bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of aminoguanidine and tolrestat on the development of ocular and renal structural changes in experimental diabetic rats
Authors: Azal Ö. , Yönem A. , Güler S. , Çakır B. , Baydar A. , Çorakçı A. , Kutlu M.
Published: March 2003

Studies that researched the role of aminoguanidine and tolestat in the prevention of diabetic retinopathy and nephropathy resulted in conflicting data. We investigated the effects of these agents in the prevention of ocular and renal changes in streptozotocin (STZ)‐induced diabetic rats. Diabetes was induced by intravenous injection of STZ in 30 rats. Ten rats that were not given STZ served as non‐diabetic control (Group 1). Ten STZ‐diabetic rats that were not given any treatment served as diabetic control (Group 2). Groups 3 and 4 were composed of STZ‐induced diabetic rats (10 each) that were given tolrestat and aminoguanidine respectively. Eyes and kidneys were examined at the 24th week under electronmicroscopy. Cataract was observed in all six of the surviving rats in Groups 2 and 4, and in one of 6 surviving rats in group 3. Cataract development was lower in Group 3 than Groups 2 and 4. All retinal samples obtained from group 2 demonstrated a number of structural abnormalities, whereas there were no significant ultrastructural changes in groups 3 and 4. Groups 2 and 3 demonstrated mesangial proliferation and expansion, diffuse glomerular basement membrane (GBM) thickening, and focal GBM thickening in the bulb form. Group 4 demonstrated a normally appearing mesangial space, minimal diffuse but no focal GBM thickening. The urinary albumin excretion (UAE) was lower in Group 4 than the other groups. In conclusion, our results suggest that aminoguanidine may be an important agent for the prevention of renal changes, whereas tolrestat may be effective for the prevention of ocular changes in diabetes mellitus.
Relationship between insulin resistance and accumulation of coronary risk factors
Authors: Ohnishi H. , Saitoh S. , Ura N. , Takagi S. , Obara F. , Akasaka H. , Oimatsu H. , Shimamoto K.
Published: March 2003

We examined correlations between the frequency of insulin resistance and the accumulation of coronary risk factors in residents of rural comities in Japanese, using simple criteria for determination of insulin resistance based on evaluation by the euglycaemic‐hyperinsulinaemic glucose clamp (GC) method. The subjects were 376 men and 589 women living in two rural communities in Japan. We measured body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceride (TG), HDL cholesterol (HDL), and homeostasis model assessment (HOMA‐R). Correlations between HOMA‐R and those parameters were examined. To assess the existence of insulin resistance in these subjects, we used a practical index based on the GC method. The subjects with value of HOMA‐R ≥ 1.73 have insulin resistance. In addition, the HOMA‐R was divided into five quantiles based on the frequency distribution (0.60 or below, from 0.61 to 0.82, from 0.83 to 1.18, from 1.19 to 1.69, and 1.70 or higher), to examine the concentration of risk factors in each group. In total, 74 (19.6%) of the men and 119 (20.3%) of the women had insulin resistance (HOMA‐R ≥ 1.73). It was found that the higher the HOMA‐R, the higher was the number of coronary risk factors, such as hypertension, obesity, hypertriglyceridaemia and hypo HDL cholesterolaemia. The number of coronary risk factors was particular high in subjects with HOMA‐R ≥ 1.70. HOMA‐R in the case of no glucose loading is a useful and practical index for evaluation of insulin resistance and coronary risk factors in the epidemiological study.
Orexin reverses cholecystokinin‐induced reduction in feeding
Authors: Asakawa A. , Inui A. , Inui T , Katsuura G. , Fujino M. A. , Kasuga M
Published: March 2003

Aim: This study was designed to investigate the effect of orexin on anorexia induced by cholecystokinin (CCK),a peripheral satiety signal.

Methods: We administered orexin A (0.01–1 nmol/mouse) and CCK‐8 (3 nmol/mouse) to mice. Food intake was measured at different time‐points: 20 min, 1, 2 and 4 h post‐intracerebroventricular (i.c.v.) or intraperitoneal (i.p.) administrations.

Results: Intracerebroventricular‐administered orexin significantly increased food intake in a dose‐dependent manner. The inhibitory effect of i.p.‐administered CCK‐8 on food intake was significantly negated by the simultaneous i.c.v. injection of orexin in a dose‐dependent manner.

Conclusions: Orexin reversed the CCK‐induced loss of appetite. Our results indicate that orexin might be a promising target for pharmacological intervention in the treatment of anorexia and cachexia induced by various diseases.
The pharmacology of cilostazol
Authors: Schrör Karsten
Published: March 2003

Cilostazol (6‐[4‐(1‐cyclohexyl‐1H‐tetrazol‐5‐yl)butoxy]‐3,4‐dihydro‐2(1H)‐quinolinone; OPC‐13013) is a 2‐oxo‐quinoline derivative with antithrombotic, vasodilator, antimitogenic and cardiotonic properties. The compound is a potent inhibitor of phosphodiesterase (PDE) 3A, the isoform of PDE 3 in the cardiovascular system (IC50: 0.2 µm). In addition, there is inhibition of adenosine uptake, eventually resulting in changes in cAMP levels, dependent on the type of adenosine receptors (A1 or A2). Cilostazol inhibits platelet aggregation and has considerable antithrombotic effects in vivo. The compound relaxes vascular smooth muscle and inhibits mitogenesis and migration of vascular smooth muscle cells. In the heart, cilostazol causes positive inotropic and chronotropic effects. Most, if not all, of these actions are cAMP‐mediated, including the modification of cAMP‐controlled gene expression. Cilostazol decreases levels of serum triglycerides and causes some increase in HDL‐cholesterol levels. The compound has a number of additional effects which might contribute to its overall clinical efficacy. Cilostazol undergoes intensive and finally complete hepatic metabolism via the cytochrome P450 systems. This might result in some drug interaction, i.e. with erythromycin and omeprazole. The half‐life is approximately 10 h, resulting in about 2‐fold accumulation of the drug during repeated administration.
Metabolic disorders associated with uncontrolled hypertension
Authors: Bøg‐Hansen E. , Lindblad U. , Gullberg B. , Melander A. , Råstam L.
Published: March 2003

Aim:  To examine the prevalence and characteristics of uncontrolled hypertension (HT).

Methods:  A cross‐sectional community‐based study (1992–93) was carried out in Skara, Sweden, including 894 patients who consecutively underwent an annual follow‐up at the hypertension outpatient clinic in primary care. Controlled HT was defined as diastolic blood pressure (DBP) ≤90 mmHg and systolic blood pressure (SBP) ≤160 mmHg and was used as reference. Uncontrolled DBP was defined as DBP >90 mmHg regardless of SBP level, and isolated uncontrolled SBP was defined as SBP >160 mmHg and DBP ≤90 mmHg. Proportions were age‐standardized using the Skara population as reference.

Results:  The prevalence of uncontrolled HT was 43% (isolated uncontrolled SBP 18% and uncontrolled DBP 25%). Both men and women with isolated uncontrolled SBP were older (73 years, CI: 70–75; and 73 years; CI: 72–75) than patients with controlled HT (64 years, CI: 63–66; and 65 years, CI: 64–66). Men and women with known cardiovascular disease (CVD) less often had isolated uncontrolled SBP (OR: 0.4, CI: 0.2–0.9; and OR: 0.5, CI: 0.3–0.9), whereas men and women with known diabetes more often had uncontrolled DBP (OR: 2.3, CI: 1.3–4.1; and OR: 3.3, CI: 1.9–5.7). Men with known CVD less often had uncontrolled DBP (OR: 0.5, CI: 0.3–1.0, p = 0.04), and men with fasting blood glucose >5.5 mmol/l more often had isolated uncontrolled SBP (OR: 1.9, CI: 1.0–3.5, p = 0.04). In women, the following high risk factor levels were associated with uncontrolled DBP: fasting blood glucose >5.5 mmol/l (OR: 1.4, CI: 1.1–1.8), fasting triglycerides ≥1.7 mmol/l (OR: 1.4, CI: 1.1–1.8), body mass index (BMI) >30 kg/m2 (OR: 1.5, CI: 1.1–1.9), waist/hip ratio (WHR) >0.85 cm/cm (OR: 1.7, CI: 1.3–2.2), insulin resistance (homeostasis model assessment (HOMA) >third quartile) (OR: 1.4, CI: 1.1–1.9) and microalbuminuria (OR: 3.2, CI: 1.7–6.2).

Conclusion:  Uncontrolled DBP is in both sexes related to type 2 diabetes, whereas isolated uncontrolled SBP is related to older age. In women, uncontrolled DBP, furthermore, is related to several other CVD risk factors of the metabolic syndrome. Patients with uncontrolled DBP should be carefully evaluated for metabolic disorders.
Detection of insulin resistance in Turkish adults: a hospital‐based study
Authors: Gokcel A. , Baltali M. , Tarim E. , Bagis T. , Gumurdulu Y. , Karakose H. , Yalcin F. , Akbaba M. , Guvener N.
Published: March 2003

Aim: The aim of the present study was to investigate the usefulness of insulin sensitivity check indices in our hospital population.

Methods: Both HOMA (insulin X glucose in mmol/l/22.5) and QUICKI (1/log insulin in μu/ml + log glucose in mg/dl) indices were calculated from fasting values in 1774 subjects from the medical records of Baskent University Adana Hospital.

Results: Subjects with diabetes, hyperlipidaemia and central obesity were characterized by significantly higher HOMA and lower QUICKI indices than those of healthy subjects. A fall in the QUICKI index (0.3469 ± 0.028 in healthy subjects and 0.3247 ± 0.025 in non‐obese diabetics) as well as an increase in HOMA index (2.24 ± 1.26 in healthy subjects and 3.59 ± 2.08 in non‐obese diabetics) corresponded to metabolic and clinical manifestations of insulin resistance in various groups of subjects. Age, low HDL cholesterol, male sex, type 2 DM and hypertension were independent risk factors for CAD. Age, male sex, waist circumference and CAD were found to be risk factors for hypertension. Fasting insulin and glucose levels contain sufficient information to assess insulin sensitivity over a wide range in a diverse population. The following can be accepted as mean values to assess insulin resistance in our hospital population: 0.3469 ± 0.028 for the QUICKI index and 2.24 ± 1.26 for the HOMA index

Conclusions: HOMA and QUICKI indices are simple and reproducible methods for determining insulin sensitivity in humans.
Antennal sensilla of the ground beetle Bembidion lampros Hbst (Coleoptera, Carabidae)
Authors: Merivee Enno , Ploomi Angela , Rahi Märt , Luik Anne , Sammelselg Väino
Published: March 2003

Antennal sensilla typology, number and distribution pattern were studied in the ground beetle Bembidion lampros Hbst (Coleoptera, Carabidae) using scanning electron microscopy. The 1.6–1.8 mm long filiform antennae of both sexes consist of the scape, pedicel and of the flagellum composed of nine flagellomeres. In both sexes, three types of sensilla chaetica, two types of sensilla trichodea, five types of sensilla basiconica, one type of sensilla coeloconica, one type of sensilla campaniformia and Böhm sensilla were distinguished. The possible function of the sensilla was discussed and three types of sensilla were considered as olfactory, sensilla trichodea type 2 and sensilla basiconica types 1 and 2. Olfactory sensilla occupy dorsal and/or ventral areas of the flagellomeres and occur sparsely (sensilla basiconica type 1) or not at all (sensilla basiconica type 2 and sensilla trichodea type 2) outside these areas. No remarkable sexual differences in the types, numbers and distribution of antennal sensilla were found.
Early juvenile development of deep‐sea asteroids of the NE Atlantic Ocean, with notes on juvenile bathymetric distributions
Authors: Sumida Paulo Y. G. , Tyler Paul A. , Billett David S. M.
Published: March 2003

The postmetamorphic ontogenesis of 11 deep‐sea asteroid species is described. Juvenile bathymetric distributions are compared to adults. The deep‐sea juvenile asteroids of the NE Atlantic could be distinguished to species level from a very early stage of development. In all species, except Porcellanaster ceruleus and Plinthaster dentatus, the arms grow faster than the body. In Porcellanaster ceruleus and Plinthaster dentatus, early growth is nearly isometric. In the appearance of the epiproctal cone, the change in form of the furrow and apical spines, the early development of the cribriform organ adjacent to the madreporite and the appearance of sediment in the stomach indicate that Porcellanaster ceruleus is likely to undergo a shift in habitat and diet during the juvenile phase. Porcellanaster ceruleus is probably a predator on meiofauna and small macrofauna during the early stages of life, changing to a burrowing lifestyle ingesting sediment particles. Juvenile sea stars showed wider bathymetric distributions than their adult counterparts, suggesting that events occurring during the early stages of life are important for the maintenance of the local population structure and diversity in the deep NE Atlantic.
A study to detect Gardnerella vaginalis DNA in interstitial cystitis
Authors: Agarwal M. , Dixon R.A.
Published: March 2003

Objective To investigate the possible role of Gardnerella vaginalis in interstitial cystitis (IC), using molecular methods to avoid difficulties with the culture and recovery of viable organisms, and the problems associated with the recovery of low numbers of culturable organisms.

Materials and methods Thirty‐three bladder biopsy samples (29 paraffin‐embedded and four freshly frozen) from patients with IC, diagnosed according to National Institute of Diabetes, Digestive and Kidney Diseases criteria, were assessed. Biopsy samples were used as urine samples may be contaminated by normal vaginal flora. A positive control comprised a ‘normal’ biopsy sample from a patient with a previous bladder tumour, seeded with G. vaginalis NCTC 10915. Microbial DNA was extracted from all paraffin‐embedded and fresh specimens, and subjected to in vitro amplification by polymerase chain reaction (PCR) with G. vaginalis‐specific primers.

Results The anticipated PCR product of 333 base pairs was obtained with the positive control, whereas none of the other biopsy samples showed positive amplification specific for G. vaginalis.

Conclusion As there was no G. vaginalis DNA in any of the samples from patients with IC, it is an unlikely candidate in the pathogenesis of IC.
Is sexual intercourse a significant cause of haematuria?
Authors: Harris N.M. , Yardley I. , Basketter V. , Holmes S.A.V.
Published: March 2003

Objectives To determine whether recent sexual intercourse might be a cause of microscopic haematuria in patients referred to a urological unit following dipstick detection of urinary haemoglobin.

Subjects and methods Forty‐eight volunteers (24 men and 24 women) consented to have heterosexual intercourse with their regular partner, and to provide samples of urine for testing before and from the first void on the morning after intercourse. After appropriate instruction, volunteers tested their own urine for the presence of blood using standard dipsticks. Any volunteer with haematuria either before or after intercourse was offered a standard haematuria assessment. The results were analysed using the chi‐squared test.

Results None of the volunteers tested positively for haematuria immediately before sexual intercourse; six of the 24 women (25%), but no men, became positive after intercourse (P < 0.01). Only one of the six women accepted the offer of a haematuria evaluation and no pathology was identified.

Conclusion These results suggest that up to a quarter of women develop microscopic haematuria as a direct result of sexual intercourse. A history of recent sexual intercourse should therefore be considered when assessing the clinical significance of microscopic haematuria in women.
Nicotine toxicity to the ultrastructure of the testis in rats
Authors: Aydos K. , Güven M.C. , Can B. , Ergün A.
Published: March 2003

Objective To investigate the influence of nicotine exposure on the ultrastructure of the rat testis.

Materials and methods Twenty rats were injected with nicotine at a dose of 0.4 mg/100 g body weight daily for 3 months; a group of 20 control rats matched for weight and age were injected with saline only for the same duration. The testes were then harvested and examined by transmission electron microscopy.

Results Rats given nicotine showed: thickening of the tunica propria, caused by an increase in the collagen fibres under the irregular basal lamina; degeneration of junctional specializations between the Sertoli cells, with malformed nuclei showing condensed chromatin; Sertoli cells with numerous polymorphic mitochondria with irregular cristae and an electron‐dense matrix. The germ cells were degenerated, spermatids retained excess cytoplasm and accumulated electron‐dense lipid droplets in the cytoplasm. The acrosomes were irregular and abnormally configured.

Conclusion There were ultrastructural alterations in rats exposed to nicotine that could be attributed to the detrimental effects of nicotine on germ cells, peritubular structures and Sertoli cells.
Evaluation of antidiuretic hormone before and after long‐term treatment with desmopressin in a group of enuretic children
Authors: Chiozza M.L. , Plebani M. , Scaccianoce C. , Biraghi M. , Zacchello G.
Published: March 2003

Objective

To determine the effect of long‐term desmopressin therapy in enuretic patients on the levels of antidiuretic hormone (ADH) during and after the end of therapy.

Patients and methods

The study comprised 25 outpatients (18 boys and seven girls) aged 8–12 years at the start of therapy and 12–16 years at the end. The morning (08.00 hours) plasma ADH level was determined before treatment (T0) with desmopressin and 2 years after (T1) ending the therapy. Seven of the 25 patients evaluated had monosymptomatic (simple enuresis, SE) and 18 had other symptoms (complex enuresis, CE).

Results

In the patients with SE, the mean (SD) duration of therapy was 305 (183) days and they were re‐evaluated 2.5 (0.67) years later. Of 18 patients with CE, eight were treated only with desmopressin for 204 (117) days. In 10 with an incomplete response after 30 days with only desmopressin, oxybutynin (5 mg twice daily) was added; the duration of their therapy was 255 (152) days and they were re‐evaluated 3.9 (0.6) years later. The mean (SD) ADH level in those with SE and CE was 2.14 (0.93) ng/L and 2.53 (1.16) ng/L), respectively, both significantly lower (P< 0.001) than in controls, at 5.1 (1.6) ng/L. On re‐evaluation at T1, there was a significant (P<0.001) increase in ADH levels over those at T0 in both groups, at 5.2 (0.8) and 5.3 (1.9) ng/L, respectively.

Conclusion

These results seem to confirm the role played by ADH in the pathophysiology of enuresis.
The objective assessment of urinary incontinence in children
Authors: Imada N. , Kawauchi A. , Tanaka Y. , Watanabe H.
Published: March 2003

Objective

To assess urinary incontinence objectively in children.

Patients and methods

Thirty‐three children (mean age 8.2 years, range 5–12) were examined, of whom 23 suffered from incontinence and 10 did not. The first method of assessing incontinence was the 1‐h pad‐weighing test proposed by the International Continence Society in 1983 and the second was a test in which the pad was weighed between one urination and the next. At the end of the tests the volume of normally voided urine was measured and the total voided volume during the test calculated. The volume of urine lost during incontinence and the ratio [incontinence volume/(incontinence volume+voided volume)] were evaluated; the ratio was used because the bladder capacity in children differed with age.

Results

In both tests, no wetting occurred in any of the 10 patients not complaining of incontinence. In the 1‐h pad‐weighing test, no wetting occurred in 14 of the 23 patients complaining of incontinence but did in the nine remaining patients, the loss being 1–30 g, and the incontinence ratio 0.5–14.8%. In the second test, no wetting occurred in 12 of the 23 patients complaining of incontinence but did so in the 11 remaining patients, with losses of 2–50 g and incontinence ratios of 1.5–80.6%.

Conclusions

There was no significant difference between the tests in the incidence of incontinence. However, the second method seemed to be more closely related to the clinical symptoms than was the 1‐h pad‐weighing test and may be useful in the assessment of incontinence in children.
Colorectal dysfunction and faecal incontinence in children with spina bifida
Authors: Ponticelli A. , Iacobelli B.D. , Silveri M. , Broggi G. , Rivosecchi M. , De Gennaro M.
Published: March 2003

Objectives

To quantify colorectal neurogenic dysfunction in children with spina bifida and to evaluate the clinical efficacy of appropriate rehabilitation performed by the coloproctologist in the spina bifida team.

Patients and methods

The bowel function of 73 patients with congenital (67) and acquired (six) spinal lesions (age 7–25 years) was evaluated by one physician. Evacuation habit was classified as full bowel control, mild and severe constipation or incontinence. Fifty‐two children had mild or severe incontinence or constipation, 22 of whom were treated by the coloproctologist using biofeedback or conventional therapy; 30 were not treated. The outcome was compared between the groups

Results

Bowel constipation remained stable in 90% and was complicated in 10% of the untreated patients, while it ameliorated in 59% of patients who received specialist treatment.

Conclusion

Neurogenic bowel dysfunction needs specialist management to achieve better results, using the concept of controlled incontinence. There was no significant difference between conventional therapy and biofeedback methods.
Comparison of the Danish prostatic symptom score with the International Prostatic Symptom Score, the Madsen‐Iversen and Boyarsky symptom indexes
Authors: Hansen  , Mortensen  , Mensink  , Flyger  , Riehmann  , Hendolin  , Nordling  , Hald  ,   the ALFECH Study Group*
Published: March 2003

Objective

 To compare the Danish Prostatic Symptom Score (DAN‐PSS) with the International Prostatic Symptom Score (IPSS), Madsen‐Iversen and Boyarsky symptom indexes in a clinical setting, and to evaluate the potential significance of any differences in information obtained from these questionnaires.

Patients and methods

 The study comprised two substudies: in the first, 205 patients with lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO), a Madsen‐Iversen score >6 and a maximum flow rate of <10 mL/s were randomized to receive either placebo or alfuzosin in a double‐blind study of 16 weeks. The symptoms were assessed using the Madsen‐Iversen, DAN‐PSS and the IPSS questionnaires. In the second, 138 patients with LUTS suggestive of BOO were selected for treatment with transurethral microwave thermotherapy (TUMT, 52°C for 60 min, microwave energy 200 kJ) and their symptoms assessed using the Boyarsky and the DAN‐PSS questionnaires. Patients were then followed for one year. Rank correlation coefficients and regression lines were calculated using Spearman’s non‐parametric test. The relative changes, i.e. responsiveness, calculated for the DAN‐PSS, IPSS and Boyarsky indexes were compared pairwise using the Wilcoxon‐Pratt test.

Results

 The DAN‐PSS, IPSS and Madsen‐Iversen indexes were correlated on a pairwise basis. The DAN‐PSS and IPSS indexes have significant construct validity in terms of correlation with the Madsen‐Iversen system (Spearman’s correlation coefficient, rs=0.51 and rs=0.45, respectively). The DAN‐PSS and the IPSS indexes were correlated (rs=0.61). The DAN‐PSS was more sensitive than the IPSS to changes after pharmacological treatment, with scores decreasing 70% and 29% (P<0.05), respectively, after treatment with an alpha‐blocker for 4 months, and 50% and 29% (P<0.05), respectively, after 4 months on placebo treatment. Finally, the responsiveness of the Boyarsky and DAN‐PSS indexes to TUMT showed that the DAN‐PSS system was significantly more responsive than the Boyarsky index, with scores decreasing 57% and 15% (P<0.05), respectively, after one year.

Conclusions

 The DAN‐PSS index is more sensitive than the IPSS, Madsen‐Iversen and Boyarsky symptom indexes, incorporates important outcome events, includes a patient‐weighting of each symptom, thereby reflecting better the patients’ global assessment of outcome.
Transversely tubularized ileal segments for the Mitrofanoff
Authors: Sugarman  , Malone  , Terry  , Koyle
Published: March 2003

Objective

 To assess the use of a transverse tubularized segment(s) of ileum in the Mitrofanoff or Malone antegrade colonic enema (MACE) procedures.

Patients and methods

Eleven patients in three centres underwent the formation of a continent conduit to bowel (MACE, eight patients) and/or bladder (Mitrofanoff, four) using either a single segment of transverse tubularized ileum (10 patients) or two segments of ileum anastomosed and tubularized into a single conduit (two).

Results

Within a follow‐up of 8 weeks to 6 months, all conduits were continent and catheterized easily. One stomal stenosis required a revision procedure.

Conclusion

This method for forming a continent catheterizing conduit, based on the Mitrofanoff principle, appears to be effective and is recommended in cases where the appendix cannot be used or where a second conduit is required.
Placebo therapy of benign prostatic hyperplasia: a 25‐month study
Authors: Nickel
Published: March 2003

Objective

 To analyse the efficacy, correlations and adverse‐event profile of placebo therapy from the initial placebo run‐in period to beyond 2 years of treatment.

Patients and methods

 The effects of placebo therapy on prostate size, maximum urinary flow rate (Qmax ) and symptoms were analysed, and adverse drug experiences documented, for a period of 25 months in 303 patients randomized to the placebo arm of a controlled trial evaluating finasteride in the treatment of BPH (the Canadian PROSPECT study).

Results

 For all variables, the values during follow‐up were significantly different from baseline (P≤0.001). Transrectal ultrasonography confirmed a progressive increase in prostate volume over 25 months (+8.4%) but Qmax improved for the first 5 months (to 1.4 mL/s over baseline) and remained 1.0 mL/s more than baseline at 25 months. The total symptom score improved by −2.9 points in the first 2 months on placebo and was ultimately 2.3 points below baseline at 25 months. The extent of the placebo response for symptoms (r=0.08, P=0.180) and Qmax (r=0.04, P=0.550) was independent of age, but the response correlated with the initial severity of symptoms (r=−0.394, P≤0.001) and initial Qmax (r=−0.134, P=0.023). Patients with a prostate of ≤40 mL had a clinically more important placebo response than those with larger prostates. In all, 246 patients (81.2%) reported adverse events thought to be secondary to placebo therapy. The most common complaint was urogenital (40.3%), specifically impotence (6.3%) and decreased libido (6.3%); 13.2% of patients discontinued placebo therapy because of significant adverse reactions.

Conclusions

 Placebo therapy rapidly produces a significant improvement in Qmax and symptoms of BPH but also causes clinically important adverse effects. The beneficial effect fades but remains after 2 years.
Correlation between genito‐urinary anomalies, semen analysis and CFTR genotype in patients with congenital bilateral absence of the vas deferens
Authors: De La Taille  , Rigot  , Mahe  , Vankemmel  , Gervais  , Dumur  , Lemaitre  , Mazeman
Published: March 2003

Objective

 To evaluate the incidence of renal and seminal vesicle (SV) abnormalities, and the presence or absence of CFTR gene mutations, in a cohort of patients referred for congenital bilateral absence of the vas deferens (CBAVD).

Patients and method

 Forty‐one patients with CBAVD, confirmed by surgical exploration, were evaluated by ultrasonography for renal and SV anomalies. Semen variables (pH, fructose level and ejaculate volume), sweat chloride levels and mutations of the 3, 4, 7, 9, 10, 11, 13, 14b, 17b, 19, 20 and 21 exons of the CFTR gene were determined.

Result

 In eight patients with renal anomalies there were no detectable mutations of CFTR, compared with 23 in the 33 patients with no renal anomalies (P<0.02). SV anomalies were not related to the presence or absence of mutations (11 of 23 vs 11 of 18), or in compound heterozygote patients carrying two mutations (eight of 13 vs three of 10). Semen variables (pH<7.2, fructose <1 g/L and ejaculate volume <2 mL) did not differentiate patients with or without anomalies of the kidney, SV or with mutations, except in patients with a pH<7.2 for which renal anomalies were less frequent (two of 25 vs six of 16, P<0.05) and mutations more frequent (19 of 25 vs five of 12, P<0.01).

Conclusion

 Renal anomalies associated with CBAVD should be considered as supporting maldevelopment as a cause, but analysis of CFTR mutations in these cases should not be omitted. Unlike anomalies of the SV, a low ejaculate volume or low fructose level, a semen pH of <7.2 is the only nonspecific variable in patients with CFTR mutations.
Does incision of the tunica vaginalis during the Palomo procedure prevent post‐operative hydrocele?
Authors: Tsikopoulos  , Roussis  , Georgakis  , Papouis  , Tryfonas
Published: March 2003

Objective

 To assess whether incision of the tunica vaginalis of the ipsilateral testis during the Palomo procedure affects the incidence of post‐operative hydrocele.

Patients and methods

 Forty‐two patients with varicocele were treated between 1992 and 1996, all undergoing the Palomo procedure. In 15 patients, incision of the tunica vaginalis of the ipsilateral testis was performed with the Palomo procedure, to prevent the formation of hydrocele. All patients were followed at regular intervals, for 3 months to 4 years.

Results

 Of 27 patients who underwent the Palomo procedure alone, four developed post‐operative hydrocele requiring operation. None of those who underwent incision of the tunica vaginalis with the Palomo procedure developed a hydrocele. The duration of hospital stay was the same in both groups (mean 2.5 days). During the follow‐up, there was no difference in the size of the testes, as assessed with the Prader orchidometer, between the two groups.

Conclusion

 Incision of the tunica vaginalis of the ipsilateral testis in addition to the Palomo procedure prevents the development of post‐operative hydrocele and causes no adverse sequelae.
Diagnosis and treatment of adrenal tumours: a review of 35 years’ experience
Authors: Xiao  , YE  , Shi  , Cheng  , LI  , Zhou
Published: March 2003

Objective

 To review and analyse clinical data on the diagnosis and management of patients with adrenal masses.

Patients and methods

 Patients admitted with adrenal masses between 1960 and 1995 were reviewed. The series comprised 116 males (mean age 41.4 years, sd 10.5, range 3–77) and 95 females (mean age 36.9 years, sd 11.6, range 1–62); eight patients were <14 years old and the overall mean (sd) age was 39.4 (12.8) years. The diagnosis was based on symptoms, signs, hormone levels and imaging studies. All tumours were confirmed by surgery, and pathology and results of analysis assessed statistically.

Results

 Over the last 35 years, the incidence of adrenal tumours was 1.7% of all patients admitted with genitourological diseases or 9.7% of patients with genitourinary tumours at our institution. The prevalence of adrenal tumours in males and females was similar but Cushing’s syndrome was 3.1 times more frequent in females than in males and phaeochromocytoma 1.9 times more frequent in males than females. Most patients with adrenal tumour were aged 30–50 years. Of 211 adrenal tumours, 151 (72%) were functional, with a prevalence of benign tumour, and 60 (28%) were nonfunctional, with 35% malignant. There were 78 ‘incidentalomas’ which included 18 functional tumours. Overall, 210 tumours were removed and one was explored. Correlation analysis between tumour size and character or hormone levels showed that size was significantly positively correlated with tumour character (r=0.4010, P<0.001), but there was no relationship between tumour size and hormonal levels. The postoperative complication rate was 3.3% and the mortality 0.5%.

Conclusions

 Based on this analysis we recommend that computed tomography is the first method used to define and localize the adrenal masses, that hormone levels should be determined in symptomatic or asymptomatic patients with adrenal masses, and that functional adrenal tumours and solid incidentalomas of any size should be removed surgically.
Zonal variation of apoptosis and proliferation in the normal prostate and in benign prostatic hyperplasia
Authors: Colombel  , Vacherot  , Gil Diez  , Fontaine  , Buttyan  , Chopin
Published: March 2003

Objective

 To determine whether benign prostatic hyperplasia (BPH) results from an imbalance between cell proliferation and apoptosis, and the extent to which the rates of these opposing processes are altered with the expression of the anti‐death oncoprotein bcl‐2.

Materials and methods

 Ten prostate glands from normal men (mean age 43.7 years) were sampled according to McNeal’s zonal anatomy, in addition to 30 prostate adenomas obtained from prostatectomy specimens from symptomatic patients (mean age 61.4 years). Tissue samples were fixed in formalin and embedded in paraffin. Proliferation and bcl‐2 expression were assessed by immunostaining using Mib‐1 and anti‐bcl‐2 antibodies, while apoptotic bodies were specifically stained using in situ nick translation. The percentage of positive cells was determined by optical microscopy.

Results

 In normal epithelium, the rates of proliferation and apoptosis were increased in the peripheral zone (Mib‐1 1.7%, apoptotic bodies 3.3%) compared with the central (0.2% vs 1.4%) and transition (0.1% vs 1.8%) zones. Proliferation was significantly greater in BPH than in normal prostate tissue (3.7%), contrasting with a stable rate of apoptosis (1.4%). In the normal prostate, bcl‐2 was expressed by glandular and basal cells in the peripheral zone. In the central zone, bcl‐2 was overexpressed in basal cells and in most glandular cells of the intraluminal ridges. Bcl‐2 expression in the transition zone was limited to dispersed basal cells. In BPH, bcl‐2 was strongly expressed by basal cells in mature glandular formations and in most cells of young small nodules.

Conclusion

 BPH may result from both an increase of proliferation within the basal compartment and a failure of apoptosis to counterbalance basal cell proliferation. Increased expression of bcl‐2 may participate in this process by blocking apoptosis.
A new operative method to treat high teat stenoses in dairy cows
Authors: John  , HÄssig  , Gobet  , Sicher  , Jaeger
Published: March 2003

Objective

 To evaluate in a pilot study an alternative technique using theloscopic surgery in the management of proximal teat stenoses of dairy cows.

Materials and methods

 The study included three lactating dairy cows (mean age 3.5 years) with a stenotic fibrous lesion in the proximal region of a teat. The lesions were suspected to be of traumatic origin and the diagnoses were confirmed by ultrasonography. For surgery, the cows were sedated and the base of the teat anaesthetized. The resectoscope was introduced through an incision in the teat cistern. The surgical area was continuously irrigated with saline solution and the stenotic lesions electroresected. Haemorrhage was controlled whenever possible by electrocoagulation.

Results

 In two cows, the procedure was successful and resulted in normal milk flow. One of the two cows was slaughtered soon after the operation for reasons unrelated to udder health. The other cow could be milked normally at a follow‐up examination 4 months later and on ultrasonography, there was no recurrence of the stenotic lesions. In both cows, there was no evidence of concurrent intramammary infection. In the third cow, the procedure had to be discontinued because of severe intraoperative haemorrhage.

Conclusions

 Video‐assisted theloscopic electroresection of fibrotic teats is a promising, novel and minimally invasive technique for the surgical correction of the glandular part of the cistern. It should be considered as an alternative to conventional surgical methods in valuable dairy cows.
Manual derotation of the twisted spermatic cord
Authors: Cornel  , Karthaus
Published: March 2003

Objective

To re‐emphasize the safety and efficacy of manual derotation in the management of the twisted spermatic cord.

Patients and methods

Seventeen patients (mean age 15 years, range 13–28) with acute unilateral torsion of the spermatic cord, initially treated by manual detorsion, were reviewed; all 17 patients were seen by one consulting urologist (H.F.M.K.).

Results

In 14 of the 17 patients the attempt resulted in successful manual derotation, i.e. the immediate relief of all symptoms and normal findings at physical examination. No testicular atrophy was detected during the follow‐up (mean 22 months, range 9–72).

Conclusions

These results reinforce the efficacy and safety of manual derotation with subsequent elective bilateral orchidopexy as the primary treatment for the twisted spermatic cord.
Genetic instability in incidentally discovered and advanced prostate cancer
Authors: Crundwell  , Morton  , Arkell  , Phillips
Published: March 2003

Objective

To investigate the frequency of microsatellite instability, a marker for genetic instability, in incidental and advanced prostate cancers, and to determine the role and prognostic importance of genetic instability in prostate carcinogenesis.

Patients and methods

Microsatellite analysis was performed on 72 prostate cancers, of which 26 were incidentally discovered at transurethral prostatectomy (TURP) for benign disease. They were staged and graded 1–3 according to glandular differentiation. Fresh prostatic tissue was obtained at TURP performed for bladder outlet obstruction, from 43 patients (median age 73 years, range 55–88), with tissue from the remaining 29 (median age 75, range 53–83) patients obtained from pathology archives, having been originally collected at TURP between 1969 and 1986.

Results

Instability was detected in 14 (19%) cancers overall, in eight (31%) of 26 incidental tumours and in six (13%) of 46 clinically apparent tumours. These differences were not statistically different (2P=0.1). The time to progression and survival were similar between men with tumours showing instability and those with no instability.

Conclusion

These data suggest that genetic instability is an early event in prostate carcinogenesis, but does not appear to influence prognosis.
The conservative management of Corynebacterium group D2 encrusted pyelitis
Authors: Meria  , Desgrippes  , Fournier  , Arfi  , Antoine  , Martinat  , Teillac  , Le Duc
Published: March 2003

Objective

To evaluate the conservative management of encrusted pyelitis (EP), an infectious disease caused by urea‐splitting micro‐organisms (Corynebacterium group D2 being the most common), and characterized by stone encrustation of the collecting system.

Patients and methods

Four patients (aged 17–62 years) with EP caused by Corynebacterium group D2 were treated conservatively with intravenous vancomycin and percutaneous acidification of the renal collecting system. Percutaneous nephrostomy tubes were placed to allow irrigation with Thomas’ acid solution, the outflow being ensured by ureteric catheters. Patients were monitored and the results of and tolerance to treatment evaluated clinically, by biological assays, and by imaging techniques (ultrasonography, computed tomography and pyelography).

Results

No kidneys were lost and in all patients with initial renal failure, creatinine levels recovered to previous values. The adverse effects were moderate, consisting of flank pain or discomfort, and low‐grade fever. Three patients developed asymptomatic fungal urinary tract infections requiring antifungal agents. The encrustations were treated effectively and almost disappeared in two patients, while the other two had no residual calcification. One transplanted‐kidney recipient developed a ureteric stricture requiring surgical repair. Within a mean follow‐up of 16 months, there was no recurrence of EP and the residual encrustation remained small.

Conclusion

The conservative treatment of EP can avoid surgery in many cases, although there are some adverse effects of irrigation. The long‐term follow‐up and prevention of recurrent EP are nevertheless required.
Ischaemic preconditioning protects the rat kidney from reperfusion injury
Authors: Toosy  , McMorris  , Grace  , Mathie
Published: March 2003

Objective

To examine the possible role of ischaemic preconditioning (IPC), an adaptive pathophysiological phenomenon that increases tolerance to ischaemia‐reperfusion (I‐R) injury, in renal protection when rats are presented with an I‐R challenge.

Materials and methods

Female Wistar rats (n=36) were divided randomly into four groups: (A) sham‐operated controls; (B) IPC only; (C) renal ischaemia (RI) only; and (D) IPC+RI. The left kidney in groups B and D was preconditioned with four cycles of renal artery occlusion lasting 4 min, each occlusion separated by 11 min of reperfusion. The ischaemic insult, applied in groups C and D, comprised 40 min of sustained left renal artery occlusion. In Group D, the IPC cycle was completed 5 min before the start of the ischaemic insult. Differential left renal function was calculated by 99mTc‐labelled dimercaptosuccinic acid scintigraphy at 0, 2 and 9 days after treatment, and expressed as a percentage of the total renal uptake.

Results

The mean (sem) maximum decrease in left renal function, to 14.5 (4.3)% of the total, occurred on day 2 in Group C. The equivalent value in Group D showed relative preservation of function, at 36.0 (3.5)% (P=0.001 compared with Group C). The mean left renal function improved by day 9, to 39.6 (6.7)% (Group C) and 48.6 (1.5)% (Group D). The mean left renal function in Group B (50.5–53.9%) did not differ from that in controls (49.4–51.4%).

Conclusion

An IPC regimen applied 5 min before RI in the rat significantly protects it from the functional impairment associated with ischaemia and reperfusion.
Up‐regulation of endothelin‐B (ETB) receptors and ETB receptor‐mediated rabbit detrusor contraction in partial bladder outlet obstruction
Authors: Khan  , Dashwood  , Thompson  , Mumtaz  , Mikhailidis  , Morgan
Published: March 2003

Objective

 To investigate, in a rabbit model of bladder outlet obstruction (BOO), whether ETB receptors initiate any contractile activity, and to assess the density of these receptors.

Materials and methods

Partial BOO was produced in male New Zealand White rabbits, with age‐matched sham‐operated rabbits acting as controls. One and 3 weeks later, the detrusor and bladder neck strips were incubated in organ baths with either BQ788 (an ETB antagonist), BQ123 (an ETA antagonist) or vehicle. Concentration‐response curves were constructed using IRL‐1620 (a selective ETB agonist). Low‐resolution autoradiography was performed on serial detrusor and bladder neck sections from control and partial BOO (3‐week) rabbits using radioligands for ETA and ETB.

Results

In strips from controls and after 1 week of partial BOO, IRL‐1620 induced no contractions, but after 3 weeks of BOO, IRL‐1620 induced significant concentration‐dependent detrusor contractions (producing 12%, 25% and 70% of the KCl response at 10−8 , 10−7 and 10−6 mol/L, respectively). The ETA antagonist had no effect on IRL‐1620‐mediated contractions. In contrast, the ETB antagonist completely abolished these contractions. Autoradiography showed the presence of ETA and ETB receptors in the detrusor and bladder neck of normal and obstructed animals, and a significant up‐regulation of ETA and ETB receptors only in the obstructed detrusor smooth muscle.

Conclusions

In BOO, ETB receptors initiate detrusor contractile activity. This is a time‐dependent process that may depend on the up‐regulation of ETB receptors in the detrusor. Therefore, ETB receptors may play a role in the pathophysiology of partial BOO.
Steinstrasse: a comparison of incidence with and without J stenting and the effect of J stenting on subsequent management
Authors: Al‐Awadi  , Abdul Halim  , Kehinde  , Al‐Tawheed
Published: March 2003

Objective

 To analyse the effect of ureteric stenting on the incidence of steinstrasse and its effects on the subsequent management of steinstrasse.

Patients and methods

 Four hundred adult patients with a unilateral stone burden (mean diameter 1.5–3.5 cm) were randomly allocated into two groups; in group 1, patients had a J stent inserted before extracorporeal shock wave lithotripsy (ESWL) and group 2 did not. Before randomization, the patients had normal renal function and no evidence of ureteric obstruction on intravenous urography. All patients underwent ESWL, with the shock waves delivered first to the most dependent part of the calculi. Patients who developed steinstrasse were identified and the effect of the size of the calculi and the presence of a J stent on the incidence and level of the steinstrasse, on the time of diagnosis, the size of the major stone fragment, associated presenting symptoms and effect on subsequent management were compared between the groups.

Results

 Patients developed steinstrasse in both groups, with 12 (6%) and 26 (13%) in groups 1 and 2, respectively (significantly different, P<0.05). The incidence of steinstrasse depended on the size of the calculus, regardless of whether a J stent was present, being 2.6% and 56% for a burden of 1.5–2.0 cm and 3.1–3.5 cm, respectively (P<0.001). There was no difference in the presenting symptoms in the two groups. The steinstrasse was in the lower third of the ureter in eight of 12 patients in group 1 and in 16 of 26 (62%) in group 2. The steinstrasse resolved spontaneously in seven patients in group 1 and in 12 (46%) in group 2 (P<0.11). Similarly, J stenting had no effect on the subsequent treatment modalities to resolve steinstrasse.

Conclusion

 The use of J stenting before lithotripsy significantly lowers the incidence of steinstrasse in patients with a stone burden of 1.5–3.5 cm. The incidence of steinstrasse increases with the size of the calculi, whether or not a J stent is present; J stenting has no apparent effect on the mode of presentation or the subsequent management of steinstrasse.
Semen cryopreservation after orchidectomy in men with testicular cancer
Authors: Sibert  , Rives  , Rey  , Mace  , Grise
Published: March 2003

Ojective

To assess the feasibility of semen cryopreservation after orchidectomy in patients with testicular tumour.

Patients and methods

The quality of semen samples was investigated in 36 men with testicular tumour (mean age 31.7 years, range 20–49) who were referred to our infertility centre for semen cryopreservation. For each patient, the number of straws, semen volume, number of spermatozoa, and sperm motility before and after freezing were evaluated.

Results

Fifteen patients (42%) banked sperm before and 21 (58%) after orchidectomy; the delay was >7 days in 19 patients (53%). The mean age, histological diagnosis and tumour stage did not differ significantly whatever the time of cryopreservation. Semen quality did not differ significantly in patients who cryopreserved sperm before or after orchidectomy and there were no significant differences in sperm values whatever the delay before preservation. Semen quality was the same in patients with seminoma or nonseminoma tumour.

Conclusion

These findings indicate that spermatogenesis of the contralateral testis is sufficient for successful semen cryopreservation after orchidectomy. Urologists should be encouraged to increase the awareness among oncology teams and patients about the new developments in preserving fertility for patients with cancer.