bluuebunny/crossref_metadata_2025 huggingface dataset:
Construction of hybrid peptide synthetases for the production of α‐l‐aspartyl‐l‐phenylalanine, a precursor for the high‐intensity sweetener aspartame
Authors: Duerfahrt Thomas , Doekel Sascha , Sonke Theo , Quaedflieg Peter J. L. M. , Marahiel Mohamed A.
Published: November 2003

Microorganisms produce a large number of pharmacologically and biotechnologically important peptides by using nonribosomal peptide synthetases (NRPSs). Due to their modular arrangement and their domain organization NRPSs are particularly suitable for engineering recombinant proteins for the production of novel peptides with interesting properties. In order to compare different strategies of domain assembling and module fusions we focused on the selective construction of a set of peptide synthetases that catalyze the formation of the dipeptide α‐l‐aspartyl‐l‐phenylalanine (Asp‐Phe), the precursor of the high‐intensity sweetener α‐l‐aspartyl‐l‐phenylalanine methyl ester (aspartame). The de novo design of six different Asp‐Phe synthetases was achieved by fusion of Asp and Phe activating modules comprising adenylation, peptidyl carrier protein and condensation domains. Product release was ensured by a C‐terminally fused thioesterase domains and quantified by HPLC/MS analysis. Significant differences of enzyme activity caused by the fusion strategies were observed. Two forms of the Asp‐Phe dipeptide were detected, the expected α‐Asp‐Phe and the by‐product β‐Asp‐Phe. Dependent on the turnover rates ranging from 0.01–0.7 min−1, the amount of α‐Asp‐Phe was between 75 and 100% of overall product, indicating a direct correlation between the turnover numbers and the ratios of α‐Asp‐Phe to β‐Asp‐Phe. Taken together these results provide useful guidelines for the rational construction of hybrid peptide synthetases.
SUBOPTIMAL PREVENTIVE PRACTICES IN PATIENTS WITH CAROTID AND PERIPHERAL VASCULAR OCCLUSIVE DISEASE IN A TERTIARY REFERRAL SETTING
Authors: Teh Lip Gen , Sieunarine Kishore , Eikelboom John , Prendergast Frank J. , Goodman Marcel A. , Joesbury Karen , Watt Eilidth
Published: November 2003

Background:  Effective strategies for the prevention of adverse vascular events in patients with atherosclerotic vascular disease include smoking cessation, platelet inhibition, antihypertensives, hypoglycaemic and cholesterol lowering agents. The current literature suggests that these practices are suboptimal in patients with peripheral vascular disease (PVD). This study aims to examine and compare the use of preventive therapy in patients admitted for interventions related to peripheral and carotid atherosclerotic occlusive disease.

Methods:  All inpatients undergoing diagnostic or therapeutic procedures for occlusive disease of the lower limb and carotid artery at Royal Perth Hospital, Western Australia, between January 2000 and December 2000 were included in the study. Their medical charts were reviewed to measure the prevalence of the use of antithrombotic, antihypertensive and cholesterol‐lowering therapies.

Results:  Medical charts of 256 patients (97%) were reviewed during the study period. Carotid related procedures accounted for 26% of the sample. Overall, 80% were prescribed antithrombotic (antiplatelet or anticoagulation) therapy at the time of discharge. In the carotid group, 97% were on some form of antithrombotic therapy as opposed to 75% in the PVD group. Antihypertensive and cholesterol lowering therapies were used in 82% and 63%, respectively, of the carotid group vs 68% and 36% in the PVD group. Rates of preventive practices were lowest in the subgroup of PVD patients without a history of coronary or cerebrovascular disease.

Conclusions:  Preventive therapies are under utilized in patients with PVD. Effective strategies need to be developed to encourage the use of these adjunctive therapies in the long‐term management of vascular patients.
TRAINING OUTSIDE OF THE BOX
Authors: Hill Andrew G. , Woodfield John C.
Published: November 2003

Background:  Developments in surgical training in Australasia allow for individualization of training to suit individual requirements. One uncommon career track is medical aid or missionary surgery in the developing world. It is difficult to receive appropriate training for this type of surgical practice in Australasia. The present paper describes a novel approach to preparing for this kind of work by spending a 6 month rotation in a mission hospital in rural East Africa.

Methods:  The surgical trainee spent 5 months working at Kijabe Hospital in Kenya. This is a large mission hospital with a busy general surgical workload and adequate staffing for training.

Results:  The trainee performed 214 major cases, in a broad range of general surgery, under appropriate supervision. He also took part in regular educational sessions, surgical audit, and helped to develop one of East Africa's pioneering laparoscopic surgical ­programmes.

Conclusions:  The present paper demonstrates that it is possible for Australasian trainees to gain useful experience in the rural African environment, in hospitals where appropriate surgical supervision is available.
EFFECT OF CAROTID BIFURCATION LOCATION ON THE LENGTH OF INTERNAL CAROTID DISEASE
Authors: Beiles C. Barry
Published: November 2003

Background:  A relationship between the height of the carotid bifurcation and the extent of disease in the internal carotid artery has not been reported. The aim of the present study was to determine if such a correlation exists.

Methods:  Fifty‐one patients undergoing carotid endarterectomy had measurements made of the height of the carotid bifurcation from the sternoclavicular joint. The length of disease removed distal to the bifurcation after carotid endarterectomy was also measured. Correlation analysis was performed.

Results:  There is a statistically significant negative correlation between the extent of disease in the internal carotid artery and the height of the bifurcation.

Conclusions:  A low carotid bifurcation correlates with a longer extent of disease in the internal carotid artery.
SERUM INSULIN‐LIKE GROWTH FACTOR‐I AND INSULIN‐LIKE GROWTH FACTOR BINDING PROTEIN‐3 FOLLOWING CHEMOTHERAPY FOR ADVANCED BREAST CANCER
Authors: Holdaway Ian M. , Mason Barbara H. , Lethaby Anne E. , Singh Vijay , Harvey Vernon J. , Thompson Paul I. , Evans Barrie D.
Published: November 2003

Background:  Insulin‐like growth factor‐I (IGF‐I) and IGF binding protein‐3 (IGFBP‐3) appear to influence the growth of breast cancer cells in vitro, and epidemiological studies suggest higher serum IGF‐I levels increase the risk of breast cancer. IGF‐I and IGFBP‐3 have therefore been measured in women with advanced breast cancer to determine if changes in serum levels predict the response to treatment by chemotherapy.

Methods:  Serum IGF‐I and IGFBP‐3 levels were measured in 14 patients before and after 1 week of chemotherapy. Changes in serum levels were compared with duration of survival.

Results:  Mean basal serum levels of IGF‐I and IGFBP‐3 were not significantly different between patients with advanced breast cancer and controls or women with early breast cancer. Serum IGFBP‐3 fell significantly 1 week after initiation of chemotherapy. Patient survival was not significantly related to baseline IGF‐I or IGFBP‐3 levels, but when the fall in serum levels 1 week after starting treatment was expressed either as absolute change or as a percentage of baseline, those individuals with a decrease in IGFBP‐3 greater than the median had significantly poorer survival (median survival 5.5 months vs 18 months). These results were independent of other prognostic variables such as previous disease‐free survival, and were also unaffected by the change in serum albumin with treatment. The fall in IGF‐I and IGFBP‐3 with chemotherapy mainly occurred in those with hepatic metastases, but prediction of survival was explained solely by the extent of the fall in IGFBP‐3.

Conclusions:  This preliminary study has shown that serum IGFBP‐3 falls significantly following initiation of chemotherapy and the extent of reduction significantly predicts the response to treatment.
ANTERIOR TONGUE CANCER: AGE IS NOT A PREDICTOR OF OUTCOME AND SHOULD NOT ALTER TREATMENT
Authors: Veness Michael J. , Morgan Gary J. , Sathiyaseelan Yasoda , Gebski Val
Published: November 2003

Background:  Mucosal head and neck cancers usually occur in older males after years of smoking and alcohol abuse. Despite this, approximately 5% of cases occur in young adults. The aetiology remains unclear and the anterior tongue is a prevalent site. Prognosis has been reported as worse in young patients and some have proposed a more aggressive treatment approach.

Methods:  Patients diagnosed with previously untreated anterior tongue squamous cell carcinoma and treated with curative intent were identified. Retrospective and prospective data were collected. Univariate and multivariate analyses were undertaken using Cox regression analysis. The outcome of patients treated with anterior tongue cancer using a cut‐off age of 40 years was compared.

Results:  Between 1980 and 2000, 106 males and 58 females with anterior tongue squamous cell carcinoma were treated at Westmead Hospital. Median follow up was 47 months (6−210 months). Twenty‐two patients (13.4%) were aged ≤40 years. Other than age, patient demographics, TNM stage and treatment approach were similar between the two groups. Eighty‐one per cent had either a T1 or T2 primary. In total, 139 patients (84.8%) had surgery or surgery and radiotherapy. A total of 56 (34%) patients experienced a recurrent event, with nodal recurrence occurring most often as the first site (n = 33, 59%). Young patients had a higher recurrence rate (45.5% vs 32.4%; P = 0.23). Relapse‐free survival at 5 years was 62% versus 81% (P = 0.27). Overall survival at 5 years was 65% versus 67% (P = 0.74).

Conclusions:  In keeping with recently published evidence, young age at diagnosis with anterior tongue cancer did not portend worse outcome. There is therefore currently no strong evidence to support a different treatment approach in young patients.
DECREASED PHAGOCYTIC CAPACITY OF AUTOTRANSPLANTED SPLENIC TISSUE
Authors: Smith Eric , J. De Young Neville , Drew Paul A.
Published: November 2003

Background:  Asplenic patients have an increased risk of infections. Operations such as autotransplantation have been proposed to restore functional splenic tissue after splenectomy, but the protective value of this tissue is unclear. Immune responses such as production of antibody remain impaired in humans and animals even when such tissue is present, and clearance of particles from the blood is reported to be less efficient than by normal spleen tissue. The present study investigated the phagocytic capacity of cells in the regenerated tissue in vitro, free of the confounding effects of hepatic clearance.

Methods:  Single cell suspensions were prepared from splenic tissue from rats 6 months after splenic autotransplantation or sham operation. Phagocytosis of killed, fluorescein‐labelled bacteria was measured by flow cytometry.

Results:  Autotransplanted tissue contained fewer phagocytic cells than normal tissue, and these cells phagocytosed less per cell. Phagocytosis by spleen cells was dependent on heat‐labile opsonic factors.

Conclusions:  Autotransplanted splenic tissue does not restore the phagocytic capacity lost following splenectomy.
ASSOCIATION OF PERIPAPILLARY FISTULA WITH COMMON BILE DUCT STONES AND CHOLANGITIS
Authors: Karincaoglu Melih , Yildirim Bulent , Kantarceken Bulent , Aladag Murat , Hilmioglu Fatih
Published: November 2003

Background:  Peripapillary choledochoduodenal fistula (PCDF) is occasionally detected during endoscopic retrograde cholangiopancreatography. Cholelithiasis and biliary bougienage are two suspected causes of PCDF.

Methods:  The medical records for 841 patients who underwent endoscopic retrograde cholangiopancreatography between 1993 and 2002 were reviewed for evaluation of PCDF.

Results:  A total of 327 patients had common bile duct stones, and 16 of these had a PCDF at the papilla of Vater. None of the 16 patients had a history of pancreatitis, duodenal ulcer, or had undergone endoscopic retrograde cholangiopancreatography previously. Seven of the 16 had not undergone biliary surgery.

Conclusions:  This study indicates that PCDF is a relatively common complication of common bile duct stones and cholangitis. According to the present results, PCDF is more frequently associated with common bile duct stones than with biliary surgery and bougienage.
DISTAL PANCREATECTOMY: IS STAPLE CLOSURE BENEFICIAL?
Authors: Takeuchi Kunio , Tsuzuki Yasushi , Ando Tetsu , Sekihara Masao , Hara Takashi , Kori Takayuki , Nakajima Hiroki , Kuwano Hiroyuki
Published: November 2003

Background:  Appropriate closure of the pancreatic remnant after distal pancreatectomy remains controversial. Data on distal pancreatectomy were reviewed to evaluate the effectiveness of staple closure compared with suture closure.

Methods:  Thirty‐three patients underwent distal pancreatectomy between January 1994 and December 2001. They were subdivided according to the method of closure of the distal pancreatic stump: the staple group comprised 10 patients and the suture group comprised 23 patients. Charts were reviewed for the method of closure of the distal stump as well as for the serum and urinary amylase level, mortality and morbidity.

Results:  In the staple group, no patient developed a pancreatic fistula, whereas in the suture group, eight patients (33.3%) developed a pancreatic fistula (P = 0.0353). The serum amylase level (mean ± SD) on the first postoperative day was 185 ± 71 IU/L in the staple group and 499 ± 461 IU/L in the suture group (P = 0.0413).

Conclusion:  Staple closure by means of a Powered Multifire Endo GIA 60 is a simple, quick and safe alternative to the standard suture closure technique, as it reduces the incidence of pancreatic fistula.
PROXIMAL GASTRIC EXCLUSION FOR UNRESECTABLE GASTRIC CANCER
Authors: Dolan Kevin , Sue‐Ling Henry
Published: November 2003

Background:  Patients with unresectable distal gastric cancer causing obstruction have classically undergone palliative gastrojejunostomy, but high mortality rates and delayed return of gastric emptying have been reported. The aim of the present study was to compare gastrojejunostomy and proximal gastric exclusion in patients with unresectable distal gastric cancer.

Methods:  Until 1996, patients with unresectable obstructing distal gastric cancer underwent antecolic gastrojejunostomy, but since 1997 we have performed proximal gastric exclusion for these patients. Mortality, morbidity, time taken to resume oral fluids and normal diet, length of palliation and survival were compared.

Results:  There was no mortality in either the gastrojejunostomy group (n = 4) or the exclusion group (n = 6). A single patient in the gastrojejunostomy group developed a sacral sore and another patient had recurrent vomiting following gastrojejunostomy. Exclusion resulted in a quicker return to diet and a slightly longer survival, although these were not statistically significant.

Conclusion:  Proximal gastric exclusion offers a safe, quick and life‐enduring palliation for unresectable malignant gastric outlet obstruction.
TECHNIQUE OF SPLIT SKIN GRAFT FIXATION USING HYPAFIX: A 15‐YEAR REVIEW
Authors: Davey R. Bruce , Sparnon Anthony L. , Lodge Michelle
Published: November 2003

The technique of graft fixation with Hypafix was introduced in 1986 and has since been adapted for use in all sites to become the standard technique in the management of paediatric burns at the Women's and Children's Hospital Burn Unit. The technique is versatile, safe, simple, reliable and inexpensive, and has proven to be effective in over 700 burn patients, with 18 patients (2%) requiring repeat grafts. The patient's care is continued in a designated Burn Scar Assessment Clinic with a range of ‘contact media’, including Hypafix, Elastofix, silicone gel and Elastomer products, being applied as necessary.
POSTMASTECTOMY SEROUS DRAINAGE AND SEROMA: PROBABLE PATHOGENESIS AND PREVENTION
Authors: Stehbens William E.
Published: November 2003

Seromas and prolonged, excessive drainage of serous fluid constitute the most common complications of mastectomy for breast carcinoma. The pathogenesis of this drainage problem is analysed from a pathological perspective and encompasses the role of biomechanical stresses involved in healing. Closed suction drainage delays healing and contributes to the accumulation of serum fluid in the wound. Suction of air into the patient's wound potentiates chronic drainage and seroma formation, adding to patient discomfort and increased risk of infection. The principle of primary union of the wound should be reinstated in mastectomies and to this end relevant changes in the surgical and postoperative management are proposed.
Controlled failure design of drillstring threaded connections
Authors: KNIGHT M. J. , BRENNAN F. P. , DOVER W. D.
Published: November 2003

The threaded connection of the type used in hydrocarbon exploration is a critical component of the drillstring that is highly susceptible to fatigue damage. Fatigue crack growth can either lead to a catastrophic failure of the connection, known as a twist‐off, or can be a non‐critical failure, known as a wash‐out. The design philosophy of Controlled Failure Design has been used in order to promote a ‘friendly’ non‐critical failure in the connection, by the controlled application of compressive residual stresses. The influence of compressive residual stress and its effect on controlling fatigue crack shape has been experimentally investigated with the development of thread root cold rolling equipment. Through the control of the cold rolling process, it has been demonstrated that fatigue crack growth can be controlled to produce a localized, non‐critical failure in the connection.
Genitourinary tract injuries in girls
Authors: Okur H. , Küçükaydin M. , Kazez A. , Turan C. , Bozkurt A.
Published: November 2003

Objective To evaluate lower genitourinary tract injuries in girls and to propose guidelines for the investigation and initial management of this unusual injury.

Patients and methods  The hospital records of 38 girls (aged 2–13 years) treated in our institution because of lower genitourinary (LG) tract injury between 1988 and 1995 were reviewed retrospectively. Urethral ruptures were detected in six patients, but the most frequent injuries were to the vulva (63%) and vagina (53%). There were pelvic fractures in eight patients and femoral fractures in a further five. Eight patients had concomitant anorectal lacerations. Vaginal and perineal lacerations were repaired primarily and a temporary urethral catheter was placed for a mean of 3 days. Partial urethral disruptions were repaired primarily over a stenting catheter in three patients. In one case, vaginal laceration and proximal complete rupture of the urethra was managed through a transvaginal approach with end‐to‐end urethral anastomosis over a stenting catheter. There was a complete rupture of the distal urethra and avulsion of the external meatus in two cases and these patients were managed by urethral advancement and meatoplasty.

Results Perineal physical signs did not reflect the severity of the lesions and cystovaginoscopy allowed localization of lacerations in some cases. Primary repair was possible in all cases. Three patients (8%) had wound infection after surgery. One patient had temporary urinary incontinence which was managed conservatively and one patient had faecal incontinence which needed secondary surgery.

Conclusion All female paediatric patients with suspected LG tract injury should undergo examination under anaesthesia to determine the degree of injury or possible concomitant injury to the urethra, bladder or rectum. Primary repair of these injuries is recommended.
Clinical, radiological and histological features of adrenal myelolipoma: review and experience with a further eight cases
Authors: El‐Mekresh M.M. , Abdel‐Gawad M. , El‐Diasty T. , El‐Baz M. , Ghoneim M.A.
Published: November 2003

Objective To review published reports of surgically treated adrenal myelolipomas and report experience with a further eight cases.

Patients and methods Eight patients (three men and five women, mean age 50.7 years) with adrenal myelolipoma were treated surgically because of the tumour size, symptomatology and/or associated renal pathology. Associated medical problems included hypertension in three patients and diabetes mellitus in one but none of the tumours was endocrinologically active.

Results Five patients were diagnosed definitively by abdominal ultrasonography, computed tomography and angiography while the other three were incidentally diagnosed during surgical intervention for ipsilateral renal cell carcinoma in one patient, hydronephrotic kidney in another and multiple renal stones in the third. On pathological examination, the masses removed were surrounded by a thin fibrous capsule and compressed cortical tissue. A cut section was bright yellow with foci of red‐brown discoloration. Microscopically, the tumour consisted mainly of mature adipose tissue with scattered islands of haemopoietic cells. There was no operative mortality and no gross morbidity.

Conclusion The management of adrenal myelolipoma should be appropriate to each individual case. Operative intervention should be reserved for symptomatic patients or those with large ‘silent’ tumours that may produce life‐threatening shock secondary to spontaneous haemorrhage. Small asymptomatic tumours with definite radiological findings can be followed expectantly.
The safety of finasteride used in benign prostatic hypertrophy: a non‐interventional observational cohort study in 14 772 patients
Authors: Wilton L. , Pearce G. , Edet E. , Freemantle S. , Stephens M.D.B. , Mann R.D.
Published: November 2003

Objective To examine the safety of finasteride as used in general medical practice to treat benign prostatic hypertrophy (BPH).

Patients and methods Information was collected on 14 772 patients who were included in an observational cohort study conducted using Prescription‐Event Monitoring.

Results Finasteride was reported to have been effective in 60% of the patients in whom an opinion on efficacy was recorded. Impotence or ejaculatory failure was reported in 2.1% of the patients, decreased libido in 1% and gynaecomastia and related conditions in 0.4%. Impotence was the most frequent reason for stopping treatment with finasteride and was the most commonly reported adverse reaction to the drug. Of the patients included in the elderly cohort involved in this study, 819 (5.5%) died; none of these deaths was attributed to finasteride.

Conclusion Impotence or ejaculatory failure, decreased libido and gynaecomastia in a small proportion of patients were associated with the use of finasteride. The results of this study strongly suggest that this drug is acceptably safe when used in accordance with the current prescribing information.
Free‐to‐total prostate‐specific antigen serum concentrations in patients with prostate cancer and benign prostatic hyperplasia
Authors: Wolff J.M. , Borchers H. , Effert P.J. , Habib F.K. , Jakse G.
Published: November 2003

Objective To determine whether the proportion of total serum prostate‐specific antigen (tPSA) which is unbound or free (free PSA) offers a better discriminant for the detection of patients with prostate cancer (CaP) and those with benign prostatic hyperplasia (BPH) than does serum tPSA alone.

Patients and methods In a retrospective analysis, the proportion of free PSA was determined in the sera of 60 patients with histologically confirmed localized (n=39; pT1–3NoMo) and metastatic (n=21; T2–4NxM+) CaP and 45 patients with BPH. Forty patients with urolithiasis served as a control group. Serum levels of free and total PSA were determined using a chemiluminescent enzyme immunoassay.

Results Patients with CaP had a lower percentage of free PSA (localized CaP median 8.8%; metastatic CaP median 7.1%) than patients with BPH (median 19.5%) and those with urolithiasis (median 18.8%; P<0.001). The percentage of free PSA did not differ significantly between patients with clinically localized and metastatic disease.

Conclusion The determination of the proportion of free PSA enhanced the discrimination between BPH and CaP and may reduce the number of unnecessary biopsies in patients with an elevated PSA. The results warrant further investigations in a broader population to improve the clinical use of serum PSA as a tumour marker for discriminating patients with an early, potentially curable CaP from men with BPH.
Expression of multidrug resistance‐related genes (mdrl, MRP, GST‐πand DNA topoisomerase II) in urothelial cancers
Authors: Kim W.‐J. , Kakehi Y. , Wu W.‐J. , Fukumoto M. , Yoshida O.
Published: November 2003

Objective To characterize the multidrug resistance (MDR) phenotype in human urothelial cancers, the expression levels of four MDR‐related genes (multidrug resistance, mdrl; multidrug resistance‐associated protein, MRP; glutathione S‐transferase‐π, GST‐π; and DNA topoisomerase II, topo II) were analysed in urothelial cancers.

Materials and methods Fifty‐two tumour tissue and three normal urothelial mucosa samples were obtained from 44 patients with urothelial cancers. The expression of each gene was analysed with a reverse‐transcription polymerase chain reaction (RT‐PCR) method using β2‐microglobulin (b2m) mRNA as an endogenous control. Levels of expression were expressed as the ratio of the specific products of the target gene to those specific to b2m.

Results In primary urothelial cancer tissues, the mean (sd) expression of mdrl, MRP, GST‐πand topo II relative to b2m expression were 0.067 (0.061), 0.27 (0.23), 0.35 (0.31) and 0.12 (0.05), respectively. The mean expressions of MRP and GST‐πwere higher than those of mdrl and topo II. The mean ratios of mdrl/b2m, MRP/b2m, GST‐π/b2m and topo II/b2m in normal urothelial mucosa were 0.06 (0.03), 0.12 (0.09), 0.30 (0.32) and 0.14 (0.01), respectively. There was no significant association of the expression of each gene with either the grade or extent of the primary tumour. The level of MRP expression in each sample was correlated significantly with the expression of mdrl and GST‐πin the urothelial cancers (r=0.637 and 0.537, respectively). Chemotherapy did not markedly influence the induction of expression of the MDR‐related genes, except for one case in which mdrl expression was 15 times greater than before chemotherapy. The expression of GST‐πin the patients not receiving chemotherapy was significantly higher than in those that did.

Conclusions These results suggest that the activation of MRP and GST‐πexpression occurs during the tumorigenesis of urothelial cancers and that it may confer de novo and acquired drug resistance on urothelial cancers. These results should provide further insight into the complex role postulated for MDR‐related genes in chemotherapy, carcinogenesis and tumour progression.
The origin of vesico‐ureteric reflux in male newborns: further evidence in favour of a transient fetal urethral obstruction
Authors: Avni E.F. , Schulman C.C.
Published: November 2003

Objective To present further arguments supporting a transient urethral obstruction occurring during early fetal development as an explanation of the origin of vesico‐ureteric reflux (VUR) in baby boys.

Patients and methods The findings of ultrasonography and voiding cysto‐urethrography (VCUG) in 25 baby boys with VUR were reviewed, studying mainly bladder and urethral anomalies on VCUG and bladder‐wall thickness on ultrasonography.

Results A bladder or urethral anomaly was found in 15 patients, comprising isolated posterior urethral dilatation in five, posterior urethral dilatation with a bladder anomaly in four, tubular appearance of the urethra in two and bladder neck hypercontractility with diverticulae in four. Bladder‐wall thickness ranged from 1 to 8 mm (mean 3.7) and in eight patients, the thickness exceeded 5 mm.

Conclusion The bladder and urethral anomalies found in this series of patients with neonatal VUR could be explained by a transient bladder outlet obstruction that possibly occurred in utero. These findings support the theory that a significant number of cases of VUR seen in baby boys result from a transient fetal urethral obstruction.
Improved reliability of uroflowmetry investigations: results of a portable home‐based uroflowmetry study
Authors: De La Rosette J.J.M.C.H , Witjes W.P.J. , Debruyne F.M.J. , Kersten P.L. , Wijkstra H.
Published: November 2003

Objectives To compare the results obtained using a portable home‐based uroflowmeter with the results of traditional flowmetry performed in the out‐patient department (OPD).

Patients and methods Sixty‐seven patients (mean age 61 years, range 38–79) with lower urinary tract symptoms and/or benign prostatic enlargement used a home‐based uroflowmeter comprising a datalogger and specially designed fluid sensors incorporated into disposable beakers. The results of these measurements were compared with those from uroflowmetry in the OPD and with other clinical variables.

Results There was a good correlation between the uroflow results obtained when voiding at home and at the OPD. The highest measured maximum flow and voided volume were obtained with the home‐based uroflowmeter system. However, the mean of all consecutive home‐based maximum flow and voided volume measurements were lower than those obtained by single‐void uroflowmetry in the OPD.

Conclusions Home‐based uroflowmetry provides reliable voiding results which are comparable with those obtained in the OPD.
The role of digital rectal examination, biopsy Gleason sum and prostate‐specific antigen in selecting patients who require pelvic lymph node dissections for prostate cancer
Authors: Rogers E. , Gürpinar T. , Dillioglugil Ö. , Kattan M.W. , Goad J.R. , Scardino P.T. , Griffith D.P.
Published: November 2003

Objective To examine the usefulness of clinical stage, tumour differentiation and prostate‐specific antigen (PSA) level, alone and in combination, to predict regional nodal metastases in individual patients with localized prostate cancer.

Patients and methods The usefulness of digital rectal examination (DRE), biopsy Gleason sum and PSA, alone and in combination, to predict nodal metastases in an individual patient was examined. The study included 689 patients who had laparoscopic or open pelvic lymph node dissection for clinical stage T1–3 prostate cancer. The Kruskal‐Wallis test, Mantel‐Haenszel test, chi‐squared test and logistic regression were used for continuous, ordinal, categorical, and multivariate analysis, respectively.

Results Of the 689 patients who underwent radical prostatectomy, 52 (8%) had nodal metastases. Although clinical stage, DRE, pre‐operative PSA level and biopsy Gleason sum were significantly related in the univariate analysis, only pre‐operative PSA level and biopsy Gleason sum were significant predictors of lymph node status in a multivariate analysis. However, based on a receiver operating characteristic curve, a model with satisfactory sensitivity and specificity could not be obtained.

Conclusion Current estimations of primary prostate cancer biology using pre‐operative PSA level, clinical stage and biopsy Gleason sum are not sufficiently sensitive to predict nodal metastases, and pelvic lymphadenectomy remains the definitive method of detection.
The management of superficial bladder cancer: an interactive seminar
Authors: McFarlane J.P. , Ellis B.W. , Harland S.J.
Published: November 2003

Objectives To determine the current management of superficial bladder cancer in the United Kingdom.

Methods An interactive seminar with a series of questions about management and hypothetical clinical scenarios was conducted at the 1995 conference of the British Association of Urological Surgeons. The responses of the audience were recorded electronically and analysed.

Results The results showed that there is a wide variation in practice and some confusion over the place of intravesical treatment using cytotoxic drugs and bacille Calmette‐Guérin.

Conclusions The management of superficial bladder cancer could be improved by a more widespread use of intravesical therapy, along with the introduction of local protocols and national guidelines.
A comparative study of laser ablation and transurethral electroresection for benign prostatic hyperplasia : results of a 6‐month follow‐up
Authors: Sengör F. , Köse O. , Yücebas E. , Beysel M. , Erdogan K. , Narter F.
Published: November 2003

Objective To compare the efficacy of standard transurethral electroresection of the prostate (TURP) and visual laser ablation in the treatment of benign prostatic hyperplasia (BPH).

Patients and methods In a randomized prospective study, the prostate glands of 60 patients with symptomatic bladder outlet obstruction caused by BPH were treated with TURP or visual ablation with the Ultraline side‐firing Nd:YAG laser; the patients were assessed using standard symptom scores, the measurement of residual urine and uroflowmetry both before and at 3 and 6 months after treatment.

Results All patients in both treatment groups had a significant improvement in symptoms and objective measures of voiding. The laser treatment gave significantly better improvements in symptom score than did TURP (P=0.034), but TURP produced significantly better peak urinary flow rates (P=0.025).

Conclusion These early results indicate that laser ablation of BPH may be a good alternative in the surgical treatment of this disease.
Retrograde contamination and practical handling of urine‐meters: a comparison of three systems for the measurement of hourly diuresis in an experimental bladder‐drainage model and in clinical use
Authors: Rasmussen A. , Frimodt‐Møller N. , Espersen F. , Roed M. , Frimodt‐Møller C.
Published: November 2003

Objective

 To compare three different urine metering systems for their ability to prevent retrograde contamination in an in vitro model of a closed urinary drainage system and for qualities important to their practical handling in a clinical setting.

Patients, materials and methods

 Using three urine‐meters (the Braun Ureofix 511, the Kendall Curity 4000 and the Unoplast Unometer 500) the in vitro model was constantly flushed with a solution of Mueller‐Hinton broth diluted with saline. On the first day, the urine collecting bag was inoculated with 108 cells of Pseudomonas aeruginosa. The system was operated for 12 days with daily sampling of the model bladder to detect any contamination. After 12 days the experiment was stopped and sampling performed at various locations, including the urine‐meter and the tubing. Nine of each type of urine‐meter were tested, i.e. three in three different experiments. In the clinical study, 45 patients were randomized to each of the three urine‐meters and the nurses attending them were asked to complete a questionnaire on the practical handling of the urine‐meters.

Results

 When the urine‐meters was omitted from the model system, the ‘bladder’ became contaminated with the test bacteria within 3 days. None of the nine Unometer 500 systems became contaminated, compared with four of each of the other two systems (P<0.05). In clinical use, the Unometer 500 and Ureofix 511 were easier to suspend and empty than was the Curity 4000. The Unometer 500 was significantly easier to handle when the collecting bag was emptied.

Conclusion

 Urine‐meters can prevent retrograde contamination in a closed bladder‐drainage model, but the degree of prevention depends upon the type of urine‐meter. In daily practice, there were differences in the ease of suspension of the systems and in the emptying of the urine‐meter and collecting bag.
A model system for the investigation of urinary stone formation
Authors: Bouropoulos N. , Bouropoulos C. , Klepetsanis P.G. , Melekos M. , Barbalias G. , Koutsoukos P.G.
Published: November 2003

Objective

 To develop an in vitro model system for the investigation of calcium oxalate urinary stones under conditions of spontaneous precipitation.

Materials and methods

 Using a calcium‐ion selective electrode and automatic titrator, a test solution was kept supersaturated with calcium oxalate and the rate of crystallization measured.

Results

 During the spontaneous precipitation at constant supersaturation at 37°C, the induction times required for the precipitation of calcium oxalate monohydrate were inversely proportional to the supersaturation of the solution. No transient phases were identified and the interfacial energy determined from kinetic analysis was 28.4 mJ/m2 . The rates of precipitation showed a first‐order dependence on the degree of supersaturation and were in good agreement with those reported for the in vivo formation of calcium oxalate monohydrate stones.

Conclusion

 This experimental model system allows precise measurements of the kinetics of calcium oxalate monohydrate. From the dependence of the rates of precipitation on supersaturation, a mechanism controlled by surface diffusion is suggested.
The impact of pre‐donated autologous blood and
Authors: Nash P.A. , Schrepferman C.G. , Rowland R.G. , Young J. , Foster R.S. , Birhle R. , Donohue J.P.
Published: November 2003

Objective To assess the impact of pre‐donated autologous blood and intra‐operative isovolaemic haemodilution on the outcome of transfusions in patients undergoing radical retropubic prostatectomy.

Patients and methods The charts and transfusion records of 192 consecutive patients undergoing radical retropubic prostatectomy were reviewed retrospectively.

Results Of 192 patients, 14% required homologous transfusions, the rate of which varied significantly depending upon blood availability (autologous, haemodilution or homologous) (P<0.001); 66% of patients with only autologous blood available were transfused a mean of 1.96 units (range 1–6) of blood, of which 87% received autologous alone, 12% both autologous and homologous and 1% homologous blood only. Of the pre‐donated autologous units, 44% were wasted.

Conclusions Both the pre‐donation of autologous blood and intra‐operative isovolaemic haemodilution lower the risk of homologous blood transfusion. It is recommended that patients pre‐donate 2 units of autologous blood and undergo intra‐operative isovolaemic haemodilution before radical prostatectomy.
Is inguinal exploration for the impalpable testis an outdated operation?
Authors: Lakhoo K. , Thomas D.F.M. , Najmaldin A.S.
Published: November 2003

Objective To evaluate the reliability of open inguinal exploration for the investigation of the impalpable testis by reviewing laparoscopic findings after previous negative inguinal exploration.

Patients and methods Laparoscopy was performed in 18 boys (with a total of 22 impalpable testes) in whom previous inguinal exploration in their referring hospitals had yielded negative or inconclusive findings. Subsequent management of the impalpable testes was based on laparoscopic findings.

Results Despite previous negative surgical findings at inguinal exploration, laparoscopy revealed that 13 of the 22 impalpable testes (59%) were present, 12 within the abdomen and one in the inguinal canal. Absence of the remaining nine testes was positively confirmed by visualizing confluent blind ending vas and vessels.

Conclusion Inguinal exploration is an unreliable method of investigating the impalpable testis, with an unacceptably high incidence of false‐negative or inconclusive findings. Laparoscopy should be undertaken as the initial diagnostic manoeuvre of choice.
Infection after transrectal core biopsies of the prostate
Authors: Aus G. , Ahlgren G. , Bergdahl S. , Hugosson J.
Published: November 2003

Objective To compare the infection rate between different durations of antibiotic prophylaxis after transrectal core biopsy and to evaluate the impact of possible risk factors.

Patients and methods The study comprised 491 patients who underwent transrectal core biopsies of the prostate and who were randomized to receive 400 mg of norfloxacin twice daily for one day or one week.

Results Patients receiving prophylaxis for one week had a significantly lower rate of infection (4.9%) compared to patients who received only two tablets (11%; P<0.05). The most pronounced effect was seen in those patients with risk factors (e.g. an indwelling catheter, a former history of urinary tract infection, diabetes or prostatitis) in whom the infection rate was reduced from 17.9% to 3.3% (P<0.02), and febrile infections from 9.5% to 1.1% (P<0.02).

Conclusions Some factors have a clear impact on the risk of developing an infection after transrectal core biopsy. Prophylaxis for one week with norfloxacin is an effective way to minimize these infections.
Bladder augmentation in the prevention of cyclophosphamide‐induced haemorrhagic cystitis in the rat model
Authors: Crocitto L.E. , Simpson J.F. , Wilson T.G.
Published: November 2003

Objective To evaluate the effects of cyclophosphamide on the bowel mucosa of the rat and to determine whether urothelium can be protected from the effects of haemorrhagic cystitis which can occur after treatment with cyclophosphamide.

Materials and methods Thirty Sprague‐Dawley rats were divided into three groups, 10 undergoing a control (sham) operation, 10 an ileal bladder augmentation and 10 a colonic bladder augmentation. Each rat underwent the appropriate surgical procedure and after a recovery period of 2 weeks, was injected with cyclophosphamide. Urine specimens were collected 24 h after the injection and analysed for gross and microscopic haematuria. The rats were killed humanely 48 h after injection and the bladders examined for haemorrhage, oedema, attenuation, inflammation and erosion.

Results None of the 20 augmented rats developed gross haematuria and only four developed microscopic haematuria, compared with the control rats where six of 10 developed gross haematuria and nine developed microscopic haematuria. In addition, the control rats had moderate to severe haemorrhage, oedema and attenuation compared with only mild changes in the augmented rats. This protection was significant for both the bowel mucosa and urothelium.

Conclusions It is possible that the administration of cyclophosphamide in patients with urinary diversion carries little risk of haemorrhagic cystitis. We propose that this protective mechanism is secondary to a substance secreted by the intestinal mucosa that may bind acrolein and render it inactive. Alternatively, this may be secondary to the production of mucus and its ability to coat and protect the epithelium.
The effectiveness of surgery for stress incontinence in women: a systematic review
Authors: Black N.A. , Downs S.H.
Published: November 2003

Objective To determine the methodological quality of studies evaluating surgery for stress incontinence, the effectiveness of different procedures and the frequency of complications associated with each procedure.

Materials and methods Eleven randomized controlled trials, 20 non‐randomized trials/prospective cohort studies and 45 retrospective cohort studies were reviewed systematically.

Results The methodological quality of the 31 prospective studies was generally poor. The considerable variation in inclusion criteria, surgical management and assessment of outcome precluded any statistical meta‐analysis. Evidence as to the effectiveness of surgery for stress incontinence is weak; therefore, any conclusions are speculative. It appears that colposuspension may be more effective and the effect more long‐lasting than that following anterior colporrhaphy and needle suspension. There is little information on the value of sling procedures. Comparisons of different ways of performing each procedure show no significant differences in outcome but this may reflect the methodological weaknesses of the studies. Valid and reliable data on the frequency of complications following surgery are lacking so the safety of the procedures is unclear. Repeat operations to correct stress incontinence are less successful than first procedures but this finding may be subject to confounding.

Conclusions There is an urgent need for some large, rigorous, prospective studies of high quality. Until such studies have been completed, recommendations as to the best clinical practice cannot be based on scientific evidence. Studies need to define cases according to widely accepted criteria, including standard measures of the severity of stress incontinence, and surgical terminology for the procedures performed needs to be standardized and outcomes need to be clearly defined, valid and reliable, not confined to short‐term assessment and include patients' views along with the surgeon's assessments.
The continent sigmoid urinary reservoir — an experimental study in pigs
Authors: Jung P. , Mersdorf A. , Wolff J. , Jahnke C. , Jakse G.
Published: November 2003

Objective To evaluate the function of a continence mechanism in combination with a colonic urinary reservoir in a pig model.

Materials and methods A colonic urinary reservoir was constructed as a bladder augmentation in six domestic pigs. The pouch was connected to a narrowed and tunnelled ileal tube as a continence mechanism. The closure pressure was measured intra‐operatively and 3 months post‐operatively.

Results The mean difference between the pressure in the continence mechanism and in the reservoir was 74 cmH2O (range 50–100). Continence was complete both intra‐operatively and 3 months post‐operatively.

Conclusion The modified narrowed and tunnelled ileal tube is a safe continence mechanism when combined with a colonic urinary pouch.
Childhood renal tumours with intravascular extension
Authors: Mushtaq I. , Carachi R. , Roy G. , Azmy A.
Published: November 2003

Objective To assess whether pre‐operative chemotherapy reduces operative morbidity in children with intravascular extension of renal tumours.

Patients and methods Thirty children with intravascular extension of their renal tumour, treated in 10 different centres in the UK, were reviewed retrospectively.

Results Twenty‐nine patients had nephroblastoma and one child had clear cell sarcoma (favourable histology in 23, unfavourable histology in six). Patients were classified into stage II (17 patients), stage III (three patients) and stage IV (10 patients). Ultrasonography had been performed in 29 patients and had correctly diagnosed intravascular extension in 11 (40%); computed tomography (CT) was accurate in 93% of patients. A pre‐operative diagnosis was made accurately in 24 patients, with caval extension in 18 and atrial extension in six. Nine patients underwent primary surgery, whilst 21 had pre‐operative chemotherapy followed by delayed nephrectomy. In the latter group, the intravascular thrombus diminished in 16 patients. Five patients died, one from tumour rupture and four from extensive or progressive tumour disease; the overall 2‐year survival was 83%. Unfavourable histology did not adversely affect survival, and patients having pre‐operative chemotherapy appeared to have a better outcome.

Conclusion CT remains the best imaging modality to assess intravascular tumour extension. Pre‐operative chemotherapy is recommended for patients with intracaval extension of tumour. Those with intra‐atrial extension or with hepatic vein obstruction (Budd‐Chiari syndrome) may require a cardiopulmonary bypass and primary surgery.