bluuebunny/crossref_metadata_2025 huggingface dataset:
Urinary tract candidiasis in neonates and infants
Authors: HITCHCOCK R.J.I. , PALLETT A. , HALL M.A. , MALONE P.S.J.
Published: November 2008

Objective To examine the range of disease caused by invasive Candida infection in neonates and infants and to discuss the available treatment options, particularly surgery and drug therapy.

Patients and methods Five consecutive infants with invasive urinary tract Candida infection presenting over an 18‐month period were reviewed. Treatment protocols included a combination of surgery and treatment with amphotericin, flucytosine and fluconazole.

Results The range of disease severity from simple Candida urinary tract infection to overwhelming multi‐organ sepsis was demonstrated. Urinary tract obstruction was identified as a predisposing factor in three of the five cases. In all cases, infection was cleared by the treatment protocol. Two cases with bilateral renal pelvic fungal balls showed resolution with no surgery in three kidneys and showed no advantage of pyelotomy and perfusion.

Conclusion The results question the role of surgery, which may be limited to the relief of primary urological obstruction. We advocate the use of oral fluconazole to prevent or treat early systemic infection and, for severe systemic infections, a prolonged course of fluconazole in combination with flucytosine should be considered as an alternative to amphotericin, which is toxic and can only be given intravenously.
Effects of denervation on muscarinic receptors in the at bladder
Authors: GUNASENA K.T. , NIMMO A.J. , MORRISON J.F.B. , WHITAKER E.M.
Published: November 2008

Objective To demonstrate the specific distribution of muscarinic receptors in the rat urinary bladder and to investigate the effects of afferent and efferent denervation on the density and distribution of muscarinic receptors.

Materials and methods Urinary bladders were obtained from female rats which had been injected with vehicle (control), or neonatally with capsaicin (NC, afferent denervation) or which had their pelvic plexus removed (post‐ganglionic denervation, PGD, efferent denervation). Tissue sections were used in radioligand‐binding studies and for autoradiography with the muscarinic receptor ligand l‐quinuclidinyl[phenyl‐4–3H]benzilate (QNB).

Results Binding of QNB was saturable and specific to a single population of binding sites, with a mean dissociation constant (Kd) of 1.05 ± 0.14 nmin controls and 0.90 ± 0.13 nmin rats with PGD. Post‐ganglionic denervation caused a 37% increase in maximal binding (Bmax) of QNB from 437.1 ± 39.1 fmol/mg protein (control group) to 599.1 ± 4.5 fmol/mg protein (P< 0.02). Autoradiograms revealed muscarinic binding sites over the smooth muscle, but none over the epithelium. Smooth muscle binding sites were doubled after PGD but were unchanged after NC treatment.

Conclusion Muscarinic receptors were localized over the smooth muscle of the rat bladder and were increased after post‐ganglionic denervation. This increase may be responsible for the increased sensitivity to muscarinic agonists reported to occur after bladder denervation.
Characterization and autoradiographic localization of [3H]α,β‐methylene adenosine 5‘‐triphosphate binding sites in human urinary bladder
Authors: BO X. , BURNSTOCK G.
Published: November 2008

Objectives To characterize [3H]α,β‐methylene adenosine 5′‐triphosphate ([3H]α,β‐MeATP, a radioligand for P2X‐purinoceptors) binding sites in the washed homogenates and membrane preparations of human urinary bladder and, using autoradiography, to localize [3H]α,β‐MeATP binding sites in human bladder.

Materials and methods Specimens were obtained from the fundus of the urinary bladder of male patients aged 56–79 years. The washed homogenates or membrane preparations of the bladder specimens were incubated with [3H]α,β‐MeATP and the bound and free radioligand separated by filtration. For autoradiography, cryostat sections were incubated with 10 nM [3H]α,β‐MeATP, washed, dried and exposed for 2 weeks to emulsion‐coated coverslips. In both experiments, 100 μmβ,γ‐methylene ATP was used to determine non‐specific binding.

Results Six of 16 specimens in the binding assay and three of seven specimens in the localization study showed specific [3H]α,β‐MeATP binding. The binding process was saturable and the specific binding sites were composed of a high‐and low‐affinity component. The specific binding to membrane preparations was reduced in the presence of Mg2+in the incubation medium. Competitive displacement experiments showed that the order of potency of the unlabelled ligands to displace the [3H]α,β‐MeATP binding was α,β‐methylene ATP < β,γ‐methylene ATP < suramin < 2‐methylthio ATP < ATP > ADP ≫ adenosine, which indicates that the binding sites are, or are linked to, P2X‐purinoceptors. Autoradiography showed that the specific [3H]α,β‐MeATP binding sites were located only over the smooth muscle of the bladder.

Conclusions The results suggest that P2X‐purinoceptors exist in human urinary bladder, although at a lower density than reported for rodent urinary bladder.
Urinary basic fibroblast growth factor in patients with bladder cancer and benign prostatic hypertrophy
Authors: O'BRIEN T.S. , SMITH K. , CRANSTON D. , FUGGLE S. , BICKNELL R. , HARRIS A.L.
Published: November 2008

Objective To investigate the role of urinary measurements of an angiogenic factor, basic fibroblast growth factor (bFGF), in the assessment of patients with bladder cancer.

Patients and methods Urine from 83 patients was assayed using a commercially available ELISA for bFGF. Thirty‐eight patients had a bladder tumour and 21 had a history of bladder cancer but no disease at the time of testing. Twenty‐four patients acted as controls, 16 of whom were about to undergo transurethral resection of the prostate (TURP) for benign prostatic hypertrophy (BPH) and eight who had no urological disease.

Results Median urinary bFGF was higher in patients with active bladder cancer than in those with a clear cystoscopy (5.20 and 2.13 ng/g creatinine, respectively; P < 0.005). Median urinary bFGF was also elevated in patients about to undergo TURP (4.52 ng/g creatinine). Using a threshold value of 6.0 ng/g creatinine, the sensitivity of the test for detecting cancer was 42% and specificity was 88%. At a threshold value of 4.0 ng/g the sensitivity was 62% and the specificity 70%.

Conclusion The relationship between urinary basic FGF and the presence of bladder cancer was significant. The test is not sufficiently sensitive or specific to use as a screening test for bladder cancer but may be very useful in monitoring the effectiveness of systemic therapies in bladder cancer. Elevated levels of bFGF in the urine of patients about to undergo TURP suggests a role for bFGF in the pathogenesis of BPH.
Exenteration as palliation for patients with advanced pelvic malignancy
Authors: WOODHOUSE C.R.J. , PLAIL R.O. , SCHLESINGER P.E. , SHEPHERD J.E. , HENDRY W.F. , BREACH N.M.
Published: November 2008

Objective To examine the place of pelvic exenteration in the palliation of advanced and recurrent pelvic tumours.

Patients and methods The notes of patients referred for palliative exenteration were reviewed retrospectively. Fourteen patients (three men, mean age 52 years, and 11 women, mean age 61 years) with a variety of pelvic tumours associated with severe symptoms, had a laparotomy with a view to pelvic exenteration and 10 underwent total or anterior exenteration.

Results Eight patients achieved excellent or good palliation based on survival and quality of life assessment, and two received no benefit. Four of eight patients were alive and apparently free of tumour at a mean of 17 months after surgery. Four were alive, symptom‐free but with evidence of malignancy at a mean of 19 months. Two patients who received no benefit died at 2 and 7 months after surgery. The planned exenteration was abandoned in four patients; three of these four patients were dead at a mean of 13 months and one was alive at 12 months.

Conclusion Our results confirm that with careful selection and appropriate multi‐speciality care, aggressive pelvic surgery is of value in the palliation of some tumours.
Tamsulosin, a selective α1c‐adrenoceptor* antagonist: a randomized, controlled trial in patients with benign prostatic ‘obstruction’ (symptomatic BPH)
Authors: ABRAMS P. , SCHULMAN C.C. , VAAGE S.
Published: November 2008

Objective To evaluate the efficacy and safety of tamsulosin 0.4 mg once daily (as a modified‐release formulation) compared with placebo in patients with benign prostatic enlargement, lower urinary tract symptoms and prostatic ‘obstruction’ (symptomatic benign prostatic hyperplasia [BPH]).

Patients and methods Of 313 patients with symptomatic BPH enrolled in a 2‐week placebo run‐in period, 296 were subsequently randomized to receive either placebo (98 patients) or tamsulosin 0.4 mg once daily (198 patients) for 12 weeks. The primary variables assessed to determine efficacy were maximum urinary flow rate (Qmax) from free‐flow measurements and the total Boyarsky symptom score.

Results Tamsulosin produced greater improvements in Qmax(1.4 mL/s, 13.1%) than did placebo (0.4 mL/s, 3.8%) (P= 0.028) and a greater decrease in total symptom score (3.4 points, 35.8% reduction) than did placebo (2.2 points, 23.7% reduction) (P= 0.002). Significantly more tamsulosin‐treated patients (67%) than placebo‐treated patients (44%) had a ≥ 25% decrease in total symptom score after 12 weeks (P< 0.001). Treatment with tamsulosin for 12 weeks also produced significant improvements in average urinary flow rate (P= 0.040), irritative (P= 0.013) and obstructive (P= 0.014) symptom scores and symptoms of nocturia (P= 0.022) and hesitancy (P= 0.004). Tamsulosin was tolerated well by the patients. The incidence of adverse events emerging during treatment was comparable in the tamsulosin‐and placebo‐treated groups (34% and 24% respectively,P= 0.109), as was the incidence of cardiovascular‐related adverse events (5% and 7% respectively;P= 0.596). There were no significant differences in changes in blood pressure or pulse rates between the tamsulosin‐and placebo‐treated groups.

Conclusion Tamsulosin 0.4 mg once daily is safe, well tolerated and clinically effective in improving symptoms and urinary flow rate in patients with symptomatic BPH.
The significance of prostatic intra‐epithelial neoplasia
Authors: ABOSEIF S. , SHINOHARA K. , WEIDNER N. , NARAYAN P. , CARROLL P.R.
Published: November 2008

Objective To investigate the relationship between the detection of prostatic intra‐epithelial neoplasia (PIN) on initial prostate biopsy and subsequent invasive prostatic adenocarcinoma.

Patients and methods Thirty‐six men (mean age 67 years, range 52–82) with PIN underwent digital rectal examination (DRE), serum prostate‐specific antigen (PSA) measurement and transrectal ultrasonography (TRUS) before the initial biopsy and documentation of PIN. They were followed up with serial PSA, TRUS and a repeat biopsy every 6 months until either invasive carcinoma was identified or 2 years had elapsed.

Results The initial biopsy revealed Grade I PIN in 33%, Grade II in 22%, and Grade III in 45% of the men. The repeat biopsy showed evidence of invasive carcinoma in 21 patients (58%; Group I), while 15 (42%) showed persistence of PIN (Group II). In Group I, 19 had had high‐grade PIN (Grade II/III) on initial biopsy compared with one in Group II. The findings on DRE, and age, were not significantly different between groups. TRUS revealed a hypoechoic lesion in 15/21 patients in Group I compared with 7/15 patients in Group II. There was an increase in PSA level in 18 patients in Group I (from 8.4 to 11.6 ng/mL).

Conclusions PIN and invasive adenocarcinoma of the prostate were closely associated, and the likelihood for coexistence was higher in patients with high‐grade PIN, increasing PSA level or positive findings on TRUS. We recommend that all patients who show high‐grade PIN on prostate biopsy be followed very closely with serial PSA measurements and repeat biopsies from both the area of PIN and other areas of the prostate.
Decreased immunoreactive androgen receptor levels are not the cause of isolated hypospadias
Authors: BENTVELSEN F.M. , BRINKMANN A.O. , VAN DER LINDEN J.E.T.M. , SCHRÖDER F.H. , NIJMAN J.M.
Published: November 2008

Objective To elucidate whether diminished levels of androgen receptor (AR) are the underlying cause for the development of hypospadias by determining AR levels in the foreskins of boys with hypospadias.

Patients and methods The content of AR was determined by a sensitive immunoblotting technique in extracts from preputial tissue obtained from 15 patients (mean age 2.5, sd± 1.5 years) with hypospadias and from seven controls (mean age 2.5, sd± 1.5 years). Immunoreactivity of the protein was measured by densitometry.

Results No significant difference in mean AR content was found between those boys with hypospadias (2.1 ± 0.9 fmol/mg protein, ±sd) and the age‐matched control group (2.2 ± 0.3 fmol/mg protein). Stratification by the severity of hypospadias (distal and proximal on the shaft, and penoscrotal hypospadias) showed that the severity was not related to tissue AR levels.

Conclusion It is unlikely that hypospadias is caused by a decreased expression of AR.
Urological community nursing: a new concept in the delivery of urological care
Authors: GROSE K. , BROOMAN P.J.C. , O'REILLY P. H.
Published: November 2008

Objective To investigate the impact of a urological community nursing service on the mode of practice, efficiency, and quality of care in a urological practice.

Methods A urological community nurse was appointed to investigate the possibility of performing various urological procedures in the community rather than in hospital, with a prospective audit of the results for a period of 1 year. The setting was a busy urological unit serving a mixed urban and rural catchment area of 300 000 people. The outcome was assessed by the number and type of procedures successfully transferred from hospital to community practice.

Results In 1 year, 464 urological episodes were performed in the patients' homes which otherwise would have required transfer or admission to hospital for treatment or, in some cases, a cancelled operation. These episodes included tuition in clean intermittent self‐catheterization and dilatation, changes and insertions of urethral, suprapubic and nephrostomy catheters, bladder instillations to treat cancer and interstitial cystitis, voiding trials with no catheter, urosheath fittings, and pre‐operative visits and follow‐up visits to avoid attendance at the clinic.

Conclusions The urological community nursing service transferred a significant number of routine urological procedures from hospital to community with considerable financial savings and improvement in the quality and efficiency of urological care.
Nottingham health profile measurement in the assessment of clinical outcome after prostatectomy
Authors: THORPE A.C. , CLEARY R. , COLES J. , NEAL D.E. ,   (on behalf of the Northern Regional Prostate Audit Group)
Published: November 2008

Objective To compare the changes in pre‐and post‐operative symptom scores with changes in Nottingham health profile (NHP) scoring, and thus determine whether NHP scoring offers a reliable assessment of outcome after transurethral resection of the prostate (TURP), and whether NHP scoring could usefully supplement the more traditional method of symptom scoring in this assessment.

Patients and methods An 8‐month audit of 1396 TURPs, involving 12 hospital sites, was performed in the Northern region between April 1 and November 31, 1991. A cohort of 371 of these patients, for whom pre‐and post‐operative NHPs and irritative and obstructive voiding symptoms had been recorded, were investigated.

Results There was a significant decrease in both obstructive and irritative voiding symptom scores 3 months after TURP and a significant fall in the NHP scores for all stations except social isolation. There were significantly higher irritative symptom scores both before and after operation in men with prostate cancer compared with those with benign prostatic hypertrophy, and significantly higher post‐operative obstructive symptom scores in men with prostate cancer. However, there were no significant differences in the pre‐and post‐operative NHP scores for these two subgroups of patients. In patients who had a good outcome on symptom scoring, there was a significant reduction in NHP scores for all stations except social isolation. However, in those patients who had a poor outcome on symptom score, there was no correlation with changes in the NHP scores, with some NHP stations showing a significant reduction after operation.

Conclusion NHP quality‐of‐life scoring cannot replace symptom scoring in the assessment of outcome after TURP and when used alone, added little further information. However, for a comprehensive assessment of outcome, symptom scores and quality‐of‐life assessments should be used together.
Validation of the self‐administered Danish Prostatic Symptom Score (DAN‐PSS‐1) system for use in benign prostatic hyperplasia
Authors: HANSEN B.J. , FLYGER H. , BRASSO K. , SCHOU J. , NORDLING J. , ANDERSEN J. THORUP , MORTENSENM S. , MEYHOFF H‐H. , WALTER S. , HALD T.
Published: November 2008

Objective To validate the Danish Prostatic Symptom Score (DAN‐PSS‐1), a self‐administered quality‐of‐life questionnaire comprising 12 questions related to voiding problems and the perceived bother of each individual symptom.

Methods Using published results from several comparisons of other symptom scoring systems with DAN‐PSS‐1, the test‐retest reliability, internal consistency, construct and content validity, and responsiveness of the DAN‐PSS‐1 system were assessed.

Results The system was internally consistent (Cronbach's alpha = 0.73), the median test‐retest reliability of answers to each question was 83.5% (range 0–99.7%) and the questionnaire was well understood by the patients. The DAN‐PSS‐1 system demonstrated a high degree of construct validity, correlating with the extensively used Madsen‐Iversen score system (Spearman's correlation coefficient, rs= 0.51) and with the patients' answers to questions about how bothersome their symptoms were (rs= 0.71). The DAN‐PSS‐1 system discriminated clearly between patients with benign prostatic hyperplasia (BPH) and control subjects (an area under the receiver operating characteristic curve of 0.94). Finally, the DAN‐PSS‐1 was sensitive to changes following intervention, with scores decreasing from a median of 20 to zero 4 months after patients underwent transurethral prostatectomy and from a median of 11.5 to 7.5 (65%) after patients had received 4 months treatment with an alpha‐blocker.

Conclusions The DAN‐PSS‐1 system is reliable, valid and responsive, and therefore can be recommended for assessing the severity of symptoms among patients presenting with lower urinary tract complaints suggestive of BPH and in the follow‐up after intervention.
Treatment of stress incontinence by vaginal cones: short‐and long‐term results and predictive parameters
Authors: KONDO A. , YAMADA Y. , NIIJIMA R.
Published: November 2008

Objective To evaluate prospectively the short‐and long‐term results of treatment with vaginal cones for women with urinary stress incontinence and to assess predictive parameters.

Patients and methods Fifty women (mean age 49 years, range 28–76) with differing severities of stress incontinence (mean parity 2.4 and mean 60‐min pad‐test 20.7 g) were treated with cones for 15 min twice a day for 8 weeks. Treatment results were evaluated immediately after and at a mean of 3 years after the treatment. Parameters were analysed to determine those with predictive value for a successful outcome.

Results Physiotherapy was assessed as being successful, i.e. a complete cure or a reduction of > 50% of the original severity, in seven patients (14%), while in 43 patients (86%) the treatment failed. After 3 years, 13 (30%) reported that the treatment was successful, 27 (61%) reported failure and four (9%) underwent surgery for stress incontinence. Those with lesser amounts of urinary loss and those with less frequent incontinence would be most likely to benefit from treatment with vaginal cones.

Conclusion The treatment had a low success rate and we recommend that the vaginal cones should be used only for those with a slight or moderate degree of stress incontinence.
Prostate‐specific antigen levels in patients receiving long‐term dialysis
Authors: HARPER L. , MCINTYRE C.W. , MACDOUGALL I.C. , MEYER P. , RAINE A.E.G. , BAKER L.R.I.
Published: November 2008

Objective To investigate the effect, if any, of renal failure upon prostate‐specific antigen (PSA) levels and the validity of PSA estimation as a marker of prostatic disease in renal failure.

Patients and methods PSA was measured in 65 men (median age 67 years, range 39–84) on regular haemodialysis and 37 men (median age 70 years, range 42–77) on continuous ambulatory peritoneal dialysis (CAPD). Patients with a PSA level >4 ng/mL underwent prostatic biopsy guided by transrectal ultrasonography.

Results There was no evidence of an artefactual elevation of PSA attributable solely to renal failure. All eight patients with a PSA level > 4 ng/mL had prostatic disease.

Conclusion PSA measurements in patients with end‐stage renal failure treated by dialysis remain a useful marker of prostatic disease.
Urethral anaesthesia with topical bupivacaine. A role for a longer‐acting agent
Authors: DAWKINS G.P.C. , HARRISON N.W. , ANSELL W.
Published: November 2008

Objective To assess the efficacy and toxicity of bupivacaine as a topical urethral anaesthetic.

Patients and methods This prospective two‐part study comprised a pilot study of 10 men (mean age 73 years, range 39–86), to determine the toxicology, pharmocokinetics and suitable preparation of bupivacaine gel, and a study of 40 men (mean age 76 years, range 59–92) to compare the efficacy of bupivacaine with lignocaine gel. All patients were undergoing treatment for benign prostatic hyperplasia by transurethral radiofrequency heating using the Direx Thermex II system.

Results There were no major adverse events. Bupivacaine provided good topical anaesthesia with a mean duration of 141 min, compared with 29 min for lignocaine. Serum samples taken from patients showed that the drug was absorbed slowly, and with a dose of 50 mg there was a wide margin between serum drug concentrations and toxic levels.

Conclusion Bupivacaine is safe and effective as a topical anaesthetic agent in the urethra in circumstances where prolonged duration of action is desirable. For lower urinary tract procedures 20–22 mL of anaesthetic gel is required, giving 2–3 h of analgesia/anaesthesia with no significant toxicity or adverse effect. The application of longer‐acting anaesthetic agents need not be only during surgical intervention, but might usefully be extended post‐operatively to provide early management of pain.
Aspiration sclerotherapy for hydroceles in the tropics
Authors: MUSA M.T. , FAHAL A.H. , ARABI Y.E. EL
Published: November 2008

Objective To assess the usefulness of aspiration sclerotherapy in the treatment of hydroceles in the tropics.

Patients and methods This prospective study included 82 patients with 94 primary vaginal hydroceles of which 62 hydroceles were treated by aspiration and tetracycline hydrochloride sclerotherapy as an outpatient procedure (mean age of patients 56.5 years, range 40–82) and 28 were treated surgically and included as controls (mean age 52.4 years, range 40–70). All patients were followed for a year.

Results In the sclerotherapy group, the overall cure rate after a year was 95%. Few complications were encountered in this group: six patients (10%) experienced pain during the procedure, seven patients (12%) had local infection and three patients (5%) developed haematoma. No recurrence was encountered in the surgical group, seven patients (25%) had infection and two patients (7%) developed haematoma. The mean hospital stay for the surgical group was 3.4 ± 1.3 days (range 1–7). Four patients with thick‐walled hydroceles had persistent swelling after sclerotherapy, the recurrence of which dissatisfied the patients.

Conclusions Aspiration sclerotherapy for thin‐walled hydroceles proved to be a curative, simple, safe and cost‐effective out‐patient procedure. It can be an alternative to surgery in developing countries where resources are limited.
The incidence of testicular cancer in Royal Air Force personnel
Authors: FOLEY S. , MIDDLETON S. , STITSON D. , MAHONEY M.
Published: November 2008

Objectives To review the incidence of testicular cancer within the Royal Air Force (RAF) compared with the national incidence.

Methods The medical statistics for RAF personnel (supplied by the Central Statistics Office, categorized by occupation) were reviewed for the incidence of testicular cancer and compared to the national rate.

Results A significantly elevated incidence of testicular neoplasm was detected in RAF personnel, which was well above the national rate. The increased incidence appeared most marked in those personnel working directly with aircraft.

Conclusion The only cause of the significantly higher incidence of testicular cancer in RAF personnel is probably related to working with aircraft. This concurs with a finding that aircraft technicians in the US Navy had an increased incidence of testicular cancer, and the exposure to hydrocarbon carcinogens in the workplace was implicated.
Further clinical experience with the ileal W‐neobladder and a serous‐lined extramural tunnel for orthotopic substitution
Authors: ABOL‐ENEIN H. , GHONEIM M.A.
Published: November 2008

Objective To report on the functional results following orthotopic substitution using an ileal W‐neobladder with an extramural serous‐lined tunnel for reflux prevention.

Patients and methods Sixty men (mean age 46 years) underwent a one‐stage radical cystoprostatectomy and an ileal W‐neobladder for invasive bladder cancer. The technique entails the creation of two serous‐lined extramural tunnels in a detubularized ileal W‐bladder fashioned from 40 cm of the terminal ileum. Fifty‐one patients were evaluable, with a minimum follow‐up of 2 years. Evaluation of patients included clinical, radiographic and urodynamic studies.

Results There was no operative mortality and no gross morbidity. The upper tracts remain unchanged or improved in 97% of the implanted renal units. Reflux was not observed in any patient. The incidence of day and night continence was 90 and 80%, respectively.

Conclusion The technique provides a non‐obstructed unidirectional uretero‐ileal re‐implantation, in a low‐pressure system constructed from a short ileal segment. No staples were required.
Urinary tract obstruction and nephrostomy drainage in pelvic malignant disease
Authors: LAU M.W.M. , TEMPERLEY D.E. , MEHTA S. , JOHNSON R.J. , BARNARD R.J. , CLARKE N.W.
Published: November 2008

Objective To determine the survival of patients after percutanous nephrostomy drainage (PND) for obstructive uropathy secondary to pelvic malignant disease.

Patients and methods The records of 77 patients undergoing PND for obstructive uropathy were reviewed. Patients were classified according to the nature of the obstructing lesion: Group I (primary untreated malignancy. 31 patients); Group II (recurrent malignancy with further treatment. 15 patients): Group III (recurrent malignancy with no further treatment. 12 patients): and Group IV (benign disease as a consequence of previous treatment, 19 patients). Outcome was assessed by survival over a mean follow‐up of 20 months (range 2 days‐8.3 years).

Results Overall median survival was 26 weeks, with a 5‐year survival of 22%. The survival in Groups I and II was not significantly different (median survival 27 and 20 weeks, respectively; 5‐year survival, 10% and 20%. respectively). Group III patients had a poor prognosis (median survival 6.5 weeks) with no patient surviving beyond one year, whilst Group IV patients fared best with a 5‐year survival of 64%. The commonest primary tumour type was carcinoma of the cervix (42 patients), and these patients were analysed as a subset. Benign post‐radiation fibrosis was found in 16 of 27 patients (59%). Survival was related to the diagnostic group.

Conclusion The nature and extent of the obstructing lesion and its potential for further treatment are the major determinants of post‐nephrostomy survival. Every effort should therefore be made to identify the nature of the obstruction before deciding on PND.
P53 and ploidy assessed by flow cytometry in bladder washings
Authors: GRIFFITHS T.R.L. , MELLON J.K. , PYLE G.A. , SHENTON B.K. , NEAL D.E.
Published: November 2008

Objective To determine p53 expression in cells in bladder washings and to relate this to DNA content and clinical outcome.

Patients and methods Washings from 102 patients (41 with newly diagnosed superficial tumours [pTa and pT1], 49 with recurrent superficial tumours and 12 with carcinoma invading bladder muscle) were studied. In 39 cases, the primary bladder tumour was also analysed. The rates of tumour recurrence and progression were determined for the new superficial tumours and related to both p53 expression and DNA content.

Results Cells positive for p53 were detected in 22 of 90 (24%) washings from patients with superficial bladder cancer. P53 expression correlated with tumour stage (P < 0.05), grade (P < 0.05) and abnormal DNA content (P < 0.05). The analysis of pure urothelial (cytokeratin‐positive) cells improved the detection of DNA abnormalities (P < 0.001). In 74% of cases where both washings and tumour were analysed, the results for DNA content agreed. Of 41 new superficial tumours, 27 (66%) recurred (11 were p53‐positive, 16 were p53‐negative, P= 0.221; 17 had abnormal DNA content, 10 were diploid, P= 0.069). Four patients progressed (one was p53‐positive, P= 0.315 and all had abnormal DNA content, P= 0.072).

Conclusion P53‐positive cells can be detected in washings using flow cytometry and were more commonly detected in association with aneuploid tumours. At short‐term follow‐up, flow cytometric analysis of DNA content in washings had greater predictive value than had p53 expression. Few washings contained aneuploid cells when the primary tumour contained diploid cells, although the collection of washings is a convenient way of sampling tumour cells.
Laparoscopic varicocelectomy: indication, technique and surgical results
Authors: MIERSCH W. D.E. , SCHOENEICH G. , WINTER P. , BUSZELLO H.
Published: November 2008

Objective To assess the efficacy of laparoscopic techniques for the operative therapy of varicocele.

Patients and methods Fifty‐one patients who underwent laparoscopic varicocelectomy due to subfertility and/or pain between June 1992 and December 1994 were evaluated.

Results In all patients, except one with a remaining slight reflux on post‐operative Valsalva's manoeuvre, operative therapy was effective and no major complications occurred. The procedure was minimally invasive, effective and, because the anatomy was readily seen, multiple veins and/or collaterals were easily assessed and the surgery precise.

Conclusion The laparoscopic technique is an efficient, minimally invasive operation with optimal results. After a brief period of training the operation can be performed in 15–30 min and is therefore no longer than embolization techniques. Treatment of both sides in one session was not a problem.
Fetal pelvi‐ureteric junction obstruction: predictors of outcome
Authors: BARKER A.P. , CAVE M.M. , THOMAS D.F.M. , LILFORD R.J. , IRVING H. C. , ARTHUR R.J. , SMITH S.E.W.
Published: November 2008

Objective To examine the relationship between pre‐natal ultrasonographic findings typical of pelvi‐ureteric junction (PUJ) obstruction and post‐natal renal function in the affected kidney,

Patients and methods This retrospective study comprised 35 infants in whom pre‐natal ultrasonography had identified a unilateral pattern of dilatation of the renal pelvis and calices typical of PUJ obstruction. In each case, the presence of unilateral hydronephrosis had been confirmed post‐natally by ultrasonography, and differential function and drainage evaluated by isotope renography. The results of isotope renography were compared with the severity and timing of onset of the fetal hydronephrosis.

Results Eleven kidneys (31%) appeared normal in the second trimester and dilatation only became apparent during the third trimester. Mean differential function in these kidneys was 48%. However, mean differential function was reduced (mean 38%) in those kidneys noted to be dilated between 16 and 24 weeks gestation. Differential function was loosely correlated with the severity of dilatation in early onset cases, i.e. the mean differential function was 42% for mild, 37% for moderate and 27% for severe dilatation. A considerable variation in differential function values was present in each group except for those with severe dilatation, which was a significant predictor of poor functional outcome when compared with mild and moderate dilatation combined (P < 0.01).

Conclusion Fetal PUJ obstruction is a heterogenous condition permitting only broad predictions of functional outcome. Severe dilatation detected on second trimester imaging predicted significant loss of function. Mild and moderate degrees of dilatation were associated with a one in three risk of functional impairment in the obstructed kidney.
Maximum and average urine flow rates in normal children‐the Miskolc nomograms
Authors: SZABO L. , FEGYVERNEKI S.
Published: November 2008

Objective To establish normal reference ranges of urinary flow rates in children.

Subjects and methods From a screening programme, 200 healthy children (96 girls and 104 boys, between 3 and 18 years old) with no renal, urological, psychological or neurological disorders were selected, and they provided 433 micturitions for analysis. The children were divided into those with body surface areas of < 0.92 m2, between 0.92 and 1.42 m2 and > 1.42 m2. The voided volume, maximum and average flow rates of urine were measured. Data were fitted by several mathematical functions and goodness‐of‐fit determined.

Results The relationship between maximal or average flow rates and voided volume was best fitted by a logarithmic function. The maximal and average urine flow rate nomograms are given in centile form for each body surface area group in both girls and boys. Flow rates showed a close relationship with voided volumes in both sexes and for all body sizes. The average maximal and average flow rates were higher in girls than in boys.

Conclusion Normal nomograms of maximal and average urine flow rates of girls and boys at three different body surfaces are presented in centile form. These may be useful for diagnosing lower urinary tract disturbances in children over a wide range of body size and voided volumes.
A method of measuring fluid balance during transurethral resection of the prostate
Authors: COPPINGER S.W. , LEWIS C.A. , MILROY E.J.G.
Published: November 2008

Objective To design a practical system for non‐invasively monitoring fluid balance during transurethal resection of the prostate (TURP) and other endoscopic procedures.

Materials and methods Load cell transducers are incorporated into a platform placed under the operating table. Output is passed to a digital weighmeter and then to a portable computer. The raw data is filtered using software written by the authors (GAL) and the output displayed both numerically and graphically on the computer screen. The device was tested under laboratory conditions and then assessed in the clinical setting.

Results The device proved stable in both the laboratory and clinical settings. Examples of the common patterns generated during TURP are presented. The prototype has been used routinely in our practice to warn the surgeon and anaesthetist of fluid overload and has been used to monitor fluid balance in several studies.

Conclusions This instrument provides a practical method of monitoring total fluid balance during TURP. It can be used with either general or regional anaesthesia and provides information not otherwise available. It provides an early warning of significant changes in total fluid balance, particularly irrigant fluid absorption. Use of this device serves to prevent development of the TUR syndrome, a potentially fatal complication of endoscopic surgery. Our ultimate aim is to produce a refined version that is simple, compact and cheap enough to be used routinely in all urological theatres. The cost of a single episode of intensive care for a patient developing iatrogenic complications from irrigant absorption would offset the cost of such a device.
Shared care for benign prostatic hyperplasia: a feasibility study
Authors: MORRIS S.B. , POGSON C. , SHEARER R.J.
Published: November 2008

Objective To determine the proportion of patients with symptoms of urinary outflow obstruction secondary to benign prostatic hyperplasia (BPH) who could be managed in the community after assessment in a shared‐care clinic (managed by nursing staff, supervised by a consultant) to which they had direct access.

Patients and methods A total of 127 men were referred to one consultant urologist in a 9‐month period for assessment of possible urinary outflow obstruction. All were investigated using urine analysis, serum prostate‐specific antigen level, urea and electrolytes, plain abdominal X‐ray, renal ultrasonography and urinary flow rate. Additional investigations were undertaken as required. The proportion of men who could have been investigated in a shared‐care clinic and then managed in the community was determined.

Results Of 127 men, 88 (69%) were found to have uncomplicated outflow obstruction secondary to BPH; of these 49 (38%) could have been managed in the community after assessment in the shared‐care clinic and a further 27 (21%) could have been managed in the community after additional investigation by a specialist. Twelve men (9%) were found to have uncomplicated outflow obstruction and chose to undergo transurethral resection of the prostate.

Conclusion Many men with uncomplicated outflow obstruction could be assessed in a shared‐care clinic and then managed in the community. A shared‐care protocol for the management of these men has now been introduced in this unit.
Reagent strip testing urine for significant bacteriuria in a urodynamic clinic
Authors: NUNNS D. , SMITH A.R.B. , HOSKER G.
Published: November 2008

Objectives To determine the effectiveness of two reagent strips in detecting significant bacteriuria amongst patients attending for urodynamic assessment.

Patients and methods Four hundred patients undergoing urodynamic assessment were recruited for the study. Routine diagnostic catheter specimens of urine were tested for nitrite, leucocytes and protein.

Results The leucocytes and nitrite strips had a high specificity rate of 99.5%. The frequency of significant bacteriuria in our population was 7% (n= 28).

Conclusion Culturing samples which test negative for these strips is unnecessary. Reagent strip testing of urine provides a cheap, rapid method of screening for infection.
Tangible Heritage: Production of Astrolabes on a Laser Engraver
Authors: Zotti G.
Published: November 2008

The astrolabe, an analog computing device, used to be the iconic instrument of astronomers during the Middle Ages. It allowed a multitude of operations of practical astronomy which were otherwise cumbersome to perform in an epoch when mathematics had apparently almost been forgotten. Usually made from wood or sheet metal, a few hundred instruments, mostly from brass, survived until today and are valuable museum showpieces. This paper explains a procedural modelling approach for the construction of the classical kinds of astrolabes, which allows a wide variety of applications from plain explanatory illustrations to three‐dimensional (3D) models, and even the production of working physical astrolabes usable for public or classroom demonstrations.
Cultural Heritage As a Vehicle for Basic Research in Computing Science: Pasteur's Quadrant and a Use‐Inspired Basic Research Agenda
Authors: Arnold David
Published: November 2008

Donald Stokes argued [Sto97] that for 50 years from the end of the Second World War to the end of the 20th century, there was an unhealthy taxonomy of research types which was formulated on a linear scale from pure to applied. The argument goes that the best research is only possible in environments which are free from contemplation of the potential uses to which results might be applied. In this paper, current research challenges in the application of ICTs to cultural heritage information are reviewed in order to consider where these applications‐linked needs require solutions that will advance the understanding of computational principles and help to develop new basic understanding in computer science, including shape manipulation and other aspects of importance in computer graphics and virtual environments. The paper draws extensively on the recently published EPOCH research agenda [AG07] for illustrations of the types of research which are required for the Cultural Heritage sector and the relationship between these and basic research challenges in Computing Science.
THE DECLINE IN THE VOLATILITY OF THE BUSINESS CYCLES IN THE UK
Authors: ATANASOVA CHRISTINA V. , GANG JIANHUA
Published: November 2008

We analyse the sources of the decline of business cycle volatility in the UK using a dynamic factor model that allows for the presence of a structural break in the conditional mean and variance of output, sales, income and unemployment. We augment the factor model with an economic component to investigate the role of structural changes and improved monetary policy in the volatility decline of the series. Our results suggest that the dominant cause for the observed volatility decline is the reduced variability of shocks.
DOES MONEY MATTER IN THE IS CURVE? THE CASE OF THE UK
Authors: JONES BARRY E. , STRACCA LIVIO
Published: November 2008

Narrow and broad money measures (including Divisia aggregates) have been found to have explanatory power for UK output in backward‐looking specifications of the IS curve. In this paper, we explore whether or not real balances enter into a forward‐looking IS curve for the UK. To do this, we test for additive separability between consumption and money over a sizeable part of the post‐Exchange Rate Mechanism period using non‐parametric methods. A main finding is that the UK data seem to be broadly consistent with additive separability for the more recent period from 1999 to 2007.
TAXES AND CAPITAL STRUCTURE: A STUDY OF EUROPEAN COMPANIES
Authors: CHENG YUE , GREEN CHRISTOPHER J.
Published: November 2008

We analyse the impact of tax policy on firms' leverage ratios in a balanced panel of 129 medium‐sized listed European companies from 1993 to 2005. A general model of company leverage is applied within which King's tax ratios are used to capture tax policy changes, controlling for non‐tax influences. Leverage measures studied include total, long‐term and short‐term debt. A generalized method of moments estimator is used to control for endogeneity. The results suggest that tax policy has a significant but small impact on firms' debt ratios and that non‐debt tax shields are a substitute for debt in company activities.
Order Imbalance in the FTSE Index Futures Market: Electronic versus Open Outcry Trading
Authors: Ning Zi , Tse Yiuman
Published: November 2008

Abstract: This study examines trading activities before and after the transfer of the FTSE 100 index futures contract from open outcry to electronic trading. Daily order imbalance exhibits strong serial persistence in the electronic limit order market, but not in open‐outcry trading. Both excess buying and selling reduce liquidity. In the electronic venue, prior market movements barely affect investors' buying or selling decisions. Excess buy orders do not generate any price impact, but sell orders do. Positive imbalances are more strongly autocorrelated than negative imbalances. No trading elements, such as order imbalance, volume, or open interest, are associated with volatility. Moreover, excess buying decreases volatility. Such evidence suggests that the development and growth of electronic trading has changed the dynamics of trading activities in many important ways.
Verbal short‐term memory span in children: long‐term modality dependent effects of intrauterine growth restriction
Authors: Geva R. , Eshel R. , Leitner Y. , Fattal‐Valevski A. , Harel S.
Published: November 2008

Background:  Recent reports showed that children born with intrauterine growth restriction (IUGR) are at greater risk of experiencing verbal short‐term memory span (STM) deficits that may impede their learning capacities at school. It is still unknown whether these deficits are modality dependent.

Methods:  This long‐term, prospective design study examined modality‐dependent verbal STM functions in children who were diagnosed at birth with IUGR (n = 138) and a control group (n = 64). Their STM skills were evaluated individually at 9 years of age with four conditions of the Visual–Aural Digit Span Test (VADS; Koppitz, 1981): auditory–oral, auditory–written, visuospatial–oral and visuospatial–written. Cognitive competence was evaluated with the short form of the Wechsler Intelligence Scales for Children – revised (WISC‐R95; Wechsler, 1998).

Results:  We found IUGR‐related specific auditory‐oral STM deficits (p < .036) in conjunction with two double dissociations: an auditory‐visuospatial (p < .014) and an input–output processing distinction (p < .014). Cognitive competence had a significant effect on all four conditions; however, the effect of IUGR on the auditory‐oral condition was not overridden by the effect of intelligence quotient (IQ).

Conclusions:  Intrauterine growth restriction affects global competence and inter‐modality processing, as well as distinct auditory input processing related to verbal STM functions. The findings support a long‐term relationship between prenatal aberrant head growth and auditory verbal STM deficits by the end of the first decade of life. Empirical, clinical and educational implications are presented.
Interprofessional learning for supervision: ‘taking the blinkers off’
Authors: Davys Allyson M. , Beddoe Liz
Published: November 2008

This article will argue the advantages of interprofessional education as a context for learning about professional supervision. In a departure from most previous research which explores how the interprofessional learning situation affects the relationships between participants, we explored how the difference between the participants affected their learning. In recent years, there has been a resurgence of interest in professional supervision in health and human services and a corresponding development in opportunities for supervision training. Evidence from a small qualitative study of participants’ views on learning in interprofessional supervision programmes was examined. It was found that the interprofessional learning environment deepened the exploration and level of understanding about supervision and encouraged participants to question taken‐for‐granted professional assumptions. The identification of difference between participants, rather than impeding learning, was seen to enhance the breadth of learning and participants were challenged to clarify ideas and language.