bluuebunny/crossref_metadata_2025 huggingface dataset:
A simplified defaecographic procedure for the assessment of faecal incontinence or obstructed defaecation
Authors: Mibu R. , Hotokezaka M. , Kai T. , Tanabe Y. , Tanaka M.
Published: March 2003

Objective

Various types of defaecography have been reported for research purposes. A simplified method for clinical use has not been devised for the assessment of disordered defaecation. The aim of this study was to describe a simplified procedure of defaecography and evaluate its usefulness in the diagnosis of faecal incontinence or obstructed defaecation.

Patients and methods

Anorectal manometry and simplified defaecography were performed in 82 consecutive patients. The procedure of defaecography consisted of instillation into the rectum with a 100% weight per volume of barium in the sitting position through a Foley catheter with an inflated balloon, and several series of static radiograph at rest, during squeezing and straining according to deflation of the balloon.

Results

Positive rate of barium leakage after barium insertion was significantly higher in incontinent patients than constipated or asymptomatic patients (P < 0.001, respectively). The degree of barium leakage was classified into mild in 18 patients with faecal incontinence, moderate in 4 and severe in 2. Constipated patients had more difficulty trying to expel a catheter than incontinent or asymptomatic patients (P=0.001, P=0.03). Twenty‐four percent of patients with obstructed defaecation could not expel the balloon and 48% could not evacuate barium sulphate completely. The positive rate of morphological changes such as rectocele, internal intussusception and band formation was higher in constipated patients than incontinent or asymptomatic patients (P=0.01, P=0.04).

Conclusion

The grade of barium leakage or balloon prolapse reflected the severity of faecal incontinence. The ability in rectal emptying of the balloon or barium sulphate also correlated with the degree of outlet obstruction. The authors concluded that the present defaecographic technique was useful for the assessment of faecal incontinence or functional outlet obstruction, and recommend it due to its simplicity.
Treatment of chronic pilonidal sinus with local anaesthesia: a randomized trial of closed compared with open technique
Authors: Testini M. , Piccinni G. , Miniello S. , Di Venere B. , Lissidini G. , Nicolardi V. , Bonomo G. M.
Published: March 2003

Objective

To compare open with closed treatment of chronic pilonidal sinus.

Patients and methods

From 1993 to 1996, 100 patients were submitted to excision of chronic pilonidal sinus, with local anaesthesia and were randomized in two groups: group A in which open treatment and group B in which direct suture were performed. The follow‐up, ranging from 37 to 89 months, was performed by outpatient visits or by phone.

Results

Short‐term results showed 6 (12.0%) post‐operative complications in group A vs 10 (20.0%) in group B. Long‐term results showed 9 (18.0%) complications in group A vs 7 (14.0%) in group B. Mean wound healing was 58 days (range: 29–93) in group A vs 12 (range: 9–61) in group B. The return to normal activity was 25.7 (range: 11–77) vs 10.4 (range: 5–32). Wound healing and the return to normal activity were the only statistically significant differences.

Conclusions

Regarding morbidity neither technique has particular advantages over the other. The closed technique produced quicker wound healing and a quicker return to normal activity.
Radiation damage to the rectum and anus: pathophysiology, clinical features and surgical implications
Authors: Reis E. D. , Vine A. J. , Heimann T.
Published: March 2003

Radiation kills cancer cells by inducing various degrees of deoxyribonucleic acid fragmentation and disruption of intracellular membranes that lead to either immediate or delayed cell death. Although radiation can be effective in destroying cancer, its usefulness is limited by damage to normal tissues that surround the target tumour or those in the path of the radiation beam. The rectum and anus are damaged frequently during radiotherapy for abdominopelvic malignancy, including preresection therapy for rectal cancer. Such damage is often associated with lesions in the perineal skin, genitourinary tract, colon, and small intestine. Surgical intervention often is required for the most severe forms of these complications.
Pre‐operative assessment of anal fistulas using endoanal ultrasound
Authors: Lengyel A. J. , Hurst N. G. , Williams J. G.
Published: March 2003

Objective  To study the accuracy of endoanal ultrasound in pre‐operative assessment of cryptoglandular anal fistulas, with respect to the site of the internal opening, type and depth of the fistula tract.

Patients and methods  A consecutive series of 151 patients with anal sepsis underwent pre‐operative endoanal ultrasound assessment of a suspected anal fistula. Hydrogen peroxide was used to define the tract when there was doubt as to the course of the fistula. All patients subsequently had surgical exploration under anaesthesia, irrespective of findings at sonography. The site of the internal opening, depth and type of fistula were recorded at surgery, and concordance with the ultrasound was assessed.

Results  One hundred and forty‐five patients were subsequently shown to have a fistula at surgical exploration. Type of fistula: Two thirds were transsphincteric (63%) and one third were inter sphincteric (32%), with a few submucosal, and supra sphincteric fistulas. Ultrasound correctly predicted surgical findings in 82% of patients (124/151). Concordance was highest for transsphincteric fistulas (87%). Internal opening: Accuracy of predicting the site of the internal opening was 93% (140/151). The commonest site for the internal opening was the midline posteriorly (49%), followed by the midline anteriorly (25%), the rest lay laterally. Fistula depth: Ultrasound and surgical assessment of the depth of fistulas was concordant in 120 of 145 patients (83%).

Conclusions  Endoanal ultrasound has a high accuracy of predicting the site of internal opening of an anal fistula. Endoanal ultrasound is able to assess the type and depth of a fistula. This information is useful for pre‐operative planning of fistula treatment.
Patients with familial adenomatous polyposis experience better bowel function and quality of life after ileorectal anastomosis than after ileoanal pouch
Authors: Günther K. , Braunrieder G. , Bittorf B. R. , Hohenberger W. , Matzel K. E.
Published: March 2003

Objective  To evaluate the quality of life with emphasis on bowel function in patients undergoing either total colectomy with ileorectal anastomosis (IRA) or restorative proctocolectomy with ileal pouch‐anal anastomosis (IPAA) for familial adenomatous polyposis (FAP).

Patients and methods  All 151 patients operated on in our department between 1971 and 2000 were analysed retrospectively. Since 42 patients had to undergo reoperations, a total of 194 bowel procedures were performed. The final operative breakdown was: 48 IRA, 62 IPAA, 33 total proctocolectomies and 8 other procedures. By the end of the period under consideration, 40 patients had died, 28 had been lost to follow‐up, 83 patients were still alive and of these 76 were analysed. Continence function and quality of life with emphasis on overall bowel function (Wexner (WS)‐, Jostarndt (JS)‐, Öresland (ÖS)‐ and Pemberton (PS)‐scores) were recorded in 59 patients (22 IRA and 37 IAP).

Results  Continence and bowel function were significantly better after IRA than after IPAA (mean scores: WS, 1.1 vs 5.4, P = 0.001; JS, 32.5 vs 24.7, P = 0.0001; ÖS, 2.9 vs 7.9, P = 0.0001), as was quality of life (PS, 25.6 vs 19.6, P = 0.001). The mean values for each single item of all 4 scores were consistently better after IRA. Neither gender, age nor type of pouch‐anal anastomosis (stapled vs hand‐sewn) had a significant influence on outcome. IPAA patients with uneventful follow‐up (n = 27) had better mean values for all 4 scores (WS, 4.2 vs 7.3; JS, 26.1 vs 23.1; PS, 20.4 vs 17.7; ÖS, 6.6 vs 9.9) than those with postoperative complications (n = 10; 27%), but statistical significance was reached only in the ÖS (P = 0.026). No such difference was seen after IRA (14% complication rate).

Conclusion  The significantly better continence after IRA resulting in superior patient comfort and quality of life must be balanced against the oncological disadvantage of this procedure. On the basis of large patient population studies, genotype‐phenotype correlations with respect to the risk for rectal cancer may need to be taken into account. Postoperative complications may have a lasting negative effect on outcome after IPAA.
Cilostazol, a phosphodiesterase inhibitor, improves insulin sensitivity in the Otsuka Long‐Evans Tokushima Fatty Rat, a model of spontaneous NIDDM
Authors: Nakaya Y. , Minami A. , Sakamoto S. , Niwa Y. , Ohnaka M. , Harada N. , Nakamura T.
Published: March 2003

Aim: Angiotensin converting enzyme inhibitors and α1‐adrenergic blockers improve insulin sensitivity, the mechanism of which was considered, at least in part, to be due to the increased blood flow to muscle. The present study aimed to clarify whether cilostazol, a phosphodiesterase inhibitor, improves insulin sensitivity in a model of spontaneous non‐insulin dependent diabetes mellitus (NIDDM), Otsuka Long‐Evans Tokushima Fatty (OLETF) rat.

Methods: OLETF rats were divided into the two groups at the age of 16 weeks: the cilostazol‐supplemented group (cilostazol 40 mg/kg/day) and the normal‐diet group. As a non‐diabetic control, we used Long‐Evans‐Tokushima‐Otsuka rats (non‐diabetic rats). Oral glucose tolerance test and hyperinsulinemic euglycemic clamp was performed at the ages of 23 and 25 weeks, respectively. Serum levels of lipids and leptin were measured.

Results: Body weight and abdominal fat was increased in OLETF rats but cilostazol supplementation did not alter them. Insulin sensitivity, as measured by the hyperinsulinemic euglycemic clamp technique, was significantly decreased in OLETF rats (glucose infusion rate: 73.5 ± 10.0 vs. 41.5 ± 9.8 μmol/min/kg body weight, p < 0.01). Cilostazol supplementation improved insulin sensitivity partially but significantly 51.0 ± 5.7 μmol/min/kg body weight, p < 0.05) in OLETF rats at 25 weeks of age, although it did not decrease serum levels of glucose, lipids or leptin. However, this effect was not observed in non‐diabetic rats.

Conclusion: Cilostazol, which is used in diabetic patients for the treatment of obstructive disease of artery, is expected to have a beneficial effect on insulin sensitivity in NIDDM.
Non‐enzymatic glycation of lens proteins and haemoglobin–inhibition by pyruvate: an in‐vivo study
Authors: Devamanoharan P. S. , Ali A. H. , Varma S. D.
Published: March 2003

Aim: Previous studies have demonstrated that pyruvate can prevent protein glycation and oxidative stress under in‐vitro conditions. The aim of this study was to examine the in‐vivo effectiveness of this metabolite against glycation of lens crystallins and haemoglobin in galactosemic rats.

Methods: Sprague‐Dawley rats were maintained on a 30% or 50% galactose‐containing diet in the absence or presence of 2% or 5% pyruvate in food and water, respectively. The animals were killed subsequently and the extent of glycation of lens crystallins and haemoglobin was determined using an affinity column chromatograpic technique.

Results: Maintenance of rats on the high galactose diet resulted in a significant increase in glycation of both the proteins. The increase was faster and more substantial in the animals maintained on the 50% galactose diet than that in the animals fed a 30% galactose diet. The increase in the latter was also very significant. Supplementation with pyruvate inhibited the process.

Conclusion: The inhibition is attributable to a competitive binding of pyruvate to the protein NH2 groups as well as to the antioxidant effect of the compound. The studies therefore suggest that this and other α‐keto‐acids may be physiologically useful in minimizing glycation and oxidative stress induced tissue pathology by the hyperglycaemic conditions, such as diabetes and galactosemia. The results are also considered pharmacologically significant.
Leptin concentrations are related to glycaemic control, but do not change with short‐term oral antidiabetic therapy in female patients with type 2 diabetes mellitus
Authors: Güler S. , & B. ,   Ccedilakır, Demirba$scedil B. , Gürsoy G. , Serter R. , Aral Y.
Published: March 2003

This study evaluated the relation of leptin with glycaemic control and the effect of 14 days of diet, or diet combined with gliclazide, glipizide‐GITS or metformin treatment, on leptin concentration in 51 female patients with type 2 diabetes mellitus. Leptin levels were similar both at baseline and after treatment in diabetic and control groups. Diabetic patients with basal fasting plasma glucose (FPG) < 10 mmol/l or with basal postprandial plasma glucose (PPPG) < 13.9 mmol/l had significantly higher leptin levels than diabetic patients with basal FPG ≥ 10 mmol/l or with basal PPPG ≥ 13.9 mmol/l (19.6 ± 8.7 vs. 13.65 ± 5.4 μg/l, p < 0.05; and 20.2 ± 7.9 vs. 12.9 ± 5.2 μg/l, p < 0.05, respectively). Mode of treatment did not influence leptin levels. Δ leptin showed a weak correlation with basal FPG (r = 0.346; p < 0.05), basal and post‐treatment PPPG (r = 0.335, p < 0.05 and r = 0.325, p < 0.05, respectively) and a moderate correlation with post‐treatment FPG (r = 0.391, p < 0.01). In conclusion, leptin level is not affected by the presence of type 2 diabetes mellitus and by short‐term treatment with diet or oral antidiabetic drugs but is directly related to glycaemic control in female patients with type 2 diabetes mellitus.
Energy metabolism and substrates oxidative patterns in type 2 diabetic patients treated with sulphonylurea alone or in combination with metformin
Authors: Avignon A. , Lapinski H. , Rabasa‐Lhoret R. , Caubel C. , Boniface H. , Monnier L.
Published: March 2003

Objective: To compare substrates oxidative patterns in type 2 diabetic patients treated with sulphonylurea alone or in combination with metformin.

Methods: Plasma glucose (PG), plasma insulin (PI) and substrates oxidation rates measured by indirect calorimetry were compared during a test day at 8.00 a.m. (before breakfast), 11.00 a.m. (before the lunch), 2.00 p.m. (2 h after the lunch) and at 5.00 p.m. in 56 diabetic patients treated with diet (group C, n = 14), sulphonylurea (group S, n = 14) or with a sulphonylurea‐metformin combination (group SM, n = 28).

Results: The three groups were comparable for age, body mass index (b.m.i.), body composition and PG levels. Mean glucose oxidation (Gox) was increased since mean lipid oxidation (Lox) was decreased in group S in comparison both with group C (3.02 ± 0.08 vs. 2.62 ± 0.08 g/min/kg/103, p < 0.05; 0.53 ± 0.04 vs. 0.88 ± 0.09 g/min/kg/103, p < 0.01). Mean Lox was also decreased in group S in comparison with group SM (0.88 ± 0.06 vs. 0.53 ± 0.04 g/min1/kg1/103, p< 0.0001) whereas the difference in Gox between these latter two groups was only significant in the basal state (1.94 ± 0.17 vs. 2.47 ± 0.17 g/min1/kg1/103, p< 0.05). Mean respiratory quotient (RQ) was increased in group S (0.90 ± 0.01) in comparison both with group C (0.86 ± 0.01, p < 0.001) and with group SM (0.86 ± 0.01, p < 0.001). Mean energy expenditure was lower in group S than in group SM (21.4 ± 0.6 vs. 23.6 ± 0.6 kcal/min/kg/103, p < 0.05). Substrates oxidative patterns, RQ values and energy expenditure were similar in group C and in group SM.

Conclusions: When compared to patients treated with a sulphonylurea‐metformin bitherapy, patients treated with a sulphonylurea monotherapy have a shift in their ratio of fat to carbohydrate oxidation that could make body weight loss more difficult in this latter group.
Implications of cardiovascular risk in patients with type 2 diabetes who have abnormal lipid profiles: is lower enough?
Authors: Garber Alan J.
Published: March 2003

Patients with type 2 diabetes are at high risk for coronary heart disease (CHD); frequently, these patients have abnormal lipid profiles, placing them at even greater risk. A syndrome of insulin resistance, hyperinsulinaemia, hypertension, and high levels of fibrinogen and plasminogen activator inhibitor contributes to cardiovascular risk, which is not sufficiently decreased by glycaemic control alone. In several large interventional trials, CHD risk in patients with diabetes was substantially reduced by aggressive lipid‐lowering therapy. In patients with diabetes, CHD, low high‐density lipoprotein levels, and normal low‐density lipoprotein levels, gemfibrozil reduced fatal and non‐fatal CHD events. For lipid‐lowering in patients with diabetes and CHD, pravastatin and simvastatin are the only HMG‐CoA reductase inhibitors shown to reduce fatal and non‐fatal CHD events. Of these, pravastatin has less potential for drug–drug interactions and may be safer to use, particularly for combination therapy with fibric acid derivatives, as may now be important for CHD prevention in mixed dyslipidaemias.
The impact of cerebrovascular disease
Authors: Brass Lawrence M.
Published: March 2003

Stroke may be affected by pathologic conditions such as atherosclerosis, vascular injury, coagulopathy, and increased platelet aggregability. Knowledge of the pathophysiology of stroke is critical in order to effectively prevent or treat this disabling state.

Cerebrovascular disease is the third leading cause of death in the USA. It is also associated with significant morbidity, leading to extremely high health care costs and lost productivity. Total estimated costs of stroke are estimated to be more than $45 billion annually. This is an especially important issue for patients with diabetes, who are at higher risk for stroke and have a worse clinical outcome than non‐diabetic patients.

This review describes the impact of vascular disease, particularly cerebrovascular disease, and describes the pathophysiology of the disease. Interventions that result in reduction of stroke will likely result in decreased health care costs and improved clinical outcomes.
Nateglinide improves glycaemic control when added to metformin monotherapy: results of a randomized trial with type 2 diabetes patients
Authors: Marre M. , Van Gaal L. , Usadel K‐H. , Ball M. , Whatmough I. , Guitard C.
Published: March 2003

Aims/hypothesis: This study evaluated the addition of nateglinide, a d‐phenylalanine derivative that restores early phase insulin release, to metformin in type 2 diabetes patients stabilized on high‐dose metformin.

Methods: This multicentre, double‐blind, parallel group trial included 467 metformin‐treated patients with glycosylated haemoglobin (HbA1c) between 6.8% and 11%. Patients were randomized to add nateglinide 60 mg, 120 mg or placebo before three meals to metformin 1000 mg b.i.d. for 24 weeks.

Results: HbA1c was significantly reduced with nateglinide 60 mg and 120 mg plus metformin compared with metformin control (−0.36%, p = 0.003; −0.59%, p < 0.001 respectively). Greater benefits occurred if patients had elevated HbA1c at baseline (−1.38% with nateglinide 120 mg in patients with HbA1c > 9.5%). A modest fasting plasma glucose reduction was observed. Most symptoms suggestive of hypoglycaemia occurred in patients with low HbA1c levels (≤ 8%) at baseline, although no confirmed cases of hypoglycaemia occurred with nateglinide 60 mg in this patient group. Events suggestive of hypoglycaemia were confirmed in 1.1% of cases (plasma glucose ≤ 3.3 mmol/l). Weight gain over 24 weeks was 0.9 kg with nateglinide 120 mg vs. metformin alone, and plasma lipids remained unchanged.

Conclusions/interpretation: In patients stabilized on high‐dose metformin, the addition of nateglinide improved glycaemic control. The combination of these agents was well tolerated and both doses of nateglinide proved effective. The efficacy of nateglinide 60 mg and the low rate of hypoglycaemia observed at this dose make it suitable for patients close to their therapeutic target on metformin monotherapy.
Glucose screening during active labour for the detection of undiagnosed hyperglycaemia and newborn malformations in a population without prenatal care
Authors: Hernandez‐Valencia M. , Carrillo Pacheco A.
Published: March 2003

Aim: This prospective study was undertaken to look at the frequency of hyperglycaemia in pregnant women who were without health benefits and did not receive prenatal specialist care, and to examine the relationship between fetal complications and the prenatal care received.

Methods: The subjects consisted of 304 pregnant women, divided into two groups. Group I included 176 women who had inadequate prenatal care (73 women with irregular care, and 103 women without any specialist care.) with a mean of 1.1 visits to a specialist. Group II included 128 women who had regular prenatal care with a mean of 6.5 consultations per patient.

Results: There were no statistical differences between the two groups in relation to maternal age, obstetrical history and gestational weeks. The familial antecedent of diabetes was found in 30.1% of women in group I and 19.5% of women in group II (p < 0.05). Hyperglycaemia was found in 55 (31.2%) patients in group I and 4 (3.1%) patients in group II (p < 0.001) with mean blood glucose levels of 163 and 130 mg/dL respectively. Clinical characteristics of newborns show statistically significant increased abnormalities in 15.9% of babies whose mothers had inadequate prenatal care vs. 3.9% of babies whose mothers had regular prenatal care. The abnormalities seen were myelomeningocele, cleft lip and palate, oesophageal atresia, polydactyly, phocomelia and encephalocele.

Conclusions: The frequency of hyperglycaemia in pregnant women with inadequate prenatal care was higher than in pregnant women with regular prenatal care. Additionally newborn abnormalities and complications occurred more frequently in babies of mothers with inadequate prenatal care. The benefits of prenatal care are evident and it is important to improve and start instituting new programmes and ways of making health information available to women in primary care clinics to educate the general population and stress the importance of regular visits to a prenatal care specialist.
Glyburide/metformin combination product is safe and efficacious in patients with type 2 diabetes failing sulphonylurea therapy
Authors: Blonde L , Rosenstock J , Mooradian A. D. , Piper B‐A. , Henry D.
Published: March 2003

Aim: To compare the efficacy, safety and tolerability of a fixed combination glyburide/metformin preparation with those of glyburide or metformin alone in patients with type 2 diabetes inadequately controlled by sulphonylurea, diet and exercise.

Methods: In this 16‐week, randomized, double‐blind, parallel group study, 639 patients with inadequate glycaemic control on at least half‐maximal dose of sulphonylurea were randomly assigned to: glyburide 10 mg b.i.d. (n = 164); metformin 500 mg (n = 153); glyburide/metformin 2.5 mg/500 mg (n = 160); or glyburide/metformin 5 mg/500 mg (n = 162). Titration was allowed to maximum doses of 2000 mg for metformin or 10 mg/2000 mg and 20 mg/2000 mg for glyburide/metformin 2.5 mg/500 mg and 5 mg/500 mg respectively. The primary outcome measure was HbA1c level after 16 weeks; secondary end‐points included fasting and 2‐h post‐prandial plasma glucose. Adverse events (AEs) were recorded and summarized by treatment group.

Results: Both strengths of glyburide/metformin equally reduced mean HbA1c by 1.7% more than did glyburide alone (p < 0.001), and by 1.9% more than did metformin alone (p < 0.001). Final mean fasting plasma glucose concentrations were also lower in both glyburide/metformin groups than in the glyburide (−2.8 mmol/l, −51.3 mg/dl; p < 0.001) and metformin groups (−3.6 mmol/l, −64.2 mg/dl; p < 0.001). Safety and tolerability were similar across all treatment groups, except for a higher incidence of gastrointestinal AEs in the metformin monotherapy group, and more patients reporting mild or moderate symptoms of hypoglycaemia while taking glyburide/metformin.

Conclusions: Both glyburide/metformin tablet strengths produced, with equal efficacy, significantly better glycaemic control than monotherapy with either agent. These data also confirm that glycaemic efficacy does not require maximal sulphonylurea doses in combination with metformin.
The influence of the Pro12Ala mutation of the PPAR‐gamma receptor gene on metabolic and clinical characteristics in treatment‐naïve patients with type 2 diabetes
Authors: Ahluwalia M. , Evans M. , Morris K. , Currie C. , Davies S. , Rees A. , Thomas A.
Published: March 2003

Peroxisome proliferator activated receptor‐gamma is an important factor in adipocyte differentiation and energy metabolism and is thus a candidate gene for obesity, insulin resistance and dyslipidaemia. We therefore assessed the associations between the most common variant of the PPAR‐γ, the Pro12Ala (P12A) substitution in the PPAR‐γ2 gene, with BMI, blood pressure, fasting plasma glucose, HbA1c, total cholesterol, LDL and HDL cholesterol and plasma triglyceride in 183 treatment‐naïve patients with type 2 diabetes (T2D). The P12A allele associated with lower fasting plasma glucose but had no influence on HbA1c or BMI. In obese patients (BMI > 29 kg/m2), the P12A substitution associated with elevated total and non‐HDL cholesterol levels.
Influence of treatment with acarbose or glibenclamide on insulin sensitivity in type 2 diabetic patients
Authors: Fischer S. , Patzak A. , Rietzsch H. , Schwanebeck U. , Köhler C. , Wildbrett J. , Fuecker K. , Temelkova‐Kurktschiev T. , Hanefeld M.
Published: March 2003

Aim: The aim of our double‐blind, placebo‐controlled study was to compare the effect of acarbose and glibenclamide on the insulin sensitivity in type 2 diabetes.

Methods: We investigated 77 patients (mean age 58.7 years, mean BMI 27.3 kg/m2), treated by diet alone for at least 4 weeks. The subjects were randomized into three treatment groups for 16 weeks: 100 mg t.i.d. acarbose (n = 25) or 1 mg t.i.d. glibenclamide (n = 27) or one t.i.d. placebo (n = 25). Before and after therapy, the levels of fasting plasma glucose, glycosylated haemoglobin, fasting insulin, plasma glucose and insulin 1 h after a standardized breakfast were measured and insulin sensitivity determined by euglycaemic hyperinsulinaemic clamp test.

Results: After the treatment period, BMI in the acarbose and placebo group decreased significantly, whereas in the glibenclamide group a significant increase was observed. Fasting plasma glucose was only significant reduced under glibenclamide. The postprandial glucose decreased significantly after acarbose (13.8 vs. 11.4 mmol/l, p < 0.05) and glibenclamide treatment (14.6 vs. 11.4 mmol/l, p < 0.05) and was unchanged under placebo (13.8 vs. 13.7 mmol/l). The fasting insulin levels remained unchanged in all three groups, whereas postprandial insulin values increased significantly under glibenclamide. Neither acarbose nor glibenclamide significantly changed insulin sensitivity [acarbose: glucose disposal rate before treatment 2.3 mg/kg body weight/min/insulin, after treatment 3.2; glibenclamide 2.2 vs. 2.1; placebo 2.6 vs. 3.0].

Conclusions: Our results show a more substantial improvement of glucose control under glibenclamide than under acarbose which, however, was not associated with an increase of insulin sensitivity.
Morphology of the bourgueticrinid and isocrinid aboral nervous system and its possible phylogenetic implications (Echinodermata, Crinoidea)
Authors: Bohn J. M. , Heinzeller T.
Published: March 2003

Bohn, J. M. & Heinzeller, T. 1999. Morphology of the bourgueticrinid and isocrinid aboral nervous system and its possible phylogenetic implications (Echinodermata, Crinoidea). —Acta Zoologica (Stockholm) 80: 241‐249.

On the basis of semithin serial sections the aboral nervous system within the calyx of five bourgueticrinid and one isocrinid species was reconstructed using the computer programm NIH Image. The aboral nervous system of all bourgueticrinids belongs to a common type which is proposed to be called ‘Bathycrinus‐type’ (B‐type), that differs from the ‘Isocrinus‐type’ (I‐type). The morphology of the B‐type and the I‐type are described and differences are discussed. Together with the B‐type there are now six aboral nervous system types well established and the consequences regarding phylogeny are discussed. Conclusions: 1) The morphology of the aboral nervous system may be a useful tool for the clarification of relationships between crinoid groups; 2) All known aboral nervous system types can be derived from the I‐type, which seems to be the most primitive one; 3) The B‐type aboral nervous system is probably a synapomorphic feature charac‐terizing a monophyletic group within the Bourgueticrinida.
Fine structure of the postpygidial gland in Aenictus army ants
Authors: Billen Johan , Gobin Bruno , Ito Fuminori
Published: March 2003

Billen, J., Gobin, B. & Ito, F. 1999. Fine structure of the postpygidial gland in Aenictus army ants. – Acta Zoologica (Stockholm) 80: 307–310

Army ants of the genus Aenictus are characterized by the presence of a conspicuous postpygidial gland, which is the source of the trail pheromone. The paired gland at each side consists of a reservoir sac into which the secretory cells open through their accompanying duct cells. The secretory cells are characterized by a well developed Golgi apparatus, numerous mitochondria and strands of smooth endoplasmic reticulum. The reservoir opens near the abdomen tip, which facilitates deposition of the secretory products onto the substrate. The large reservoir of the postpygidial gland may enable the incessant trail laying of at least one of the investigated species.
Ultrastructural investigations of the female genital system of Epiperipatus biolleyi ( Bouvier 1902) (Onychophora, Peripatidae)
Authors: Brockmann Claudia , Mummert Renate , Ruhberg Hilke , Storch Volker
Published: March 2003

Brockmann, C., Mummert, R., Ruhberg, H. and Storch, V. 1999. Ultrastructural investigations of the female genital system of Epiperipatus biolleyi (Bouvier 1902) (Onychophora, Peripatidae). — Acta Zoologica (Stockholm) 80: 339–349.

The female genital system of the neotropical peripatid Epiperipatus biolleyi was examined using transmission and scanning electron microscopy. Special attention is given to the two accessory organs of the paired oviducts: the receptacula seminis and the ovarian funnels (Ovarialtrichter). The latter occur only in the Peripatidae, whereas receptacula seminis may also be present in the Peripatopsidae, the only other family in the Onychophora. The ovarian funnels of E. biolleyi are thin‐walled and closed from the haemocoel. This trait has also been reported from Epiperipatus trinidadensis, Macroperipatus torquatus, and Eoperipatus weldoni, whereas other peripatids have ovarian funnels which have been reported to open into the haemocoel. The occurrence of artificially opened ovarian funnels, caused by tissue rupture during specimen preparation, is discussed. The presence of spermatozoa both in the receptaculum seminis and in parts of the uterus of the female examined in this study supports the hypothesis that in E. biolleyi insemination of juvenile females occurs directly via the genital opening. The female contained one unstalked cleavage embryo in each uterus horn. Two features of the uterus were found to be unique to E. biolleyi: (1) a second cell layer overlying the uterine epithelium with a pronounced secretory activity (2) embryos are enclosed in a noncellular coat interspersed with numerous transport vesicles.
The ventral skin glands, new additional cloacal glands in Proteus anguinus (Caudata, Proteidae). II. Male
Authors: Guillaume Olivier
Published: March 2003

Guillaume, O. 2000. The ventral skin glands, new additional cloacal glands in Proteus anguinus (Caudata, Proteidae). II. Male. —Acta Zoologica (Stockholm) 81: 223–234

Cloacae from male Proteus anguinus were examined for the first time by light and electron microscopy. Male P. anguinus possess anterior and posterior ventral glands, dorsal and lateral pelvic glands, vent glands and Kingsbury’s glands as do Necturus males. However, male P. anguinus also possess the new additional cloacal glands found in females and which the author has called the ventral skin glands. Furthermore, the number, the length and the diameter of these tubular glands are higher in males. Therefore the inference is that these glands are sexually dimorphic glands.
Synthesis and function of the fibrous layers covering the eggs of Siphlonurus lacustris (Ephemeroptera, Siphlonuridae)
Authors: Gaino Elda , Rebora Manuela
Published: March 2003

Ultrastructural analysis (transmission and electron scanning microscopy) of the eggs of the mayfly Siphlonurus lacustris (Eaton) showed that they are wrapped in a thick coat composed of a network of tightly entwined filaments. Groups of twisted filaments form slightly uplifted buttons that are scattered on the coat surface. After experimentally induced egg deposition, egg–water interaction promotes marked cohesion of the eggs and their firm adhesion to the substrate. Egg masses include numerous gametes; the covering of those located close to the substrate greatly extends to anchor the whole mass. Eggs removed from the coat reveal a slightly punctuated smooth chorion and tagenoform micropyles (three to five). The coat increases egg size by about 20%. The lack of female reproductive accessory glands in Ephemeroptera transfers the synthesis of the adhesive coats to the follicle cells, which are typically competent for insect egg shell deposition (vitelline envelope and chorionic layers). This covering results from electron‐dense granules that give rise to filaments progressively organized to form superimposed layers variously orientated around the egg. In addition to egg adhesion to the substrate, a trophic function and protection from shear stress are postulated for this covering.
Functional morphology of the feeding apparatus of the nymph of Farrodes sp. (Ephemeroptera: Leptophlebiidae)
Authors: Polegatto C. M. , Froehlich C. G.
Published: March 2003

Farrodes nymphs are specialized periphyton/biofilm scrapers. Their maxillae are the most specialized mouthparts, but other elements, with their systems of variously modified setae, are designed to obtain and transport food particles to the pharynx with a minimum of loss. The morphology and adaptations of these mouthparts and related head areas, as well as associated musculature, are described.
Morphology of the spermatozoa of the Microhylidae (Anura, Amphibia)
Authors: Scheltinga David M. , Jamieson Barrie G. M. , Bickford David P. , Garda Adrian A. , Báo Sônia N. , McDonald Keith R.
Published: March 2003

Microhylid spermatozoa show the autapomorphic condition of possessing a thin post‐mitochondrial cytoplasmic collar. Their spermatozoa are apomorphic in several respects. They have lost the distinct nuclear shoulder, endonuclear canal and axial perforatorium observed in urodeles, caecilians and primitive frogs, possess a conical perforatorium and apomorphically lack any fibres associated with the axoneme. The spermatozoa of Cophixalus, however, differ in several respects from those of the other microhylids examined. Cophixalus spermatozoa are longer in almost all measurements, the acrosome vesicle is cylindrical and does not completely cover the putative perforatorium, the perforatorium is asymmetrical and composed of fine fibres, the nucleus is strongly attenuated and narrower, and the mitochondria are elongate. The absence of fibres associated with the axoneme is an apomorphic condition shared with the Ranidae, Rhacophoridae and Pipidae.
Morphology of the salivary glands of three Squamata species: Podarcis sicula sicula, Tarentola mauritanica and Coluber viridiflavus
Authors: Baccari Gabriella Chieffi , Ferrara Diana , Di Matteo Loredana , Minucci Sergio
Published: March 2003

The histology, histochemistry and ultrastructure of the salivary glands of three species of squamata, Podarcis sicula sicula (mandibular glands), Tarentola mauritanica (sublingual gland) and Coluber viridiflavus (supra‐ and infralabial glands) were studied. Each gland contained acidic cells, positive for both periodic acid Schiff and Alcian blue reactions. These cells can be distinguished as seromucous and mucous types based on the different electron density of their granules. α‐Amylase, until now detected only in mammalian salivary glands, was not found in any of the salivary glands examined. The ultrastructural study revealed that the salivary glandular cells of T. mauritanica lack intercellular canaliculi, which by contrast, are present between the seromucous cells in the salivary glands of C. viridiflavus and P. s. sicula. Comparable variation is also seen when the ultrastructural features of the secretory granules in salivary glands of the three Squamata species are compared. The salivary granules of T. mauritanica and C. viridiflavus are more or less dense but structureless, while the mucous granules of P. s. sicula have a distinctive and characteristic substructure. Therefore, this study, designed to obtain comparative data on the histology, histochemistry and ultrastructure of the salivary glands of three representative, but hitherto unstudied, species of Squamata, reveals great variation in the structure of these glands within the Squamata lineage, even when compared to previously documented species.
Sperm structure and spermiogenesis inAtelura formicariaHeyden (Zygentoma, Insecta)
Authors: Dallai R. , Lupetti P. , Carapelli A. , Frati F. , Afzelius B. A.
Published: March 2003

The spermatozoon ofAtelura formicaria(Zygentoma) shows several features that are typical of insects: an apical acrosome, an elongated dense nucleus, a centriole with expanded centriolar adjunct material, two large mitochondrial derivatives, and two thin accessory bodies located beneath the nucleus. The axoneme exhibits a 9 + 9 + 2 pattern with accessory tubules formed by 16 protofilaments and intertubular material. However, spermatozoa ofA. formicariashow some remarkable features. The sperm cell is short for an insect, being only 50 µm in length. The nucleus is characterized by the presence of two lateral grooves which are filled with numerous infoldings of the nuclear envelope. In a cross‐section the chromatin has the configuration of the Leonardo da Vinci’s ‘Vitruvian man’. Each mitochondrial derivative has a peculiar structure with peripheral cristae and four crystalline bodies in its matrix; two of these crystalline bodies are large and have differently orientated cristal planes. At the end of spermiogenesis, sperm bundles are stored in the proximal part of the testes. Secretions from the epithelial wall of this region give rise to large globular structures. These include sperm bundles intermingled with dense granules, forming the so called ‘spermatolophids’. These formations descend along the deferent duct and are stored in the expanded seminal vesicle.Ateluraspermatozoa do not pair as in some Lepismatidae, nor do they fuse as inTricholepidion(Lepidotrichidae). Thus, sperm aggregation in Zygentoma is realized according to different modalities and can hardly be considered as a synapomorphic trait of its subtaxa.
Sensory pathways in amphioxus larvae II. Dorsal tracts and translumenal cells
Authors: Lacalli Thurston C. , Kelly Samantha J.
Published: March 2003

Serial and interval EM series were used to examine the dorsal nerve tracts in the anterior nerve cord of a 12.5 day larva ofBranchiostoma floridae. Fibres within the tracts derive from peripheral sensory cells and a class of intramedullary sensory neurones known as dorsal (Retzius) bipolar cells. Both form repeated synapses of similar type, apparently with the same targets. The synapses occur at points where, at intervals, the tracts expand to form large synaptic zones. The target dendrites, which form complex tangles, belong chiefly to dorsal translumenal cells, a class of neurone distinguished by their apical processes. The latter range from short extensions of the cell apex that contact the opposite side of the cord via junctions, but go no further, to elongate processes with slender branches that project to the contralateral dorsal tract. The morphology indicates that translumenal cells play the same role in amphioxus as internuncial neurones in vertebrate spinal cord. Their axons can be ipsilateral or contralateral; some synapse with motoneurones directly while others innervate other interneurones, including other translumenal cells. From the circuitry, the cells appear to be chiefly involved in integrating sensory input from peripheral mechanoreceptors. This could include acting as a filter that amplifies some input patterns over others, or that normalizes input, so that CNS circuits are not overloaded as new sensory cells differentiate during development. The functional importance of the translumenal system to the organism is reflected in a massive increase in size and cell numbers during the larval phase. The anterior, brain‐like integrative centres of the cerebral vesicle, in contrast, are initially small and change very little.
Outcome of radical cystectomy for bladder cancer according to the disease type at presentation
Authors: Yiou R. , Patard J.‐J. , Benhard H. , Abbou C.‐C. , Chopin D.K.
Published: March 2003

Objective To examine whether the outcome of cystectomy for invasive transitional cell carcinoma (TCC) of the bladder was influenced by the type of disease at initial presentation.

Patients and methods The charts of 76 patients treated for TCC by radical cystectomy from 1987 to 1997 in our unit were reviewed. The patients were divided into three groups: group 1 comprised 43 patients with primary invasive disease; group 2 included 12 patients with progression of an initial superficial bladder tumour after failure of conservative treatment; and group 3 comprised 21 patients who had a radical cystectomy for superficial TCC, with a high risk of progression after attempts at conservative treatment. The pathological findings on transurethral resection and cystectomy specimens, cancer‐specific survival and the time to progression were compared among the three groups.

Results The rate of pT0 in cystectomy specimens was 16%, 41% and 24% in groups 1, 2 and 3, respectively. Under‐staging occurred in 24% of cases in group 3. The 10‐year cancer‐specific survival rates were 48%, 47% and 82% in groups 1, 2 and 3, respectively. The cancer‐specific survival rate and progression rate were not significantly different between groups 1 and 2, but were significantly lower/higher in these patients than in group 3 (P < 0.01).

Conclusions These data suggest that the prognosis of superficial TCC which progresses despite conservative management is no better than that of invasive TCC at initial presentation, despite the closer follow‐up received by the former patients. Early identification of this group of patients may improve the cancer‐specific survival, as early cystectomy for high‐risk superficial TCC yields better results.
Pelvicalyceal stone load: a factor affecting the outcome of extracorporeal shockwave lithotripsy for renal pelvic calculi
Authors: Küpeli B. , Tunç L. , Alkibay T. , Karaoglan Ü. , Bozkirli I.
Published: March 2003

Objectives To determine the effect of variations in pelvicalyceal volume on the results of extracorporeal shock wave lithotripsy (ESWL) and the relationship of stone load to estimated pelvicalyceal volume in patients with renal pelvic stones.

Patients and methods In all, 204 patients with renal pelvic stones were treated primarily by ESWL. Exclusion criteria were radiolucent stones, dilatation of the renal collecting system, JJ stent insertion before ESWL and an inadequate follow‐up. The surface area of the stones and the renal collecting system were measured using a grid of 1 mm2 divisions. The pelvicalyceal volume was calculated as 0.6 (area)1.27. To evaluate the treatment results a pelvicalyceal stone load (PSL) index, describing the relationship of stone load to total estimated pelvicalyceal volume, was defined as stone volume/renal collecting system volume.

Results The mean (range) pelvicalyceal volume of the patients was 13.24 (4.12–28.47) mm3 and the mean PSL index was 26.2%. The cumulative success rates according to the PSL decreased from 97% to 90% with increasing PSL, but remained at > 95% in patients with a PSL index of < 50%. In all, 184 sessions were applied and the session/patient ratio increased from 1.41 to 3.0 with increasing PSL. Complications were acute pyelonephritis in three and steinstrasse in five patients.

Conclusion The PSL index appears to be a more accurate and reproducible method for predicting the outcome of ESWL, and has the advantage of considering the effect of pelvicalyceal anatomy.
Simultaneous bilateral compared with unilateral percutaneous nephrolithotomy
Authors: Holman E. , Munim Khan A. , Pásztor I. , Tóth C.
Published: March 2003

Objective To compare simultaneous bilateral percutaneous nephrolithotomy (SBPCNL) and unilateral PCNL in separate sessions in patients with bilateral renal stones for several variables before and after surgery.

Patients and methods The results from SBPCNL carried out at two centres in different countries on 198 patients (aged 1.25–70 years) were compared with those from 300 patients undergoing unilateral PCNL in separate sessions. At one centre where extracorporeal shockwave lithotripsy (ESWL) was available SBPCNL was used for stones where at least two sessions of ESWL would have been required on each side. Other associated procedures were also used wherever required.

Results The stones were cleared bilaterally in one session of SBPCNL in 190 patients; in eight, fragments of < 3 mm remained but were not clinically significant. A second session was required in six patients on one side only. Variables assessed before and after treatment (e.g. hospital stay, analgesia requirements and complications) were not significantly different between SBPCNL and PCNL. The mean (range) total operative duration for SBPCNL was 46 (20–100) min and the hospital stay 4.3 (3–8) days.

Conclusion From this experience, SBPCNL is a cost‐effective and beneficial solution for selected patients, with clear advantages over separate unilateral PCNL in patients with bilateral stones.
Muscle precursor cell autografting in a murine model of urethral sphincter injury
Authors: Yiou R. , Dreyfus P. , Chopin D.K. , Abbou C.‐C. , Lefaucheur J.‐P.
Published: March 2003

Objective To determine whether muscle precursor cells (MPCs) harvested from limb skeletal muscle can enhance the regeneration process of the striated urethral sphincter after injury.

Material and methods Striated urethral sphincters of male mice were injured by an injection of a myotoxic substance (notexin). In the experimental group, 2 days after injury, MPCs were enzymatically harvested from striated muscles of the lower limbs and labelled with PKH 26, then immediately re‐injected into the injured urethral sphincter of the same animal. In the control group, saline buffer was injected instead of MPCs. Animals were killed 7 days or 1 month after injury and the sphincters removed for histological study (the presence of PKH 26‐labelled myofibres, measurement of myofibre diameter and total number of myofibres).

Results MPC autografting accelerated sphincter muscle repair, as shown by a higher myofibre diameter (P = 0.03) and number (P = 0.01) in the experimental group than in the controls at 7 days. One month after their injection MPCs were still detectable in the regenerating sphincters and participated in the formation of new myofibres.

Conclusion This study provides the experimental basis for a new therapeutic approach to urethral sphincter insufficiency after surgical or obstetrical injury, based on MPC autografting.