bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of constipation in adults associated with idiopathic megarectum by behavioural retraining including biofeedback
Authors: Mimura T. , Nicholls T. , Storrie J. B. , Kamm M. A.
Published: March 2003

Background  Constipation in adults associated with a grossly dilated rectum and recurrent faecal impaction, idiopathic megarectum, is rare. The aetiology of idiopathic megarectum is unknown, but may involve neuromuscular or behavioural factors. It is unknown whether the condition is reversible. This study aimed to determine the efficacy of behavioural therapy, including biofeedback, in such patients.

Methods  Six patients (4 female; median age 27) with a history of rectal faecal impaction and a grossly dilated rectum on radiological examination were evaluated by structured questionnaire before, immediately after biofeedback therapy, and on follow‐up. Physiological testing was performed before treatment, and 2 patients were evaluated by repeat physiological testing and contrast radiology on follow‐up.

Results  On median follow‐up of 18 months (range 11–27), five patients felt major and one patient minor improvement in symptoms, including two with complete symptom relief. Four patients came off laxatives without recurrent faecal impaction. In the 2 studied patients rectal size did not appear to decrease.

Conclusion  Behavioural retraining, including biofeedback, improved symptoms in most patients with idiopathic megarectum. In some patients symptoms completely resolved, without the need for laxatives. Although further studies are necessary in terms of both larger number of patients and longer follow‐up period, behavioural treatment may be useful for such patients.
Smoking habits and circulating leptin in postmenopausal non‐obese women
Authors: Larsson H. , Ahrén B.
Published: March 2003

This study examined whether smoking habits affect the correlation between serum leptin levels and body mass index (BMI) in 101 postmenopausal Caucasian non‐obese women, all aged 57–59 years. Mean serum leptin level in the entire group was 19.8 ± 12.3 ng/ml (mean ± s.d.) and mean BMI was 25.3 ± 3.5 kg/m2. These parameters correlated significantly to each other (r = 0.70, p < 0.001). Between those who have smoked regularly for more than 2 years (n = 26) and those who are ex‐smokers or have never smoked (n = 75), serum leptin levels or BMI did not differ and the correlation between serum leptin and BMI was identical. This suggests that smoking habits do not influence circulating leptin in Caucasian postmenopausal non‐obese women.
Vascular disease prevention in patients with diabetes
Authors: Gavin James , Kagan Steven
Published: March 2003

Prevention is the key to reducing the vascular sequelae of diabetes. Prevention starts with good glycaemic control and continues with a comprehensive programme of risk modification, such as lipid‐lowering therapy, antihypertensive treatment, and improved lifestyle. With regard to lipid modification, agents such as statins may provide additional, non‐lipid effects in both the diabetic and non‐diabetic patient. This review discusses recent studies supporting risk reduction, available treatments, and recommendations applicable to the diabetic patient.
Treatment of high‐risk diabetic patients with angiotensin II receptor blockers
Authors: Estacio R.
Published: March 2003

In the United States, ≈ 16 million people have diabetes; 90–95% have type 2 diabetes. They are at increased risk of developing hypertension and cardiovascular disease (CVD). The benefits of treating hypertension in diabetic patients and the potential to delay complications and reduce mortality have been demonstrated in clinical trials. Increasing evidence shows that angiotensin‐converting enzyme (ACE) inhibitors and angiotensin II (Ang II) receptor blockers (ARBs) may be equally effective in delaying progressive renal disease in diabetic patients. Large, multicentre trials are ongoing to confirm the efficacy and superior safety profile of ARBs in this population.
The cypris larvae of the rhizocephalan barnacle Heterosaccus lunatus with particular reference to antennular morphology
Authors: Walker Graham
Published: March 2003

SEM investigation of laboratory‐reared cyprids of the parasitic barnacle Heterosaccus lunatus has revealed morphological differences between the male and female larvae, particularly the attachment organ of their antennules. The detailed features of the attachment organ (segment III) and segment IV for each sex are described and compared with those of other rhizocephalan cyprids, particularly Sacculina carcini, a reportedly closely related species. The absence of the large posterior sac from segment III in the H. lunatus male highlights the need for careful larval investigations on other sacculinid species. Settlement of female H. lunatus cyprids occurred on the gill lamellae of the host crab with the subsequent kentrogon stage taking the sacculinid form. The inclusion of H. lunatus in the Sacculinidae was therefore confirmed, based on the morphology of the cypris antennules and kentrogon.
Observations on the structure of larval attachment organs in three species of gymnotiforms (Teleostei: Ostariophysi)
Authors: Britz Ralf , Kirschbaum Frank , Heyd Andreas
Published: March 2003

Attachment organs are known in certain teleosts but have not been reported in gymnotiforms. This study demonstrates the presence and describes the structure of attachment organs in three species of gymnotiforms: the apteronotids Apteronotus albifrons and A. leptorhynchus, and the rhamphichthyid Rhamphichthys sp. Attachment organs are present only during the first few days after hatching. Organs were studied with light microscopy, SEM, and TEM. In all three species attachment organs are restricted to the head region. They consist of numerous individual attachment cells and modified epithelial cells distributed on the frontal, lateral, and dorsal head area. Only the apical parts of the attachment cells reach the body surface between the epithelium of the epidermis. Attachment cells contain considerable amounts of rough ER and Golgi vesicles filled a the glutinous substance. Epithelial cells in the area in which attachment cells are developed differ in structure from those on the rest of the body and form a functional complex with the attachment cells. In the two Apteronotus species they possess 4–10 μm long projections that are located in the cell centre in A. albifrons, but are slightly shifted to one side of the cells in A. leptorhynchus. Epithelial cells in the organ area of Rhamphichthys sp. lack any projections and resemble cells of the trunk region. However, their pattern of microridges on the outer cell surface is more pronounced and conspicuous. Projections along with modified microridges may aid in distributing and focusing adhesive substances released by attachment cells, and thus may enhance adhesive properties.
Evolution of cerebral vesicles and their sensory organs in an ascidian larva
Authors: Sorrentino M. , Manni L. , Lane N. J. , Burighel P.
Published: March 2003

Sorrentino M., Manni L., Lane N. J. and Burighel P. 2000. Evolution of cerebral vesicles and their sensory organs in an ascidian larva. —Acta Zoologica (Stockholm) 81: 243–258

The ascidian larval nervous system consists of the brain (comprising the visceral ganglion and the sensory vesicle), and, continuous with it, a caudal nerve cord. In most species two organs, a statocyst and an ocellus with ciliary photoreceptors, are contained in the sensory vesicle. A third presumptive sensory organ was sometimes found in an ‘auxiliary’ ganglionic vesicle. The development and morphology of the sensory and auxiliary ganglionic vesicles in Botryllus schlosseri and their associated organs was studied. The sensory vesicle contains a unique organ, the photolith, responding to both gravity and light. It consists of a unicellular statocyst, in the form of an expanded pigment cup receiving six photoreceptor cell extensions. Presumptive mechano‐receptor cells (S1 cells), send ciliary and microvillar protrusions to contact the pigment cup. A second group of distinctive cells (S2), slightly dorsal to the S1 cells, have characteristic microvillar extensions, resembling photoreceptor. We concur with the idea that the photolith is new and derived from a primitive statocyst and the S2 cells are the remnant of a primitive ocellus. In the ganglionic vesicle some cells contain modified cilia and microvillar extensions, which resemble the photoreceptor endings of the photolith. Our results are discussed in the light of two possible scenarios regarding the evolution of the nervous system of protochordates.
Serous cutaneous glands in the paludiculine frog Physalaemus biligonigerus (Anura, Leptodactylidae): patterns of cytodifferentiation and secretory activity in premetamorphic specimens
Authors: Delfino G. , Nosi D. , Brizzi R. , Alvarez B. B.
Published: March 2003

The development of serous cutaneous glands is described in tadpoles of the leptodactylid frog Physalaemus biligonigerus, with attention to the cytodifferentiation processes of the secretory unit (adenomere). Secretory differentiation causes the adenomere to assume the structure of a syncytium and triggers biosynthesis of the serous product (poison), consisting of granules with peculiar repeating substructure. The secretory granules resemble glomerular‐like aggregates of randomly orientated tubular subunits. This complex substructure derives from the rearrangement of the dense, compact material released by the Golgi apparatus in the form of small, membrane‐bounded particles. Both early and advanced features of P. biligonigerus poison closely resemble those found during serous gland development in the Italian treefrog Hyla intermedia. The similar aspects described during serous biosynthesis in these leptodactylid and hylid frogs suggest they are phylogenetically informative. On the other hand, the peculiar features of their poisons may reflect the differential patternings of their secretory repertories along the divergent phylogenetic paths, which led these frogs to be currently included in different families.
Morphology and evolution of respiratory structures in the pleopod exopodites of terrestrial Isopoda (Crustacea, Isopoda, Oniscidea)
Authors: Schmidt Christian , Wägele Johann Wolfgang
Published: March 2003

The morphology of the respiratory structures located in the pleopod exopodites of terrestrial Isopoda is described for representative species of different genera. Special emphasis is set on the evolution of these lungs in the context of phylogenetic relationships as revealed by other morphological characters. In the most primitive species of the Oniscidea, and still of subordinate taxa of the Crinocheta, respiration takes place in the thin ventral integument of the exopodites. The evolution of dorsal respiratory fields with a weakly wrinkled surface occurred at least six times within the Crinocheta. In five of these cases, a further development can be observed. The evolution of a partly covered respiratory field with strongly wrinkled surface may have taken place six times. It is assumed that completely internalized lungs with spiracles surrounded by a water‐repellent surface microsculpture, evolved at least six times independently within the Oniscidea: in the Tylidae, Actaecia, Aphiloscia, the Eubelidae, the Armadillidae and in a taxon probably comprising Porcellionidae plus Armadillidiidae.
Mapping cladograms into morphospaces
Authors: Stone J. R.
Published: March 2003

In cladistic analyses, taxa are grouped hierarchically into clades according to shared apomorphic character states to construct cladograms; cladograms are interpretable as phylogenetic hypotheses. In morphological space analyses, organism forms are represented as points in morphospaces; point proximities in morphospaces represent similarities that might be attributable to phenetic convergence and, consequently, may correspond inaccurately with hypothesized evolutionary relationships. A method for synthesizing phylogenetic results that are interpreted from cladistic analyses with phenetic results that are obtained from morphological space analyses is presented here; in particular, points that represent forms typifying taxa in morphospace are assigned as terminal nodes for appropriate cladograms that are mapped into morphospaces by positioning nonterminal nodes and orienting internodes according to a geometric algorithm. Nonterminal nodes may be interpreted as ancestors in phylogenetic hypotheses and occupy positions that represent particular organism forms in morphospaces. By mapping cladograms into morphospaces, therefore, evolutionary morphologists can reconstruct ancestral morphologies and test historical transformation hypotheses.
The penile disassembly technique in the surgical treatment of Peyronie's disease
Authors: Perovic S.V. , Djordjevic M.L.J.
Published: March 2003

Objective To present an approach for treating Peyronie's disease, using the penile disassembly technique for reconstructive surgery.

Patients and methods From November 1996 to September 2000, 74 patients with Peyronie's disease were treated surgically. The penile disassembly technique was used in 46 of the patients (mean age 51 years, range 21–63). The indications were severe penile deviation under the glans cap, plaque in the distal third of the corpora cavernosa with the ‘hour‐glass’ phenomenon, and more than one plaque at different sites. The corporal bodies are separated from the glans, neurovascular bundle and urethra. The technique enables the complete preservation of all structures of the neurovascular bundle, especially if it is incorporated into the plaque. The method provides an excellent approach to the repair of all deformities on the completely free corpora cavernosa and that are affected by the plaque. In the plaque region, incisional grafts are placed using full‐thickness penile skin or saphenous vein. The technique also enables reduction corporoplasty, i.e. amputation of the tips of the corpora cavernosa that include plaque, in those with sufficient penile length. Penile re‐assembly involves joining the glans, neurovascular bundle, urethra and repaired corpora cavernosa into their normal anatomical relationships.

Results The mean (range) follow‐up was 27 (6–53) months. The penis was completely straightened in 40 patients (87%) but the deviation recurred in six. In four patients the deformity was < 10° and in two was < 20°. Penile shortening occurred in 9% of the patients. There was no evidence of inflammation or infection after surgery. There were no injuries of either the neurovascular bundle or urethra.

Conclusion The penile disassembly technique could be a good alternative to other surgical techniques in treating selected patients with Peyronie's disease; it allows an excellent approach to penile deformities which can then be easily and safely corrected.
The role of volume‐weighted mean nuclear volume in predicting tumour biology and clinical behaviour in patients with prostate cancer undergoing watchful waiting
Authors: Arai Y. , Egawa S. , Kuwao S. , Ogura K. , Baba S.
Published: March 2003

Objective To investigate whether the volume‐weighted mean nuclear volume (MNV, the only means by which unbiased estimates of three‐dimensional variables can be obtained from a two‐dimensional section by stereological methods) at diagnosis correlates with tumour biology and clinical behaviour in patients with prostate cancer treated by watchful waiting.

Patients and methods In a prognostic study, 64 patients with clinically localized prostate cancer were followed prospectively with initial expectant management. The median (mean, range) follow‐up was 22 (27, 6.0–68) months. The prostate specific antigen (PSA) doubling time (PSADT) was calculated by linear regression. The MNV was estimated using biopsy specimens, based on a stereological method, and compared with PSADT and traditional clinicopathological variables.

Results PSADT was significantly associated with MNV, but not with other clinicopathological variables. The PSA ‘rapid‐riser’ subset (PSADT<median value) had significantly larger MNVs than did the PSA ‘slow‐riser’ (PSADTmedian value) and PSA‐stable subsets (P = 0.0017 and 0.004, respectively). On multivariate analysis using a stepwise Cox proportional hazards regression, only MNV remained independently significant as a predictor of clinical progression among the clinicopathological variables (P < 0.001).

Conclusions These findings suggest that cancer cell nuclear volume is significantly associated with tumour biology and behaviour in patients with prostate cancer. Although further study with a larger patient population is needed to confirm the findings, estimates of MNV may be an important prognostic indicator in men treated with watchful waiting.
Prediction of tumour volume and pathological stage in radical prostatectomy specimens is not improved by taking more prostate needle‐biopsy cores
Authors: Grossklaus D.J. , Coffey C.S. , Shappell S.B. , Jack G.S. , Cookson M.S.
Published: March 2003

Objective To determine what, if any, additional prognostic information is available from the prostate needle biopsy by comparing the number of biopsy cores obtained with the pathology assessed from the radical retropubic prostatectomy (RRP) specimen.

Patients and methods The results from 135 consecutive patients who underwent RRP at a single institution were reviewed. Needle biopsy information (number of cores, percentage of positive cores, laterality of the positive cores, and Gleason sum) were compared with the pathological data of the RRP specimen, including stage, Gleason sum and tumour volume. Patients were further stratified into those with six or fewer cores (96 men) or more than six cores (39 men). Clinical data, including biopsy information and pathological findings, were compared using univariate and multivariate models.

Results Overall, univariate analysis showed that the total prostate‐specific antigen (PSA) level, number of positive cores, bilateral positive cores and percentage of positive cores were directly correlated with tumour volume (P = 0.01). Also, PSA and percentage of positive cores were directly correlated with extracapsular extension (P = 0.008 and P = 0.01, respectively). In the multivariate model, the most important independent predictors of RRP tumour volume and pathological stage were the preoperative PSA level and percentage of cancer in the biopsy (P < 0.01). There was no significant relationship between the number of cores obtained and the predicted pathology of the RRP specimen. There were no differences in the number of positive cores, bilateral positive cores or percentage tumour in the cores between men with more or less than six biopsies. In men with more than six core biopsies, there was no significant increase in prognostic information for tumour volume and extracapsular extension, or a correlation between the Gleason sum on biopsy and the RRP specimen. Taking more than six biopsies did not result in a significantly greater detection of potentially indolent tumours (defined as a tumour volume of < 0.5 mL).

Conclusions While taking more prostate needle biopsy cores seems to improve the detection of prostate cancer, there appears to be no major improvement in prognostic information over that gained from traditional sextant biopsies. Furthermore, the results suggest that the percentage of positive cores is the best predictor of both pathological stage and tumour volume, from among the information readily available from prostate needle biopsy. Given the variability in the number of cores obtained for diagnosis in clinical practice, these results add credence to the use of the percentage of positive cores in the biopsy set, with known predictors such as PSA and Gleason score, into future models that attempt to predict tumour biology.
Combination therapy in the treatment of persistent nocturnal enuresis
Authors: Cendron M. , Klauber G.
Published: March 2003

Objective

To evaluate, in a retrospective study, the response rate of older children to combination therapy using a sustained‐release anticholinergic agent, hyoscyamine, and a synthetic analogue of antidiuretic hormone, desmopressin acetate.

Patients and method

Twenty‐eight patients (20 males and eight females, aged 9–18 years) diagnosed with nocturnal enuresis were evaluated using a questionnaire, history and physical examination. None had success with single‐agent pharmacological therapy. All were begun on 0.375 mg of hyoscyamine and 20 μg of desmopressin intranasally at bedtime. The response rate was monitored at 2 and 4 weeks, and then every 3 months by recording dry nights on a calendar. To improve efficacy, the dosage of medication was adjusted up to 0.750 mg of hyoscyamine and 60 μg of desmopressin. Upon achieving dryness and spontaneous awakening to void, medication doses were tapered.

Results

Within 6 months 16 (57%) patients were completely dry and six (21%) were dry at least 80% of nights. Nine patients relapsed during dose tapering and therapy was reinstituted. Presently, 17 (60%) patients are off medication (after a mean of 8 months of medication). Eight patients are still on medication and are dry at least 80% of nights. Combination therapy failed in three patients and they have transferred to a different regimen. None experienced untoward side‐effects from the medications.

Conclusion

Most older children with nocturnal enuresis responded to combination therapy. These children require long‐term follow‐up and may need medication for up to 6 months because the relapse rate is fairly high. Combination therapy appears safe and reliable in treating nocturnal enuresis in older children who have had no success with other treatment modalities.
Does sacral posterior rhizotomy suppress autonomic hyper‐reflexia in patients with spinal cord injury?
Authors: Schurch  , Knapp  , Jeanmonod  , Rodic  , Rossier
Published: March 2003

Objective

 To study the occurrence of autonomic hyper‐reflexia (AHR) after intradural sacral posterior rhizotomy combined with intradural sacral anterior root stimulation, performed to manage the neurogenic hyper‐reflexic bladder, and to determine the pathophysiological basis of the uncontrolled hypertensive crisis after sacral de‐afferentation.

Patients and methods

 Ten patients with spinal cord injury operated using Brindley’s method between September 1990 and February 1994 were reviewed. Systematic continuous non‐invasive recordings of cardiovascular variables (using a photoplethysmograph) were made during urodynamic recordings and the pre‐ and post‐operative vesico‐urethral and cardiovascular data compared.

Results

 Nine of the 10 patients were examined using a new prototype measurement system; one woman refused the last urodynamic assessment. Eight of the nine patients who presented with AHR before operation still had the condition afterward. There was a marked elevation in systolic and diastolic blood pressure during the urodynamic examination in all eight patients, despite complete intra‐operative de‐afferentation of the bladder in five. The elevation of blood pressure started during the stimulation‐induced bladder contractions and increased during voiding in all cases. Five patients showed a decrease in heart rate during the increase in blood pressure. However, in three patients the heart rate did not change or even sometimes slightly increased as the arterial blood pressure exceeded 160 mmHg, when the blood pressure and heart rate then increased together.

Conclusions

 These results confirm that even after complete sacral de‐afferentation, AHR persisted in patients with spinal cord injury and always occurred during the stimulation‐induced voiding phase. In cases of incomplete de‐afferentation, small uninhibited bladder contractions without voiding occurred during the filling phase. The blood pressure then increased but never reached the value recorded during stimulation‐induced micturition. Stimulation of afferents that enter the spinal cord by the thoracic and lumbar roots and that are not influenced by sacral rhizotomy could explain why AHR increases during urine flow. The distinct threshold of decreased heart rate by increasing blood pressure to >160 mmHg focuses attention on the chronotropic influences of the sympathetic nerves in the heart by an exhausted baroreceptor reflex.
Expression of Tamm‐Horsfall protein in stone‐forming rat models
Authors: Miyake  , Yoshioka  , Yoshimura  , Honda  , Yamaguchi  , Koide  , Okuyama
Published: March 2003

Objectives

 To examine the expression of Tamm‐Horsfall protein (THP) and calcium oxalate deposition in three rat models to clarify whether THP plays an active role in crystal formation or whether crystals induce the secretion of this protein.

Materials and methods

 A stone‐forming rat model (model 1) with marked tubular dilatation in an entire kidney was produced by rendering Wistar rats (aged 8 weeks) hyperoxaluric and hypercalciuric, through compulsorily feeding with 0.12 mL of 5% ethylene glycol (in two doses daily) and 0.5 μg of vitamin D3 every other day. Two other rat models were also produced. Model 2 comprised stone‐forming rats with minimal tubular dilatation, achieved by giving rats the same dose of ethylene glycol once daily, and model 3 comprised stone‐free rats with marked tubular dilatation achieved by unilateral ureteric ligation. The rats’ kidneys were resected after 4 weeks and all resected kidneys immunohistochemically stained with an antibody to THP. Simultaneously, the location of calcium oxalate (CaOx) crystals was established with von Kossa staining. The relation between crystals and the secretion of THP was also assessed in vitro. Cultured renal epithelial cells (NRK‐52E) were stained with an antibody to THP after they had been cultured for 72 h in a medium containing CaOx crystals.

Results

 In model‐1 kidneys with both tubular dilatation and many crystals, there was local and intense expression of THP in many renal tubules. CaOx crystals and the intense expression of THP tended to occur in the same renal tubules. In model 2 kidneys with little tubular dilatation, only a few renal tubules expressed THP strongly and the location of the crystals rarely coincided with that of THP expression. In model 3 kidneys with marked tubular dilatation but no crystals, THP was expressed strongly in many renal tubules. The expression of THP in cultured NRK‐52E cells was not stimulated by CaOx crystals.

Conclusions

 The results from the in vivo models suggest that THP did not initiate crystal formation and the strong expression of THP was induced not by crystals but by renal tubular damage caused by tubular dilatation. From the close association of THP and crystals in model 1 kidneys, this protein might play a secondary role as an adhesive, promoting stone formation.
‘Potency’: the validation of information from a self‐administered questionnaire using objective measurements of night‐time erections and test‐retest reliability
Authors: Helgason  , Arver  , Adolfsson  , Dickman  , Granath  , Steineck
Published: March 2003

Objective

 To assess the validity and reliability of a questionnaire assessing ‘physiological potency’.

Patients and methods

 The study comprised 89 patients with prostate cancer and 43 men without; the latter were attending a consultation clinic because of problems with erection. All men answered three questions assessing erectile rigidity during sexual activity, morning and spontaneous erections. In the questionnaire, ‘potency’ was defined as erectile rigidity ‘sufficient for intercourse most of the time’ or better. ‘Potency’ in one or more of the three aspects of erection was defined as ‘physiological potency’. The patients with prostate cancer answered the questionnaire twice with a 3‐week interval. The men attending the consultation clinic underwent two nights of erectile monitoring (using the RigiScan device) and the minimum criterion for RigiScan potency was defined as 55% rigidity at both tip and base.

Results

 The test‐retest assessment showed 93% conformity in the questionnaire diagnosis of ‘physiological potency/impotence’ between the tests. The sensitivity and specificity of the questionnaire assessment compared with the RigiScan method were 40% and 100%, respectively, when the question assessing sexually stimulated erectile rigidity was used alone. Using ‘physiological potency’, the sensitivity increased to about 60% without jeopardizing the specificity, and when men reporting depression were excluded from the analysis, the sensitivity increased to about 80%.

Conclusions

 The test‐retest reliability of the questionnaire was satisfactory. Using questions in a self‐administered questionnaire, ‘physiological impotence’ can be diagnosed with complete and ‘physiological potency’ with 60–80% sensitivity. The sensitivity of the self‐assessment for ‘potency’ depended on the number of questions asked and the proportion of men reporting depression.
Comparison of intraurethral liposomal and intracavernosal prostaglandin‐E1 in the management of erectile dysfunction
Authors: Engelhardt  , Plas  , Hübner  , Pflüger
Published: March 2003

Objective

 To compare the intraurethral application of liposomal prostaglandin‐E1 (PGE1) with intracavernosal injection of PGE1 in patients with organic or psychogenic erectile dysfunction (ED).

Patients and methods

 Penile tumescence and rigidity were classified by palpation in 25 patients (10 with psychogenic and 15 with organic ED; median age 45 years, range 23–67). All patients were undergoing primary treatment for ED, the median (range) duration of which was 23 (2–44) months. After administering PGE1 by each route (1 mg intraurethral and 0.02 or 0.01 mg intracavernosal), the degree of erection was assessed and duplex ultrasonography of the deep penile artery was performed.

Results

 After the intraurethral application of liposomal PGE1, there was mild penile tumescence in 12 patients with organic ED, the others having no response. In contrast, intracavernosal injection produced sufficient rigidity in 13 patients with organic ED, while two only had a slight increase in tumescence. In patients with psychogenic ED, intraurethral application gave adequate rigidity in six, with four having little or no tumescence, and intracavernosal injection induced sufficient rigidity for intercourse in all. Duplex ultrasonography of the deep penile artery of the penis showed that intraurethral application induced lower flow rates than intracavernosal injection. No patient reported pain after intraurethral application but two of 25 reported severe pain after intracavernosal injection.

Conclusions

 The intraurethral application of liposomal PGE1 did not produce sufficient rigidity and was not effective in patients with organic ED. However, it did produce sufficient rigidity in six of 10 patients with psychogenic ED and may thus provide a therapeutic alternative in selected patients.
A clinical‐care pathway for decreasing hospital stay after radical prostatectomy
Authors: Keetch  , Buback
Published: March 2003

Objectives

 To evaluate the use of a clinical‐care pathway that decreased the stay in hospital after radical retropubic prostatectomy from 3 to 2 days, assessing the costs and quality of care.

Patients and methods

 Forty‐four consecutive men who underwent radical retropubic prostatectomy were evaluated prospectively. The first 22 men were hospitalized under the standard 3‐day clinical‐care pathway in use at our institution. This pathway was evaluated, shortened to construct a 2‐day pathway, and a second group of 22 consecutive men hospitalized under the new pathway. Both groups were evaluated and compared 6 weeks post‐operatively.

Results

 The mean (sd) hospital stay was 2.1 (0.3) days for men in the 2‐day and 2.9 (0.4) days for men in the 3‐day pathway (P<0.001). The mean (sd) hospital cost was $8468 (801) in the 2‐day and $8806 (630) in the 3‐day pathway (P=0.13). None of the men in the 2‐day and one of 22 men in the 3‐day pathway experienced a major complication (P=0.31). Two of 22 men in the 2‐day and one of 22 in the 3‐day pathway exceeded the expected stay by one day (P=0.55).

Conclusion

 The hospital stay after radical retropubic prostatectomy can be safely shortened from 3 to 2 days for most men. However, the shorter hospital stay does not result in significant cost savings. The shorter stay does not appear to compromise quality of care. Proper patient education and careful pre‐ and post‐operative supervision are necessary for a successful outcome.
The penile disassembly technique in hypospadias repair
Authors: Perovic  , Vukadinovic  , Djordjevic  , Djakovic
Published: March 2003

Objective

 To report experience and results with penile disassembly in hypospadias repair.

Patients and methods

 From November 1995 to May 1997 penile disassembly was used in 92 patients aged from 9 months to 32 years. The indications for operation were hypospadias with severe penile curvature (especially with curvature in the distal third of the corpora cavernosa), chordee without hypospadias, and small penis with hypospadias. The technique involves separating the penis into its component parts, i.e. the glans cap with neurovascular bundle dorsally, together with the undivided or divided urethra and urethral plate ventrally, and the corpora cavernosa. The manoeuvre allows any curvature to be corrected, especially when in the distal third of the corporal bodies, glans tilt to be rectified, and the penis to be enlarged, particularly elongated, which is a significant gain in small penises with hypospadias.

Results

 The patients were followed for 3–20 months (mean 14); the penis was straightened in all cases, with no recurrence of curvature. In 37 patients (40%) penile disassembly combined with extensive urethral mobilization resolved the hypospadiac meatus with no need to form a neourethra; the penis was larger after surgery. Complications were related to urethroplasty and included four urethral stenoses, two fistulae and three diverticula. There was no injury to the neurovascular bundle and urethra; sensitivity and erection were preserved in all patients.

Conclusion

 The penile disassembly technique is most effective for hypospadias with severe curvature, especially for glans tilt and curvature located distally. Penile augmentation is possible using this technique.
A questionnaire‐based outcome analysis of the Stamey bladder neck suspension procedure for the treatment of urinary stress incontinence: the Hannover experience
Authors: Kuczyk  , Klein  , GRÜnewald  , Machtens  , Denil  , HÖfner  , Wagner  , Jonas
Published: March 2003

Objectives

 To evaluate the long‐term continence rate, including subjective satisfaction and therapy‐associated morbidity, of patients undergoing Stamey bladder neck suspension.

Patients and methods

 Eighty‐five women (median age 55 years, range 30–85) with urinary stress incontinence treated by Stamey bladder neck suspension at our institution between 1987 and 1995 were evaluated using an anonymous questionnaire over a mean (range) follow‐up of 61 (13–93) months.

Results

 Of the 85 patients, 44 (52%) reported an improvement in clinical symptoms at the evaluation and 29 (34%) were completely continent after the Stamey procedure. However, 53 (62%) patients reported subjective satisfaction with the result, because they had a durable improvement in continence for a mean (range) of 44 (10–79) months. There was no correlation between the number of previous urogynaecological operations undergone by the patients and the success of the Stamey procedure. However, the frequency of complications other than urinary retention was significant during and after surgery, at 27%, and in accord with the complication rate reported in earlier studies.

Conclusions

 Compared with other bladder neck suspension procedures, e.g. Burch colposuspension, the Stamey procedure appears to be associated with a higher frequency of postoperative recurrent urinary stress incontinence. Therefore, the Stamey procedure should only be used if the patient demands a minimally invasive surgical procedure for bladder neck suspension. Although 60% of patients were satisfied with the durable improvement in clinical symptoms, it is appropriate to inform patients before surgery of the high recurrence rate after Stamey bladder neck suspension.
The artificial urinary sphincter in men incontinent after radical prostatectomy: 5 year actuarial adequate function rates
Authors: Klijn  , Hop  , Mickisch  , SchrÖder  , Bosch
Published: March 2003

Objective

 To determine the success (as both continence and revision rates) of the artificial urinary sphincter (AUS) in men incontinent after radical prostatectomy, and thus improve the preoperative counselling provided for these patients.

Patients and methods

 The AUS was implanted in 27 men incontinent after radical prostatectomy (mean age 69 years, range 59–75) at a mean (range) interval of 20 (4–60) months after surgery. The Kaplan–Meier method of survival analysis was used to determine the ‘primary adequate function’ (PAF) rate and the ‘additional procedure‐assisted adequate function’ (APA‐AF) rate. Adequate function was defined as satisfactory continence (use of at most one pad per 24 h) in combination with good AUS function. PAF was defined when no revisions of the AUS were required and APA‐AF when one or more revisions of one or more parts of the AUS were required; a complete exchange or explantation of the AUS defined failure, i.e. the end of APA‐AF.

Results

 At a mean follow‐up of 35 months, 81% of the patients had achieved satisfactory continence. However, the 5 year PAF and APA‐AF rates, based on the Kaplan–Meier curves, were 49% and 71%, respectively.

Conclusions

 Implantation of an AUS can provide excellent continence rates in patients incontinent after radical prostatectomy, but only at the expense of a considerable re‐operation rate. The outcome is best represented by Kaplan–Meier curves of the PAF and the APA‐AF.
Modified minimal cost retroperitoneoscopic nephrectomy, nephrectomy with isthumusectomy and nephroureterectomy in children: a pilot study
Authors: Hemal  , Gupta  , Wadhwa
Published: March 2003

Objective

To assess the feasibility of retroperitoneoscopic nephrectomy, nephrectomy with isthmusectomy and nephroureterectomy in children with nonfunctioning kidneys and renal anomalies, at minimal cost using a modified technique.

Patients and methods

Eleven children (aged 4–16 years) underwent retroperitoneoscopic nephrectomy, nephroureterectomy, or nephrectomy with isthmusectomy for nonfunctioning kidneys. Three patients had previously undergone percutaneous nephrostomy to evaluate whether the kidney could be salvaged, but this did not alter the success of technique, although adhesions and fibrosis required careful and precise dissection.

Results

All procedures were completed successfully with minor complications (peritoneal transgression via the port in two patients, with no consequences). The mean operative duration, blood loss and hospital stay were 109 min, 82 mL and 2.25 days, respectively.

Conclusion

Retroperitoneoscopic procedures can be conducted safely, successfully and at minimal cost without compromising any principles of technique. It is not essential to prepare the bowel or use ureteric catheterization and renal artery embolization. Expensive balloon dissectors, trocar‐sealing balloons, endostaplers and endobags, lap sacs or morcellators are not required. The direct approach to the kidney via retroperitoneoscopy is also quicker.
Intracavernosal versus intraurethral alprostadil: a prospective randomized study
Authors: Shokeir  , Alserafi  , Mutabagani
Published: March 2003

Objective

To compare the medicated urethral system for erection (MUSE) with standard intracavernosal prostaglandin E1 (PGE1) in the treatment of erectile dysfunction.

Patients and methods

Sixty consecutive men with organic erectile dysfunction were prospectively randomized to receive either 20 μg of intracavernosal PGE1 (group 1, 30 patients) or 1 mg MUSE (group 2, 30 patients). Response to the drugs was recorded in the outpatient clinic and all patients continued a home‐treatment programme for 3 months. After each home administration, patients recorded the grade of erection in diaries, whether or not sexual intercourse occurred and any adverse reactions to the drugs. Comfort and ease of administration were also recorded.

Results

The characteristics of the patients of both groups were similar; 10 patients in group 1 and 25 in group 2 completed the 3‐month treatment programme, i.e. a withdrawal rate of 67% and 17% for groups 1 and 2, respectively (P<0.05). During outpatient dosing, 27 (90%) patients in group 1 and 18 (60%) patients in group 2 achieved a good erection (P<0.05). Intercourse during the 3 months of home treatment was reported at least once in 26 (87%) patients in group 1, compared with 16 (53%) patients in group 2 (P<0.05). After 3 months of home treatment, patients had administered a total of 242 doses of intracavernosal PGE1 and 360 doses of MUSE; intercourse was reported after 206 (85%) and 198 (55%) administrations of PGE1 and MUSE, respectively (P<0.05). The most common adverse reaction was urogenital pain, reported by 14 (47%) patients in group 1 and two (7%) patients in group 2 (P<0.05). Home treatment was assessed as easy by 12 (40%) patients in group 1 and 27 (90%) in group 2 (P<0.05).

Conclusion

Although MUSE is less effective than intracavernosal PGE1, it is more attractive and accepted well by most patients as an easy method of treatment with minimal or no discomfort.
Is surveillance for stage 1 germ cell tumours of the testis appropriate outside a specialist centre?
Authors: Jones  , Fergus  , Chapman  , Houghton
Published: March 2003

Objective

To assess the results of treatment for stage 1 germ cell tumours of the testis, outside a specialist centre.

Patients and methods

From May 1984 until March 1996, 123 patients with stage 1 disease were treated at our institution. Sixty patients with seminoma and 31 with teratoma were treated with orchidectomy only and surveillance; 32 patients with stage 1 seminoma elected for orchidectomy and adjuvant radiotherapy. The mean ages were 40, 31 and 35 years, and the median follow‐up 52, 47 and 49 months, respectively.

Results

There were no disease‐ or treatment‐related deaths. However, 18 (30%) patients with seminoma treated by orchidectomy only relapsed (median time 8 months, range 3–19); 14 of these responded to radiotherapy, three to radiotherapy and chemotherapy for second relapses outside the irradiated fields, and one to chemotherapy initially, for large‐volume relapse. Fifteen (48%) patients with teratoma relapsed (median time 3 months, range 1–12); all responded to 4–6 courses of bleomycin/etoposide/cisplatin chemotherapy. One patient had a second relapse and is currently disease‐free 3 years after surgical excision of a lung metastasis.

Conclusion

These results show that stage 1 testis tumours can be managed successfully in a district general hospital. However, we are concerned about the high relapse rates and are now attempting to identify patients at greater risk of recurrence, to consider adjuvant therapy in this group.
The role of vitamin A in preventing renal scarring secondary to pyelonephritis
Authors: Kavukçu  , Soylu  , Türkmen  , Sarioglu  , Büyükgebiz  , Güre
Published: March 2003

Objective

To evaluate the efficiency of exogenously administered vitamin A in preventing renal scarring caused by experimental pyelonephritis in rats.

Materials and methods

Forty Wistar rats were injected with 0.1 mL of solution containing Escherichia coli (1010 /mL) into both renal medullae. Five equal groups were then formed: group 1 was treated only with ciprofloxacin (30 mg/kg per day, twice daily, intraperitoneally) for 5 days, starting 3 days after bacterial inoculation; in group 2, 60 kIU of vitamin A was injected intramuscularly with the bacterial inoculation; in group 3, 60 kIU of vitamin A was injected similarly, but 3 days after bacterial inoculation; in group 4, 60 kIU of vitamin A was given orally with the bacterial inoculation; and group 5 was treated with ciprofloxacin for 5 days and vitamin A intramuscularly from the third day after bacterial inoculation. All the rats were killed 6 weeks after bacterial injection; blood samples were obtained to determine serum vitamin A and β‐carotene levels, and both kidneys were examined pathologically for scarring, graded as 0 (none), 1 (mild), 2 (moderate) and 3 (severe).

Results

Serum vitamin A levels were higher in the rats given vitamin A (group 2–5) than in group 1, being highest in group 4, although only this group had significantly higher levels of vitamin A than group 1 (P<0.05). Histopathologically, the fibrosis was mildest in groups 2 and 4 (two of 16 kidneys grade 1), whereas it was most severe in group 1 (all 16 grade 2–3). Fibrosis was significantly less in groups 2–5 than in group 1 (P<0.05). There was a significant negative correlation between vitamin A levels and the sum of the fibrosis, inflammation and tubular atrophy scores of all rats (r=−0.391, P<0.02). β‐carotene levels were unrelated to renal scarring.

Conclusion

The administration of vitamin A could have a role in preventing renal scar formation from pyelonephritis induced experimentally in rats.
Expression of p75LNGFR and Trk neurotrophin receptors in normal and neoplastic human prostate
Authors: Guate  , Fernández  , Lanzas  , Escaf  , Vega
Published: March 2003

Objective

To analyse the occurrence and cell distribution of p75LNGFR and Trk neurotrophin receptors in normal prostate, benign prostatic hypertrophy (BPH) and prostate carcinoma, and to determine the effect of androgen suppression on the expression of these proteins in prostate cancer samples.

Materials and methods

The study comprised formalin‐fixed and paraffin‐embedded material, obtained during surgery and from cadavers during removal of organs for transplantation. Light microscopy immunohistochemistry was carried out using polyclonal antibodies against Trks, and a monoclonal antibody against p75LNGFR . General markers for epithelial and endocrine cells were assessed in parallel.

Results

TrkA immunoreactivity (IR) was restricted to the basal epithelial cells in some acini (37%). This pattern remained unchanged or IR extended to the whole acini in BPH, and varied widely in prostate cancer. In normal tissue and BPH, TrkC IR was detected exclusively in the stroma. Nevertheless, it progressively increased in the epithelial cells of well‐differentiated to moderately differentiated prostate carcinoma, whereas in stromal cells there were no substantial changes. TrkB IR was absent in all the samples. There was weak p75LNGFR IR in normal epithelial cells, which increased in prostate cancer and to a lesser extent in BPH. Androgen suppression was ineffective in reversing TrkA modifications, whereas it caused a decrease in the expression of TrkC and p75LNGFR .

Conclusion

The abnormal growth of prostatic epithelium is accompanied by increased TrkA expression and the induction of TrkC expression in epithelial cells. These results suggest that neurotrophins could be involved in the abnormal growth of the human prostate, acting through specific Trk signal‐transducing receptors whose expression is regulated by androgens.