patients achieving continence compared with eight of 15 patients in the MNS group (P<0.05). In women who had undergone previous surgery seven of 11 were continent following MNS compared with five of 10 after a VOS procedure. Both techniques had a much lower continence rate when compared with a classical colposuspension operation which was reported in a previous series [1].

Conclusion As a primary procedure VOS was more successful than MNS. In patients who had undergone previous surgery for incontinence neither procedure gave acceptable results.
Superficial bladder cancer: the response of a marker tumour to a single intravesical instillation of epirubicin
Authors: POPERT R. J. M. , GOODALL J. , COPTCOAT M. J. , THOMPSON P. M. , PARMAR M. K. B. , MASTERS J. R. W.
Published: November 2008

Objective To determine the response of a marker tumour to a single instillation of intravesical epirubicin.

Patients and methods Eighty‐one patients (54 men, 27 women) with a mean age of 69.3 years (range 36–92) with superficial bladder cancer were randomized to receive a single instillation of intravesical epirubicin. At the initial cystoscopy all but one papillary marker tumour was resected. Subsequently the patients were a randomized to receive either intravesical epirubicin at a concentration of 1 mg/ml (n=40) or 2 mg/ml (n=41) in 50 ml of saline for 1h. THe response of the marker tumour was determined at 3 months (first check cystoscopy). The toxicity associated with both treatments was also recorded.

Results A complete response (no visible or microscopic bladder carcinoma) was observed in 46% (95% confidence interval (CI) 35–57%) of a patients. No patient experienced systemic side‐effects. Chemical cystitis and bladder irritability were the most frequent local sideeffects, occurring in 15% (95% CI 8 ‐ 24%) of the patients.

Conclusions A single instillation of intravesical epirubicin has a demonstrable effect in superficial bladder cancer. The results compare farvourably with more onerous regimes. Side‐effects were minimal at 1 mg/ml and acceptable at 2 mg/ml.
Procoagulant properties of benign and malignant prostatic tissue
Authors: ADAMSON A. S. , FRANCIS J. L. , WITHEROW R. O'N. , SNELL M. E.
Published: November 2008

Objective To determine the factor‐X activating procoagulant activity (FXAA) of prostatic tissue removed at transurethral resection in a specific chromogenic assay.

Patients and methods FXAA was extracted from transurethrally resected prostatic tissue using a cryofragmentation technique. Tissue from 50 patients with prostate cancer was analysed and compared with that from 36 control patients with benign prostatic‐hypertrophy. Enzyme activities were assayed in a two stage chromogenic assay and correlated with conventional markers of tumour aggressiveness.

Results FXAA was found to be significantly lower (P <0.001) in tissue from malignant prostates compared with benign prostatic hypertrophy tissue. Loss Of FXAA was also related to Gleason grade (P <0.03), percentage of chips involved by tumour (P <0.04) and bone scan status (P <0.02). Using antibody inhibition tests this procoagulant was characterized as being a factor VII/tissue factor complex.

Conclusions Malignant change in the prostate is associated with a reduction in FXAA and this may be an important factor in prostatic tumour growth anddissemination.
Percentage area density of epithelial and mesenchymal components in benign prostatic hyperplasia: comparison of results between single biopsy, multiple biopsies and multiple tissue specimens
Authors: Robert M. , Costa P. , Bressollef F. , Mottet N. , Navratil H.
Published: November 2008

Objective To determine whether histological analysis of six multiple random biopsies of the gland or analysis of only one biopsy provides a good estimate of the different components of the hyperplastic gland compared with the results obtained from tissue specimens {reference values).

Materials and methods The various components of prostate tissue obtained from 30 men undergoing suprapu‐bic adenomectomy were investigated. The histological analysis was performed on multiple tissue specimens reflecting adenoma (reference values) and on one and six biopsies performed at random on the enucleated material of the hyperplastic gland. Immunohisto chemistry using anti‐actin as a label of smooth muscle and specific histological staining coupled with computer‐assisted quantitative morphometric analysis was used to ascertain the histological composition of the prostate.

Results The mean (±SD) area densities obtained from tissue specimens were 34.1 ±5%, 32.4 ± 6.9%, 17.6 ±4.5% and 15.9 ±5.5% of smooth muscular and fibrous tissue, and epithelium and glandular lumen, respectively. The mean ratio of stromal to epithelial hyperplasia averaged 4.05 ± 1.73. Both one and six biopsies gave a good estimate of fibrous tissue and glandular epithelium, but the percentage of smooth muscle was overestimated and the percentage of glandular lumen was underestimated. There was a significant relation between the prostate area densities of glandular epithelium (r=‐0.41, P<0.05), the percentage area density of prostate smooth muscle (r=0.43, P<0.05), and the weight of enucleated adenoma. No correlation was found with prostate‐specific antigen (PSA).

Conclusion It seems feasible to propose medical treatment of benign prostatic hyperplasia (BPH) based on the histological composition of the prostate gland. One biopsy, reflecting in good proportions the nature of the adenoma, would be used to provide insight into the pathogenesis and therapy of BPH.
Treatment of penile curvature — a retrospective study of 175 patients operated with plication of the tunica albuginea or with the Nesbit procedure
Authors: Poulsen J. , Kirkeby H.J.
Published: November 2008

Objective To evaluate the outcome and complications after operative correction of sexually disabling penile angulation.

Patients and methods Between January 1 1987 and December 31 1991,175 patients underwent operative correction of penile angulation due to Peyronie's disease (57 patients) or congenital curvature (118 patients). Thirty two patients were treated by plication of the tunica albuginea and 143 by the Nesbit procedure. Post‐operatively 91% of the patients were seen in the out‐patient clinic after 3–5 months. A questionnaire sent to all patients 6–60 months after surgery was returned by 74% of the patients, and the present Results are based on the most recent information obtained.

Results In the plication group good or acceptable results were obtained in 12 of 32 patients (38%) after the first operation, and in a further nine patients (22%) after a second operation. In the Nesbit group 126 of 143 patients (88%) obtained good or acceptable Results after the first operation and a further seven patients (5%) reported success after a second operation. The failures in the Nesbit group were due mainly to post‐operative erectile dysfunction in patients with Peyronie's disease, in contrast to the plication group where failures were primarily due to recurrence of angulation.

Conclusion Operative correction of penile curvature is a reasonably safe procedure, but should not be performed solely for cosmetic reasons. In the present retrospective study the results were better after the Nesbit procedure compared with plication of the tunica albuginea. However, a review of the literature does not give support to one operative technique over the other. This can only be clarified by performing a prospective randomized trial.
The role of tobacco in penile carcinoma
Authors: Harish K. , Ravi R.
Published: November 2008

Objective To study the role of tobacco in squamous cell carcinoma of the penis.

Subjects and methods The use of tobacco in the form of cigarettes, chewing tobacco and snuff was studied in a total of 503 patients and age‐matched controls.

Results By multivariate analysis, a significant association was found between smoking (P= 0.002) or chewing tobacco (P< 0.001) and the use of snuff (P= 0.004) in patients with penile carcinoma as compared with controls. A dose‐response relationship was observed for both smoking and chewing.

Conclusions The use of tobacco is a significant risk factor for penile carcinoma, and the use of more than one form of tobacco increases this risk.
Local Access to Care Programs (LACPs): New Developments in the Access to Care for the Uninsured
Authors: BLEWETT LYNN A. , ZIEGENFUSS JEANETTE , DAVERN MICHAEL E.
Published: November 2008

Context: New, locally based health care access programs are emerging in response to the growing number of uninsured, providing an alternative to health insurance and traditional safety net providers. Although these programs have been largely overlooked in health services research and health policy, they are becoming an important local supplement to the historically overburdened safety net.

Methods: This article is based on a literature review, Internet search, and key actor interviews to document programs in the United States, using a typology to classify the programs and document key characteristics.

Findings: Local access to care programs (LACPs) fall outside traditional private and publicly subsidized insurance programs. They have a formal enrollment process, eligibility determination, and enrollment fees that give enrollees access to a network of providers that have agreed to offer free or reduced‐price health care services. The forty‐seven LACPs documented in this article were categorized into four general models: three‐share programs, national‐provider networks, county‐based indigent care, and local provider–based programs.

Conclusions: New, locally based health access programs are being developed to meet the health care needs of the growing number of uninsured adults. These programs offer an alternative to traditional health insurance and build on the tradition of county‐based care for the indigent. It is important that these locally based, alternative paths to health care services be documented and monitored, as the number of uninsured adults is continuing to grow and these programs are becoming a larger component of the U.S. health care safety net.
What Ever Happened to N‐of‐1 Trials? Insiders' Perspectives and a Look to the Future
Authors: KRAVITZ RICHARD L. , DUAN NAIHUA , NIEDZINSKI EDMUND J. , HAY M. CAMERON , SUBRAMANIAN SASKIA K. , WEISNER THOMAS S.
Published: November 2008

Context:When feasible, randomized, blinded single‐patient (n‐of‐1) trials are uniquely capable of establishing the best treatment in an individual patient. Despite early enthusiasm, by the turn of the twenty‐first century, few academic centers were conducting n‐of‐1 trials on a regular basis.

Methods:The authors reviewed the literature and conducted in‐depth telephone interviews with leaders in the n‐of‐1 trial movement.

Findings:N‐of‐1 trials can improve care by increasing therapeutic precision. However, they have not been widely adopted, in part because physicians do not sufficiently value the reduction in uncertainty they yield weighed against the inconvenience they impose. Limited evidence suggests that patients may be receptive to n‐of‐1 trials once they understand the benefits.

Conclusions:N‐of‐1 trials offer a unique opportunity to individualize clinical care and enrich clinical research. While ongoing changes in drug discovery, manufacture, and marketing may ultimately spur pharmaceutical makers and health care payers to support n‐of‐1 trials, at present the most promising resuscitation strategy is stripping n‐of‐1 trials to their essentials and marketing them directly to patients. In order to optimize statistical inference from these trials, empirical Bayes methods can be used to combine individual patient data with aggregate data from comparable patients.
The Relative Merits of Population‐Based and Targeted Prevention Strategies
Authors: ZULMAN DONNA M. , VIJAN SANDEEP , OMENN GILBERT S. , HAYWARD RODNEY A.
Published: November 2008

Context: Preventive medicine has historically favored reducing a risk factor by a small amount in the entire population rather than by a large amount in high‐risk individuals. The use of multivariable risk prediction tools, however, may affect the relative merits of this strategy.

Methods: This study uses risk factor data from the National Health and Nutrition Examination Survey III to simulate a population of more than 100 million Americans aged thirty or older with no history of CV disease. Three strategies that could affect CV events, CV mortality, and quality‐adjusted life years were examined: (1) a population‐based strategy that treats all individuals with a low‐ or moderate‐intensity intervention (in which the low‐intensity intervention represents a public health campaign with no demonstrable adverse effects), (2) a targeted strategy that treats individuals in the top 25 percent based on a single risk factor (LDL), and (3) a risk‐targeted strategy that treats individuals in the top 25 percent based on overall CV risk (as predicted by a multivariable prediction tool). The efficiency of each strategy was compared while varying the intervention's intensity and associated adverse effects, and the accuracy of the risk prediction tool.

Findings: The LDL‐targeted strategy and the low‐intensity population‐based strategy were comparable for CV events prevented over five years (0.79 million and 0.75 million, respectively), as were the risk‐targeted strategy and moderate‐intensity population‐based strategy (1.56 million and 1.87 million, respectively). The risk‐targeted strategy, however, was more efficient than the moderate‐intensity population‐based strategy (number needed to treat [NNT] 19 vs. 62). Incorporating a small degree of treatment‐related adverse effects greatly magnified the relative advantages of the risk‐targeted approach over other strategies. Reducing the accuracy of the prediction tool only modestly decreased this greater efficiency.

Conclusions: A population‐based prevention strategy can be an excellent option if an intervention has almost no adverse effects. But if the intervention has even a small degree of disutility, a targeted approach using multivariable risk prediction can prevent more morbidity and mortality while treating many fewer people.
Development of psychophysics in Japan1
Authors: OYAMA TADASU
Published: November 2008

Abstract:  In Japan, psychophysics began as early as 1888 with the first lecture on it given by Yujiro Motora at the Imperial University (the University of Tokyo), following the completion of his PhD, at the laboratory of G. S. Hall. In 1910, A Photographic Album of Experimental Psychology was published, which included many photographs of psychophysical experiments. In 1933, Sadaji Takagi conducted the first experiment on animal psychophysics to investigate shape constancy in small birds. In 1949, the first experiment on infant psychophysics was conducted by Jyuji Misumi to study the early development of size constancy. And, in 1955, Tadasu Oyama proposed a new psychophysical technique, naming the method of transposition to measure perceived size ratios without using numerical expressions. This method has been successfully applied to the measurement of illusions, figural after‐effects, and size constancy. In 1960, Tarow Indow and his collaborators published their first systematic application of multidimensional scaling to color perception. They also applied it to study the perceptual structure of visual space. Recent developments in those topics in Japan are also reviewed.
Low‐level audiovisual synchrony: Experiments and model
Authors: LUU SHEENA , WONG WILLY , NOORDIN HAFIZ
Published: November 2008

Abstract:  We have carried out experiments to explore the effect of prior knowledge and expectation on the detection of audiovisual synchrony. By expanding on earlier methodologies, we have shown that the perception of synchrony is not affected by prior knowledge of lag type (i.e., visual signal precedes audio signal or vice versa). This result suggests that higher‐level cognitive processes like expectation do not play a significant role in synchrony perception. We also introduce here a systems‐level model based on cross‐correlation that is compatible with both the observations of our experiments and with the observations of other studies.
Visual search of trained and untrained drivers in a driving simulator1
Authors: SEYA YASUHIRO , NAKAYASU HIDETOSHI , PATTERSON PATRICK
Published: November 2008

Abstract:  To investigate the effects of driving experience on visual search during driving, we measured eye movements during driving tasks using a driving simulator. We evaluated trained and untrained drivers for selected driving road section types (for example, intersections and straight roads). Participants in the trained group had received driving training by the simulator before the experiment, while the others had no driving training by it. In the experiment, the participants were instructed to drive safely in the simulator. The results of scan paths showed that eye positions were less variable in the trained group than in the untrained group. Total eye‐movement distances were shorter, and fixation durations were longer in the trained group than in the untrained group. These results suggest that trained drivers may perceive relevant information efficiently with few eye movements by using their anticipation skills and useful field of view, which may have been developed through their driving training in the simulator.
Algorithm for determining optimum sequestration depth of CO2 trapped by residual gas and solubility trapping mechanisms in a deep saline formation
Authors: LIN C. K.
Published: November 2008

An algorithm is proposed here for determining the optimum sequestration depth (in terms of depth corresponding to maximum net income per unit rock volume) in a saline formation for CO2 trapped by residual gas and solubility trapping mechanisms. The Peng–Robinson equation of state was used to determine the density and fugacity of sequestered CO2 and the compression energy required for CO2 injection. Geochemist’s Workbench®, a commercial geochemical software package, was used to estimate CO2 solubility in groundwater. Operational costs and CO2 emissions due to compression energy consumption were estimated. A hypothetical reference case was constructed to illustrate the proposed algorithm, assuming constant values of geothermal gradient, hydrostatic pressure gradient, sweep efficiency and initial groundwater chemistry, with a depth‐dependent porosity and porosity‐dependent saturation of residual gas. In general, the algorithm was illustrated successfully for the hypothetical reference case and produced the following results. The depth corresponding to maximum trapping capacity was approximately 3000 m, but the depth representing maximum net income was approximately 1300 m. CO2 emissions due to compression energy consumption per unit mass of CO2 sequestration cannot be ignored, but may be <0.15, even down to a depth of 7000 m. Both the trapping capacity and net income of CO2 sequestration decreased with geothermal gradient, but the corresponding optimum depths increased with geothermal gradient.
Effects of changes in reservoir thermodynamic conditions on 222Rn composition of discharged fluids: study for two wells at Los Azufres geothermal field (Mexico)
Authors: BARRAGÁN R. M. , ARELLANO V. M. , PORTUGAL E. , SEGOVIA N.
Published: November 2008

222Rn anomalies that occurred at the time of the 19 September 1985 M8.1 Michoacan, Mexico, earthquake in fluids from two wells of Los Azufres, geothermal field were studied considering (i) the changes in well‐bottom thermodynamic conditions (pressure, enthalpy and steam/water ratio) and (ii) the discharged mass flow rates. In the studied steam well the anomalously high 222Rn concentration (as compared with background data) was observed on 11 September and was due to an important compressive process, which formed two‐phase fluids at reservoir, where usually single steam occurred. This caused the increase in 222Rn, as it remained in the steam. The compressive process was partially induced by changes in the production conditions at wellhead (because a well test was being developed) when sampling, but it was also seismic‐induced, as similar 222Rn anomalies were observed in other steam wells for which stable conditions at sampling were maintained. Another case is given for a two‐phase well where anomalously low 222Rn values (compared to background data) were recorded in September–October 1985. As stable conditions were maintained during sampling (1983–1986), 222Rn data were correlated to ?twb> the total mass flow rates produced by the well. Results suggested that the well produced two types of liquid–steam mixtures with a common end‐member regarding the liquid, but implying two ‘end‐member’ fluids with different 222Rn contents. The most 222Rn enriched end‐member was regarded as the original reservoir steam while that with relatively lower 222Rn concentration was stated as likely constituted by a mixture of reservoir and reinjection fluids. From the linear correlations, 222Rn contents for both end‐members were estimated while the 222Rn composition of the reservoir liquid feeding the studied well was estimated to be negligible compared to steam from the intersection of both curves. As one anomalously low 222Rn value was measured for a sample collected on the 12 September 1985, it seemed that a seismic‐induced process increased the reservoir permeability just before the earthquake allowing the liquid to reach the production zones of some two‐phase wells. This interpretation was supported by the behaviour of gas species (CO2 and N2) and δD in the two‐phase well studied and injection mass flow rates in one probably‐related reinjection well.
Genetic Structure of Threatened Native Populations and Propagules Used for Restoration in a Clonal Species, American Beachgrass (Ammophila breviligulataFern.)
Authors: Fant Jeremie B. , Holmstrom Rebecca M. , Sirkin Eileen , Etterson Julie R. , Masi Susanne
Published: November 2008

An important goal of native plant restorations was to reconstitute populations that are genetically similar to native ones, thereby increasing the probably of successful establishment and persistence. We examined the extent to which this goal has been accomplished in Great Lakes restorations ofAmmophila breviligulataFern., a beachgrass species that is widely used for habitat restoration and is considered threatened in the study areas. In parallel studies on Lake Michigan and Lake Superior, we used polymorphic Intersimple Sequence Repeat markers to assess genetic similarity between well‐established and new native populations, restored populations, and restoration propagules obtained from two commercial suppliers. Native populations were generally more diverse than expected for a clonal species, whereas the commercially cultivated releases were monotypic. One of the commercial releases used in Minnesota was exclusively found in restored populations and did not occur in any other native population at this site. The propagules used in the newly planted restoration in Illinois were derived from a release that commercial suppliers maintain was derived from a native Michigan population, as opposed to a selected release. Diversity in this restoration was equivalent to that native Illinois’ populations; however, many of the genotypes were not of local origin. Overall, study underscores the importance of obtaining baseline genetic surveys of remnant native populations and restoration propagules before restoration efforts are initiated, especially when the populations are threatened or endangered.
Differences in Belowground Heterogeneity Within a Restoration of a Dewatered Reservoir in Southwestern Wisconsin
Authors: Wells Ana J. , Balster Nick J. , VanWychen Stefanie , Harrington John
Published: November 2008

Integrating belowground properties into ecological restoration is critical for understanding aboveground response. We investigated a recently dewatered basin in southwestern Wisconsin to test hypotheses related to the magnitude, heterogeneity, and spatial dependence of physicochemical properties between sediments and buried soils. A spatial grid was established in a 2.4‐ha basin to sample 7 physical and 13 chemical properties. Sediment depth (Sd) averaged 43 cm (std dev = 15) across the study area. The mean bulk density (BD) of the buried soils (1.41 g/cm3) was significantly greater than the sediments (0.97 g/cm3), which corresponded with a significantly higher soil moisture content (SMC) and hydraulic conductivity (Ks) of the sediments. Relative to one another, buried soils had significantly higher concentrations of Bray P, Cu, and Mn, whereas sediments had higher concentrations of Bray K, K, total phosphorus, Na, S, Al, and Ca and thus had a higher pH; Fe and B concentrations were similar between the sediments and the buried soil. Sediments were consistently less spatially heterogeneous than the buried soils. Using geostatistics, sediment BD and SMC displayed both small‐scale spatial structures and large‐scale trends, whereas Sd and the buried soil SMC displayed only small‐scale variability. Distance from the former dam was positively related to nine physicochemical properties and negatively related to only S, SMC, and the percentage of clay; no trends were found in the buried soils. These results demonstrate that damming, inundation, and dewatering due to dam removal yielded a spatially distinct and homogenized substrate relative to the soils that were buried.