bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased urinary nitrite excretion in primary enuresis: effects of indomethacin treatment on urinary and serum osmolality and electrolytes, urinary volumes and nitrite excretion
Authors: Al‐Waili N.S.
Published: March 2003

Objectives To assess urinary nitrite excretion, a stable end product of nitric oxide (NO), in patients with enuresis and in normal controls, and to evaluate the effects of indomethacin (a potent prostaglandin synthesis inhibitor) on urinary nitrite excretion, other urinary variables and bladder capacity.

Patients and methods The study comprised 10 patients with primary enuresis and 10 normal comparable controls (age range 6–14 years). Nitrite was assayed in ‘spot’ morning urine samples in both the enuretics and normal controls. Enuretics were then given 50 mg indomethacin suppositories each night; urine volume, urinary osmolality and electrolytes, serum osmolality and electrolytes and urinary nitrite were assayed before indomethacin treatment and after 15 days of treatment.

Results The mean (sd) urinary nitrite excretion was 24.4 (19.6) µmol/L in normal children and 275.9 (111.2) µmol/L in enuretics (P<0.05). With indomethacin, the urinary nitrite concentration was significantly decreased to 141 (45.1) µmol/L (P<0.05) and associated with a significant reduction in bed‐wetting episodes and voiding frequency. The functional bladder capacity was <70% of the predicted value for age in six of the patients; they had significant improvements on indomethacin, to values similar to those in patients with a nearly normal functional bladder capacity. Indomethacin decreased the 24‐h urinary volume by 41%, the night volume by 40%, clearance of free water by 46% and increased the day : night urinary volume ratio by 55%. The absolute amounts of urinary calcium, magnesium, phosphorus, urea, creatinine, and glucose were lower on indomethacin, although not statistically significantly so. Indomethacin decreased the 24‐h urinary and ‘spot’ morning osmolality and osmotic clearance. There were no significant changes in serum osmolality and electrolyte concentrations. Indomethacin also decreased the absolute amount of urinary sodium, chloride and potassium, fractional sodium and potassium excretion, and filtered sodium. Creatinine clearance was decreased by 20% (P>0.05) and normal 24‐h urinary protein was significantly lower, by 47%, after indomethacin treatment (P<0.05).

Conclusion Urinary nitrite excretion increased significantly in patients with primary nocturnal enuresis; indomethacin markedly reduced bed‐wetting episodes and decreased the frequency of voiding in enuretics with small or normal functional bladder capacity, which was associated with a significant decrease in urinary nitrite excretion. Indomethacin reduced bed‐wetting by decreasing the urine volume, clearance of free water and urinary electrolytes, and through possible effects on bladder and urethral contraction, by inhibiting NO and prostaglandin synthesis. NO and prostaglandins might be important in the pathogenesis of primary enuresis.
A high easy‐to‐treat complication rate is the price for a continent stoma
Authors: De Ganck J. , Everaert K. , Van Laecke E. , Oosterlinck W. , Hoebeke P.
Published: March 2003

Objective To evaluate the conduit‐related complications and their treatment in Mitrofanoff continent urinary diversion and antegrade colonic enema (ACE) procedures.

Patients and methods The files of 53 patients (18 men and 35 women) in whom 58 continent stomas were created were retrospectively reviewed. Gender, age, age at the time of surgery, underlying disease, concomitant surgery, abdominal position of the stoma, follow‐up, complications and treatment were assessed. The mean (sd) age at the time of surgery was 19 (13) years; 30 patients were aged <15 years and the mean follow‐up was 2.8 (1.9) years. Fifty‐three continent vesicostomy‐type Mitrofanoff stomas were constructed and five ACE procedures performed. Forty‐five stomas were in the umbilicus and 13 on the abdominal wall. For 45 conduits the appendix was used; in the other 13 a transverse tubularized ileal segment according to Monti was created.

Results There were stoma‐related complications in 19 patients (36%), with 27 in all and stomal stenosis accounting for more than half. Five patients had urinary leakage. The median time to the first complication was 9 months. Multiple regression analysis showed that gender and stoma location were the only significant determinants of the complication/follow‐up ratio. Women had more complications than men and umbilical stomas fared worse than those on the abdominal wall. Age, underlying disease and type of stoma were not significantly related to the complication/follow‐up ratio. The complication was treated by one procedure in 13 patients; four needed two and two needed three surgical revisions. Most complications were relatively easy to treat, i.e. dilatation in five, endoscopic incision in one, re‐anastomosis in four, Y‐V plasty in seven, a new channel in two, reimplantation in three, a bladder cuff in two for stomal leakage, and abdominoplasty in two. Only one stoma had to be abandoned.

Conclusion The complication rate for continent small‐diameter stoma is high. However, most complications are relatively easy to treat. Despite these complications, patient satisfaction remains high.
The presence or absence of an impalpable testis can be predicted from clinical observations alone
Authors: Mesrobian H.‐G.O. , Chassaignac J.M. , Laud P.W.
Published: March 2003

Objective  To evaluate, in a prospective study, the accuracy of predicting the presence or absence of unilateral or bilateral impalpable testes from a clinical examination, particularly whether the contralateral descended testis (CDT) is hypertrophied.

Patients and methods  Whether the ipsilateral scrotal appendages were palpable, and the size of the CDT, were determined before surgery in a series of patients, and compared with age‐matched controls. Between 1992 and 2000, 100 impalpable testes in 86 consecutive patients (mean age at orchidopexy 45 months, range 6–223; 66% <36 months) were evaluated and treated. In addition to the presence or absence of palpable ipsilateral scrotal appendages, the size of the CDT, when present, and the intraoperative findings were recorded. Logistic regression analysis was used to model the probability of the presence or absence of the testis, as determined by the preoperative clinical findings alone.

Results  Of the 86 testes that were located at surgery, 50 (58%) were intracanalicular, 28 (32%) intra‐abdominal and the remainder (10%) were in the superficial inguinal pouch. Of 13 patients with the ‘vanishing testis syndrome’, the atrophic testicle was intracanalicular in nine, in the upper scrotum in three and intra‐abdominal in only one. All viable testes were successfully relocated in the scrotum, with one atrophic after surgery. The positive predictive value (PPV, with 95% confidence interval) of a testis being present when the ipsilateral appendages were palpable and the CDT was not hypertrophied was 0.93 (0.83–0.97). Conversely, the PPV of the impalpable testis being absent when the appendages were impalpable and the CDT was hypertrophied was 0.95 (0.64–0.99).

Conclusion  When evaluating and surgically treating impalpable testes, the presence of palpable ipsilateral scrotal appendages and a CDT with no hypertrophy is associated with a 93% likelihood of discovering a testis that can be successfully relocated to the scrotum. Conversely, when the ipsilateral scrotal appendages cannot be palpated and the CDT is hypertrophied, there is a 96% probability that the impalpable testis is absent (vanishing testis syndrome). This readily available information may be valuable in preoperative counselling and planning.
Modulation of heat‐induced cell death in PC‐3 prostate cancer cells by the antioxidant inhibitor diethyldithiocarbamate
Authors: Moriyama‐Gonda N. , Igawa M. , Shiina H. , Urakami S. , Shigeno K. , Terashima M.
Published: March 2003

Objective To examine the relationships between the form of cell death (apoptosis or necrosis), reactive oxygen species (ROS) generation, superoxide dismutase (SOD) activity and the level of heat‐shock protein 70 (hsp 70) expression after thermotherapy of PC‐3 prostate cancer cells; also assessed were the tumoricidal effects of combined treatment with both heat and the antioxidant inhibitor diethyldithiocarbamate (DDC).

Materials and methods PC‐3 cells were treated with thermotherapy at 42, 43 or 44°C for 30, 60, 90 or 120 min. Cell proliferation, ROS generation, SOD activity and cellular hsp 70 level were determined using tetrazolium‐based cytotoxicity, fluorescent dichlorofluorescein (DCF) and nitroblue tetrazolium assays, Western blot analysis and flow cytometry, respectively. The apoptotic and necrotic cells were determined by staining with propidium iodide and fluorescein isothiocyanate‐labelled annexin V. These variable were also measured after combined treatment of PC‐3 cells with 1 mmol/L DDC and thermotherapy at 43 or 44°C for 60 min.

Results Cell survival was significantly lower after heating cells at 43°C for 60, 90 and 120 min and at 44°C for all periods tested (P<0.05). At 43°C apoptosis increased with the duration of heating and was similarly enhanced after heating at 44°C for 30 min. Necrosis was not increased by heating at 42 or 43°C, but was markedly enhanced after heating at 44°C with both the duration of heating and with time after heating. Significant increases in DCF production were induced by heating at 43°C for 60, 90 and 120 min (P<0.05) and at 44°C at all times (P<0.010–0.005). There was a significant correlation between the level of ROS generation and necrosis (P<0.001) but no correlation between the ROS level and apoptosis. SOD activity increased in cells after heating at 43°C, with significant differences among cells heated for 60, 90 and 120 min (P<0.05). After heating at 44°C, SOD activity was maximal in cells heated for 30 min (P<0.005), by 30 min and then decreased with time after heating. There were significant increases in hsp 70 level in cells heated at 43°C for 90 and 120 min (P<0.05) and at 44°C for 30 and 60 min (P<0.05 and <0.025, respectively). Hsp 70 levels decreased after heating at 44°C for 90 and 120 min. The combination of DDC and heating significantly increased ROS generation and the percentage of cell death, and decreased SOD activity (P<0.05).

Conclusions These findings show a qualitative change in the form of cell death induced by thermotherapy of PC‐3 cells, which changed from apoptosis to necrosis according to the degree and duration of heating. Mild thermotherapy induced marginally low occurrence of apoptosis of PC‐3 cells and DDC may represent a useful future strategy for the treatment of prostate carcinoma.
Is microscopic haematuria a urological emergency?
Authors: Khan M.A. , Shaw G. , Paris A.M.I.
Published: March 2003

Objective  To determine the prevalence of urological pathology in a retrospective and prospective study of patients with microscopic haematuria attending a haematuria clinic.

Patients and methods  Between January 1998 and May 2001, 781 patients attended the haematuria clinic; of these, 368 (47%; median age 60 years, range 18–90) had a history of microscopic haematuria, as detected by urine dipstick testing. These patients were investigated by urine culture and cytology, renal ultrasonography, intravenous urography (IVU), flexible cystoscopy, urea and electrolyte analysis, and assay of prostate specific antigen (PSA) where appropriate.

Results

 Urine cytology showed no malignant cells in any patient with a history of microscopic haematuria. In 143 patients (39%), urine cytology showed no red blood cells and all other investigations were normal. Of the remaining 225 patients, IVU showed a tumour in one (bladder), renal stones in 15 and an enlarged prostate in two. Renal ultrasonography detected no additional pathology. Urine analysis showed one urinary tract infection. Flexible cystoscopy detected five patients with a bladder tumour (all G1pTa), two urethral strictures, five bladder stones and enlarged prostates, six enlarged prostates only, and nine red patches in the bladder, showing one patient with carcinoma
in situ . No PSA levels were suggestive of prostate cancer.

Conclusion  Patients with dipstick‐positive haematuria should be re‐assessed by urine microscopy before referral. As only 1.4% of patients had a malignant pathology (all noninvasive), microscopic haematuria should be regarded as a separate entity from macroscopic haematuria, and such patients do not need to be referred urgently.
Efficacy and safety of sildenafil for treating erectile dysfunction in patients on dialysis
Authors: YeniçerioGlu Y. , Kefi A. , Aslan G. , Çavdar C. , Esen A.A. , Çamsari T. , Çelebi I.
Published: March 2003

Objective  To assess the efficacy of sildenafil for erectile dysfunction (ED) in patients on haemodialysis (HD) or peritoneal dialysis (PD), as men with end‐stage renal disease (ESRD) often have sexual dysfunction (up to 82% among those on chronic dialysis).

Patients and methods  Forty‐one patients with ED and in ESRD participated in an open‐label prospective study. Thirty patients on HD and 11 on PD were asked to complete the International Index of Erectile Function (IIEF) and Fugl‐Meyer life‐satisfaction scale before and after sildenafil treatment. A total score in the erectile function domain of ≤ 25 was accepted as indicating ED. All patients were started on a 25‐mg dose, which was increased to 50 mg if there was no response after two trials. In addition, the overall efficacy question was used to evaluate satisfaction, and patients reported any side‐effects during treatment.

Results

 The erectile function and intercourse satisfaction domains improved significantly in both groups (
P

 < 0.01). After sildenafil treatment, two‐thirds of those on HD (20/30) and nine of the 11 on PD recovered their erectile function. The pretreatment scores on the IIEF and four domains (except sexual desire) of those responding were significantly higher than in those not responding (
P  < 0.05). The satisfaction rate on the overall efficacy question was 80% and 82% for the HD and PD groups, respectively. At least one side‐effect was seen in 17 patients (43%); one had severe hypotension in the PD group. Overall, mild headache (seven patients, 18%) and flushing (12, 30%) were reported most often.

Conclusions  Sildenafil is a safe and satisfactory drug for improving erectile function in patients with ESRD. Patients were satisfied whether treated by HD or PD. Pretreatment scores on the IIEF may be useful for predicting the success of treatment.
The CAG trinucleotide repeat length in the androgen receptor does not predict the early onset of prostate cancer
Authors: Mir K. , Edwards J. , Paterson P.J. , Hehir M. , Underwood M.A. , Bartlett J.M.S.
Published: March 2003

Objective  To relate the repeat length of the androgen‐receptor CAG trinucleotide to the age of onset of prostate cancer, stage and grade of disease.

Patients and methods  After obtaining ethical approval, 265 patients with locally confined or locally advanced/metastatic prostate cancer were identified and evaluated for age at diagnosis (< 65 years and > 75 years). DNA was extracted from peripheral blood lymphocytes and 1 µg aliquots subjected to polymerase chain reaction using fluorescently labelled primers. Samples were then run on an ABI 377 gene scan analysis gel with an internal molecular weight marker. The length of the CAG repeat was determined by comparing the gene scan product size to samples where the CAG repeat length had been quantified using direct sequencing. The Kruskal–Wallis, Mann–Whitney and Wilcoxon two sample tests were used to analyse the data.

Results
 The mean (range) length of the CAG repeat in the androgen receptor was 22.2 (10–31) in the younger and 22.5 (16–32) in the older group, and was not statistically different. There was no significant association between the CAG repeat length and the age of onset of prostate cancer (
P
 = 0.568) or with stage (
P
 = 0.577) and grade (
P  = 0.891) of prostate cancer.

Conclusion  These results suggest that there is no correlation between the androgen receptor CAG repeat length and the age of onset, stage and grade of prostate cancer, confirming recent doubts from other similar studies of a suggested correlation between shorter androgen receptor CAG repeat and early onset and aggressiveness of prostate cancer.
Levels of urinary inter‐α‐trypsin inhibitor trimer as a function of age and sex‐hormone status in males and females not forming stones
Authors: Ricchiuti V. , Hartke D.M. , Yang L.Z. , Goldman H.B. , Elder J.S. , Resnick M.I. , Marengo S.R.
Published: March 2003

Objectives  To determine if levels of inter‐α‐trypsin inhibitor (IαTI)‐trimer differ in normal individuals based on age, gender or hormonal status, as the regulation of calcium oxalate (CaOx) crystallization inhibitors, e.g. by sex steroids, could be a mechanism contributing to the differences in CaOx urolithiasis between the sexes.

Subjects and methods
 Voided urine samples were collected from normal males and females. In Experiment 1 samples were grouped by gender and age, i.e. paediatric (PED) ≤ 10 years, male (M) 21, female (F) 14; young adult (YGAD) 20–30 years, M 23, F 18; adults (AD), 35–50 year, M 25, F 13; adults aged ≥ 60 years (> 60), M 24, F 16 (totals, M 93, F 61). In Experiment 2 samples were grouped by gender, age and hormonal status, i.e. PED, M 24, F 17;
AD , M 24, F 22; > 60 and not on hormonal therapy, M 23, F 30; M > 60 and on androgen deprivation therapy (ANDEP) 18; and F > 60 on oestrogen supplementation, F+EST, 18 (total M 89, F 85). Levels of urinary IαTI‐trimer were determined by immunoblotting and enhanced chemiluminescence, and relative densities of the bands determined.

Results
 In both experiments the relative levels of IαTI‐trimer were 2–7 times higher in M‐PED than in all other groups of males (
P
 ≤ 0.007). Among adult males, IαTI‐trimer levels were similar in all groups, including ANDEP (
P
 ≥ 0.9). There were no differences in the relative levels of IαTI‐trimer among any of the groups of females, regardless of age or hormonal status (
P  ≥ 0.7).

Conclusions  In males a decrease in IαTI‐trimer was associated with the onset of adulthood and entry into the ‘stone‐forming years’. Females did not show this decrease, and neither sex showed an increase in IαTI‐trimer in the > 60 group, when the incidence of CaOx urolithiasis is supposedly declining. While changes in urinary IαTI‐trimer levels in males may reflect maturational changes in the kidney, overall these data do not support the hypothesis that the age‐related changes in the incidence of urolithiasis are paralleled by changes in the expression IαTI‐trimer. Additionally, the sex steroids do not appear to acutely regulate the expression of IαTI‐trimer in adults, making differences in IαTI‐trimer levels unlikely to be the reason for the disparity in the incidence of CaOx urolithiasis between the sexes.
Survival prospects after screen‐detection of prostate cancer
Authors: Nicholson P.W. , Harland S.J.
Published: March 2003

Objective  To ascertain more realistic survival values for screen‐detected prostate cancer than those in current use which are derived from conventionally presenting, usually symptomatic, populations.

Materials and methods  Survival data for conventionally detected cases were derived from the Surveillance, Epidemiology and End Results database for men diagnosed in the years 1983–1988. The incidence of screen‐detected prostate cancer by age and grade was taken from published data.

Results  For a cohort of men, initially 55 years old, screen‐detected cases were estimated to outnumber by 2–3‐fold, depending on age, those detected by conventional means. By assuming various survival characteristics for the screen‐detected cases the mean lead time was estimated to be 9 years. Because screen‐detected cases usually have clinically localized disease they are commonly advised on survival times derived from conventionally detected cases. Applying these survival times over‐predicts the number of deaths by factors of at least 3.4, 1.9 and 1.5 at 65, 75 and 85 years old, respectively.

Conclusions  Screening detects prostate cancer a mean of 9 years before clinical presentation. The prognosis of screen‐detected prostate cancer is considerably better than that of conventionally presenting localized disease. The advice given to patients with early prostate cancer should take account of this.
Priapism in sickle‐cell disease; incidence, risk factors and complications – an international multicentre study
Authors: Adeyoju A.B. , Olujohungbe A.B.K. , Morris J. , Yardumian A. , Bareford D. , Akenova A. , Akinyanju O. , Cinkotai K. , O'Reilly P.H.
Published: March 2003

Objective  To define the incidence, risk factors and complications of priapism in a large population of patients with sickle‐cell anaemia in five centres in the UK and Nigeria, as priapism is common among these patients, but the precise characteristics of the condition in this population are poorly documented.

Patients and methods  A questionnaire was developed and administered to patients with sickle‐cell disease. Questions were designed to define the incidence, nature, precipitants, duration, treatment and complications of priapism. A distinction was made between acute (severe) priapism and the recurrent, ‘stuttering’ type.

Results  The questionnaire was completed by 130 patients (mean age 25 years, sd 11, range 4–66) from the five centres; 102 (78%) were homozygous Hb SS genotype, 19 (15%) were Hb SC genotype and two (1.5%) were Hb Sα−thalassaemia. Of the patients, 46 (35%) reported a history of priapism, and of these, 33 (72%) had a history of stuttering priapism, while 24 (52%) had had an acute episode of priapism. The mean age of onset of priapism was 15 years, with 75% of patients having the first episode before their 20th birthday. Sexual activity was the most frequent precipitating factor, with fever and/or dehydration being the next most common. Of the 46 patients, 10 (21%) with a history of priapism reported having erectile dysfunction. A similar proportion reported dissatisfaction with sexual intercourse, including a fear of engaging in sexual activity.

Conclusion  The incidence of priapism among patients with sickle‐cell anaemia is high (35%). The implications of priapism for erectile and sexual function are significant and documented in this large series. The treatment of this condition in these patients remains unstandardised. This study highlights the need for an increased awareness of the problems associated with priapism among patients, families and medical professionals.
Histopathological evaluation of the urethra after the Snodgrass operation: an experimental study in rabbits
Authors: Genç A. , TanelI. C. , Günşar C. , Türkdoğan P. , Yilmaz Ö. , Arslan O.A. , Mir E.
Published: March 2003

Objective  To investigate the histopathological outcome of the incised urethral plate after tubularized incised‐plate urethroplasty (the Snodgrass procedure to repair hypospadias) in a hypospadiac rabbit model, as it can produce meatal and neourethral strictures, and healing with scarring.

Materials and methods  The study comprised 10 male New Zealand White rabbits (2.2–2.4 kg); under general anaesthesia the ventral urethra was completely excised 1 cm from the meatus proximally and a model of hypospadias formed. A full‐thickness incision was then made in the distal dorsal urethra and the two sides of the incision marked by Indian ink tattooing. After placing a feeding tube (5 F) as a urethral catheter, both urethral wings were sutured ventrally by a 7/0 polydioxanone running suture, and the penile skin approximated by 5/0 chromic catgut. At 21 days and 3 months after surgery the penises were harvested, assessed histopathologically, and compared with those from control untreated rabbits of the same age and weight.

Results  In the study group the incised area of the dorsal urethra was re‐epithelialized; the regional tissue and vascularity were normal.

Conclusion  In this rabbit model the dorsal urethral incisions healed with no scar tissue; only the ventral suture lines had minimal fibrosis and inflammatory reaction.
Sildenafil influences lower urinary tract symptoms
Authors: Sairam K. , Kulinskaya E. , McNicholas T.A. , Boustead G.B. , Hanbury D.C.
Published: March 2003

Objective  To assess the possible relationship between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) in men, and whether treatment of their ED with sildenafil influences their LUTS.

Patients and methods  In all, 112 men with ED attending the andrology outpatient clinic were offered oral sildenafil and reviewed 1 and 3 months after treatment. They completed the International Index of Erectile Function and the International Prostate Symptom Score (IPSS) questionnaires at baseline and each review. Scores were designated to indicate the visit number and differences between the visits calculated.

Results  A third of the men had an initial IPSS of > 7; there was no relationship between baseline urinary and sexual function scores. After treatment with sildenafil, the urinary scores at 3 months correlated strongly with the sexual function scores. There was a significant inverse relationship between the baseline IPSS and sexual function scores after treatment. The overall trend in the IPSS was towards improvement after treatment with sildenafil.

Conclusions  In men with ED there is no relationship between sexual function scores and urinary symptom scores before treating ED. Treatment with sildenafil appears to improve urinary symptom scores. A lower IPSS at baseline appears to predict a better response to ED therapy with sildenafil.
A radiation perspective for treating loin pain in pregnancy by double‐pigtail stents
Authors: Hellawell G.O. , Cowan N.C. , Holt S.J. , Mutch S.J.
Published: March 2003

Objective:  To review the risks of placing double‐pigtail stents during pregnancy in women presenting with loin pain associated with hydronephrosis.

Patients and methods  A consecutive series of women presenting with loin pain and hydronephrosis in pregnancy were treated with double‐pigtail ureteric stents. A flexible cystoscope was used to identify the ureteric orifice and to pass a guidewire into the renal pelvis under fluoroscopic guidance. Stents were placed using the exchange technique over a stiff guidewire. Procedures were carried out under none or limited sedoanalgesia. Screening times and radiation dose were recorded. Data were collected for the average uterine radiation dose from a variety of radiological procedures. Previous publications were reviewed to determine the lethal, teratogenic and carcinogenic risk to the developing fetus from radiation exposure.

Results  Seven patients referred with symptomatic hydronephrosis during pregnancy were treated. The screening time during placement was minimized. The mean (range) uterus (i.e. fetal) dose was 0.40 (0.03–0.79) mGy. Most radiological procedures involve uterine doses of < 20 mGy, far below the 100 mGy that may result in fetal damage during periods of maximum radiosensitivity.

Conclusion  Minimized radiation exposure from a range of uroradiological procedures in pregnant women has limited fetal risk. The use of fluoroscopy for symptomatic hydronephrosis during pregnancy allows ureteric stents to be placed safely and reliably. The average excess risk to the fetus from this procedure is 1 in 43 000 of cancer induction and 1 in 100 000 of heritable disease, i.e. very small when compared with the natural incidence. Pregnancy should not exclude the use of appropriate diagnostic radiation exposure and urologists may conduct appropriate diagnostic and therapeutic procedures, taking care to limit X‐ray exposure without fear of risk to the developing fetus.
Knowledge of female bladder care among medical staff, nurses and midwives: results of a questionnaire survey
Authors: Williams A. , Taylor K. , Bates C. , Tincello D.G. , Richmond D.H.
Published: March 2003

OBJECTIVE

To determine knowledge about bladder care among junior medical staff and allied health professionals, and to examine any difference in knowledge among the subgroups.

SUBJECTS AND METHODS

Using a single‐questionnaire survey in a large obstetrics and gynaecology Hospital Trust in an inner city setting, midwives, nurses and medical staff (not consultants) were asked eight questions about different aspects of female bladder physiology and care. The differences in responses among the professional groups were assessed.

RESULTS

In all, 120 completed questionnaires were returned (32 doctors, 40 nurses, and 48 midwives). Knowledge was similar on urethral length, bladder capacity, daily fluid intake, ideal size of catheter, catheter balloon size, and the maximum time of use of a short‐term catheter. Correct responses for normal daily fluid intake, duration of both short and long‐term catheterization were given by fewer than half the respondents. There were significant differences among the professional groups in the correct response rate for long‐term catheter duration (P = 0.031) and the normal time interval between voids (P = 0.038).

CONCLUSION

There were significant differences in the knowledge of all subgroups about bladder care, and poor levels of knowledge in several areas. This is a potentially serious problem for women at risk of bladder complications after gynaecological surgery and childbirth. All staff involved in managing women after childbirth and gynaecological surgery should have formal training in bladder care, to optimize patient care.
A prospective evaluation of detrusor ultrastructural changes in bladder outlet obstruction
Authors: Brierly R.D. , Hindley R.G. , McLarty E. , Harding D.M. , Thomas P.J.
Published: March 2003

OBJECTIVES

To characterize the ultrastructure of detrusor smooth muscle from the bladders of symptomatic men with bladder outlet obstruction (BOO) caused by benign prostatic enlargement (BPE) and compare this with a matched control group; to determine how detrusor morphology relates to urodynamic findings and to develop a better understanding of the natural development of bladder dysfunction related to BOO.

PATIENTS AND METHODS

Twelve men (mean age 66 years, range 52–77) with urodynamically confirmed BOO caused by BPE and 12 age‐matched asymptomatic normally voiding controls (mean age 67.8 years, undergoing cystoscopy for other conditions) had detrusor biopsies taken endoscopically. The biopsies were processed for electron microscopy using standard methods. The specimens were randomized and examined at medium power (× 4000) by an examiner unaware of the urodynamic findings. Any ultrastructural patterns identified subjectively were noted.

RESULTS

In the BOO group eight of the 12 men had a myohypertrophic pattern, half of which were associated with a degenerative pattern of hypocontractility. Of the remaining four patients, two had the degenerative pattern alone and two were normal. The six men whose biopsies had a degenerative pattern had consistent postvoid residual volumes of> 150 mL; the remainder all had volumes of < 150 mL. There were no ultrastructural abnormalities in the control patients.

CONCLUSIONS

There are interesting qualitative ultrastructural changes in the obstructed detrusor, but they are not consistent enough to provide a reliable diagnostic tool. However, there may be an important relationship between the degenerative pattern and postvoid residual volume in BOO.
Improvements in the provision of hospital diabetes services in an English region 1988–98
Authors: Parr J. H. , Kelly W. F. , Large D. M. , Roberts S. H.
Published: March 2003

Aims To investigate the changes in provision of hospital‐based services for patients with diabetes in an English region over a 10‐year period.

Methods Questionnaires were completed by lead clinicians in hospitals in the Northern region of England in 1988 and repeated in 1998. Information was sought on diabetes service provision including the staff and their working practices. Data are presented to demonstrate changes during the 10 years.

Results During a 10‐year period the number of consultants providing specialized diabetes services increased from 16 to 25 (to become one per 126 240 population). Their outpatient sessions changed from 34 to 55.5 per week, with a decrease in nonspecialists providing diabetes services. Reductions occurred in registrar numbers providing sessions from 23 to 15 and senior house officers from 16 to 14. Increases occurred in other health care professionals: diabetes specialist nurses from 19 to 30.3 whole time equivalents (WTEs); dieticians from 16 to 32.3 WTEs and chiropodists from 8 to 23 WTEs. The numbers of specialized clinics and units providing services from diabetes care centres increased. Improved facilities in clinics and access to laboratory tests were available to all units. Diabetes registers came into use in 12 of 16 units, but there have been difficulties in providing funding. ‘Out‐of‐hours’ advice has moved towards advising their patients to see their general practitioners or the accident and emergency department of the hospitals.

Conclusions The number of diabetes professional staff and the provision of specialized diabetes services have increased during a 10‐year period in the Northern region of England. However, they still fall far short of recommended staffing levels and services are far from comprehensive in most districts.
Comparison of effects of captopril used either alone or in combination with a thiazide diuretic on insulin action in hypertensive Type 2 diabetic patients: a double‐blind crossover study
Authors: Hunter S. J. , Wiggam M. I. , Ennis C. N. , Whitehead H. M. , Sheridan B. , Atkinson A. B. , Bell P. M.
Published: March 2003

Aims It has been suggested that the adverse metabolic effects of antihypertensive therapy offset some of the benefits of blood pressure reduction. It has also been suggested that angiotensin converting enzyme (ACE) inhibitors reduce insulin resistance and that, if used together with thiazide diuretics, the adverse effects of thiazides on insulin sensitivity may be eliminated. We examined the effects on insulin sensitivity of captopril either alone or in combination with bendrofluazide in 11 hypertensive Type 2 diabetic patients.

Methods Insulin action was assessed using an isoglycaemic hyperinsulinaemic clamp in a double‐blind, randomized, crossover study after a 6‐week placebo run‐in and following two 12‐week treatment periods with captopril (C) (100 mg) alone or in combination with bendrofluazide (CB) (2.5 mg).

Results Blood pressure was lower following CB compared to C (128/82 vs. 144/88 mmHg; P < 0.005) and both were lower than baseline (162/101 mmHg; P < 0.001). CB resulted in a significant increase in fasting plasma glucose compared to C (9.7 ± 0.8 vs. 8.5 ± 0.6 mmol/l; P < 0.05). Exogenous glucose infusion rates required to maintain isoglycaemia during hyperinsulinaemia were lower after CB compared to C (22.3 ± 2.4 vs. 27.4 ± 4.2 mol.kg‐1.min‐1; P < 0.05). Suppression of endogenous glucose production was reduced after CB compared to baseline (4.0 ± 0.6 vs. 2.4 ± 0.5 mol.kg‐1.min‐1; P < 0.05).

Conclusions Combination of bendrofluazide with captopril lowered blood pressure but resulted in deleterious effects on insulin action compared to captopril alone.
Effect of oral vitamin E (α‐tocopherol) supplementation on vascular endothelial function in Type 2 diabetes mellitus
Authors: Gazis A. , White D. J. , Page S. R. , Cockcroft J. R.
Published: March 2003

Aims Vascular endothelial dysfunction, an early marker of atherosclerosis, has been demonstrated in Type 2 diabetes mellitus (DM). Vitamin E preserves endothelial function in animal models of diabetes and reduces cardiovascular risk. We examined endothelial function and the effect of vitamin E supplements in uncomplicated Type 2 DM.

Methods Forty‐eight subjects with Type 2 DM and 21 controls had endothelial function assessed using forearm venous occlusion plethysmography with endothelium‐independent (sodium nitroprusside) and dependent (acetylcholine, bradykinin) vasodilators. Those with diabetes received 1600 iu daily oral α‐tocopherol or placebo, double‐blind for 8 weeks, and had endothelial function reassessed.

Results The diabetic group had higher HbA1c (6.9 ± 1.4 vs 4.8 ± 0.6%; P < 0.01) and systolic (145 ± 15 vs 130 ± 16 mmHg; P < 0.01) but not diastolic blood pressure (79 ± 8 vs 76 ± 9 mmHg; P = 0.15). There was blunted vasodilation to acetylcholine (15 μg/min; P < 0.01) in subjects with diabetes. Vasodilation to sodium nitroprusside and bradykinin was similar (all P > 0.1). α‐tocopherol did not affect vasodilation to nitroprusside (P > 0.1), acetylcholine (P > 0.1) or bradykinin (P > 0.1).

Conclusions There may be receptor‐specific endothelial dysfunction in subjects with uncomplicated Type 2 DM. This is not improved by treatment with α‐tocopherol.

Diabet. Med. 16, 304–311 (1999)
Glycaemic control and familial factors determine hyperlipidaemia in early childhood diabetes
Authors: Abraha A. , Schultz C. , Konopelska‐Bahu T. , James T. , Watts A. , Stratton I. M. , Matthews D. R. , Dunger D. B.
Published: March 2003

Aims To determine whether abnormal lipid levels in children with Type 1 diabetes mellitus are the result of poor metabolic control or may in part be determined by genetic factors.

Methods Non‐fasting lipid levels were measured in 141 children with Type 1 diabetes (age range 7.7–19 years) 3 years after diagnosis, and in 192 of their parents. Glycosylated haemoglobin and the urinary albumin–creatinine ratio (three urine samples) were estimated in each child annually.

Results The children had a mean total cholesterol of 4.46 ± 1.25 mmol/l (± SD) and a median triacylglycerol of 1.18 mmol/l (range 0.32–4.7). A total of 15.3% of the population had a total cholesterol > 5.2 mmol/l and 17.9% had a triacylglycerol > 1.7 mmol/l; in 5.6% both total cholesterol and triacylglycerol were greater than these cut‐off points. Total cholesterol, triacylglycerol and very low density lipoprotein‐cholesterol were significantly correlated to glycaemic control. However, total cholesterol was also significantly related to parental total cholesterol either as analysed separately or as mean parental total cholesterol (r = 0.37, P = 0.0001). In stepwise multiple regression analysis both mean parental total cholesterol (P = 0.001) and HbA1c (P = 0.015) were significant determinants of the child’s total cholesterol. The children studied were being followed prospectively for the development of microalbuminuria and there was a weak association across tertiles of total cholesterol, linking higher levels to the development of microalbuminuria (P < 0.05).

Conclusions We conclude that both glycaemic control and familial factors may be important determinants of lipid levels in young people with diabetes. Both may contribute to the subsequent risk of cardiovascular disease and possibly the development of incipient diabetic nephropathy.
Vascularized pancreas allotransplantation – clinical indications and outcome
Authors: White S. A. , Nicholson M. L. , London N. J. M.
Published: March 2003

AimsThis review examines the status of vascularized pancreas transplantation as a treatment for Type 1 diabetes mellitus (DM).

MethodsThe world literature, with a particular emphasis on data from the International Pancreas Transplant Registry (IPTR), is reviewed and interpreted particularly for clinical indications and outcome.

ResultsOver 9000 cases of vascularized pancreas transplant (VPT) have been registered, with insulin dependence approaching 82% at 1 year with 94% patient survival. The majority of transplants are simultaneous pancreas and kidney (SPK) transplants, with far fewer pancreas after kidney (PAK) or pancreas transplants alone (PTA). The success rates differ between the procedures but are generally improving as technical advances, improvements in immunosupression and greater experience are gained. The most obvious advantage is an improved quality of life (QoL) but there are risks associated with the procedure and with the immunosuppression. There is some evidence coming to light of a very slow beneficial effect on microvascular complications.

ConclusionsVPT is an attractive option to offer Type 1 DM patients who need or already have a renal allograft. Patients have to decide between the increased surgical risk and the risks of long‐term immunosuppression and the benefits of improved QoL. In the absense of end‐stage renal failure (ESRF) there is no justification for PTA, except where the diabetes itself poses a greater risk to life than the transplantation procedure.
Cross‐sectional but not longitudinal associations between non‐esterified fatty acid levels and glucose intolerance and other features of the metabolic syndrome
Authors: Byrne C. D. , Maison P. , Halsall D. , Martensz N. , Hales C. N. , Wareham N. J.
Published: March 2003

Aims Cross‐sectional studies have demonstrated an association between high non‐esterified fatty acid (NEFA) concentrations and glucose intolerance. However, the direction of causality in these studies is uncertain. The aim of this study was to examine whether NEFA levels predicted the development of glucose intolerance in a prospective population‐based cohort study.

Methods Four hundred and eighty‐one women and 345 men participated in a prospective cohort study in which NEFA concentrations and glucose tolerance were measured at baseline and then repeated at follow‐up 4.5 years later.

Results The data do not show longitudinal relationships between baseline NEFA levels and either glucose intolerance or other features of the metabolic syndrome at follow‐up. In contrast, strong cross‐sectional associations were observed between NEFA measures and glucose intolerance (and other features of the metabolic syndrome) in both baseline and follow‐up studies. At follow‐up, fasting NEFA levels and two measures of NEFA suppression were markedly different in subjects with features of the metabolic syndrome, compared to subjects with normal glucose tolerance (NGT) (NGT vs. metabolic syndrome for each NEFA value, P <  0.001).

Conclusions These results support the hypothesis that plasma NEFA levels change as a consequence of the metabolic syndrome and do not support the notion that increased NEFA levels cause either the metabolic syndrome or diabetes.
Population‐based genetic screening for the estimation of Type 1 diabetes mellitus risk in Finland: selective genotyping of markers in the HLA‐DQB1, HLA‐DQA1 and HLA‐DRB1 loci
Authors: Nejentsev S. , Sjöroos M. , Soukka T. , Knip M. , Simell O. , Lövgren T. , Ilonen J.
Published: March 2003

Aims To improve sensitivity and specificity of the diabetes risk assessment of the population‐based genetic screening used in the Finnish Diabetes Prediction and Prevention (DIPP) trial.

Methods One thousand consecutive newborns enrolled in the DIPP were compared with 316 samples from children with Type 1 diabetes mellitus. A modification of the previously described technique based on hybridization of relevant PCR products with five lanthanide‐labelled probes detected by time‐resolved fluorometry (TRF) was used. A new probe was designed and allowed discrimination between DQB1*0602 and *0603 alleles, in addition to DQB1*02, *0301 or *0302, each of which required specific probes. A new, added screening strategy was developed for individuals carrying low‐risk genotypes through specific typing of DQA1*05 and *0201 alleles in DQB1*02 positive, and DRB1 typing for DR4 subtypes in DQB1*0302 positive subjects, with a new specifically designed high‐resolution TRF‐based DR4 subtyping technique.

Results This two‐step screening approach enhanced the sensitivity of the detection of genetic risk for Type 1 diabetes mellitus in this cohort up to 85.4%. In the general population cohort, 24.4% were identified for prospective follow‐up, 2.6% of these are expected to develop Type 1 diabetes mellitus before the age of 15 years. Exclusive typing for HLA‐DQB1 locus as an alternative screening strategy had sensitivities of 26.3–77.2% with general population cohorts of 2.3–23.1% identified for follow‐up.

Conclusions The described strategy for genetic prediction of Type 1 diabetes mellitus relies on the convenient genotyping procedure and could be applied in large scale screening projects such as DIPP.
Length rather than a specific allele of dinucleotide repeat in the 5′ upstream region of the aldose reductase gene is associated with diabetic retinopathy
Authors: Fujisawa T. , Ikegami H. , Kawaguchi Y. , Yamato E. , Nakagawa Y. , Shen G. ‐Q. , Fukuda M. , Ogihara T.
Published: March 2003

Aims To assess the possible contribution of a genetic factor to diabetic retinopathy.

Methods (CA)n repeat length was investigated in the 5′ upstream region of the gene coding for aldose reductase (AR), which is a key enzyme of the polyol pathway and plays a role in hyperglycaemia‐induced tissue damage, in Japanese patients with Type 2 DM.

Results The dinucleotide repeat length was significantly associated with proliferative diabetic retinopathy (PDR) (P=  0.029, Mann–Whitney U‐test); i.e. shorter alleles were more prevalent in the PDR group than in the control group.

Conclusions (CA)n repeat length, rather than a specific allele, in the 5′ upstream region of the AR gene is associated with diabetic retinopathy. These data suggest that the AR locus plays a role in genetic susceptibility to diabetic retinopathy and that dinucleotide repeats in genomic DNA may be related to disease predisposition.
Comparison of questionnaire, breath carbon monoxide and urine cotinine in assessing the smoking habits of Type 2 diabetic patients
Authors: Ismail A. A. , Gill G. V. , Lawton K. , Houghton G. M. , MacFarlane I. A.
Published: March 2003

Aims Previous studies have suggested that the self‐reporting of smoking amongst diabetic patients is unreliable, and that objective markers such as breath carbon monoxide (CO) or urinary cotinine are needed. As these studies have been mostly in young Type 1 diabetic patients, the reliability of smoking history has been assessed in a large group of older Type 2 diabetic patients.

Methods Two hundred and ninety‐nine Type 2 diabetic patients were investigated for smoking habits by unstructured questionnaire, breath CO, and urinary ratio.

Results Mean age of the group was 63 (range 30–80) years and 41% were female. Direct questioning suggested 77 (26%) to be smokers, and of these 852 had raised (> 1 μg/mg) urinary cotinine–creatinine , and 71% raised (> 8 p.p.m.) breath CO. Assuming urinary cotinine–creatinine as the ‘gold standard’, the sensitivity, specificity and positive predictive values for questionnaire were 97%, 95% and 85%, respectively; and for breath CO they were 74%, 98%, and 93%.

Conclusion It is concluded that at least in this population of Type 2 diabetic patients, a structured smoking history appeared to identify current smokers with good accuracy.