bluuebunny/crossref_metadata_2025 huggingface dataset:
In defence of the middle ground
Authors: Dawson Paul J.
Published: February 2006

Robyn Holden (1991) asserts that nursing must adopt a dualist notion of mind, in order to maintain scientific respectability. This solution to the vexed question of the relationship of mind and matter is itself a philosophical scandal, the prevalence of which in psychiatric theory should not be taken as a measure of its veracity. Advocates of such solutions run the risk of peremptody closing down the debate in the name of one philosophical misconception or another. Rather, we should hold our views lightly, ever willing to surrender them in the light of new empirical evidence. This paper explores some ‘new’ evidence germane to the debate, and proposes some tentative options for a non‐dualist theory of mind, more in tune with the emerging person‐centred emphasis in nursing theory. Our notions of who and what we are structure, and are structured by, our social and cultural relationships, and this is particularly true of the nurse—client relationship. The middle order reality approached in this paper emphasizes the role of culture and language, and the concept of person, in considering the ramifications of the mind matter debate. It does not aspire to provide the answer, but does provide an alternative point of view, a different perspective from which to consider the problem. Time and empirical research will provide the final answer, no doubt in the form of even more complex theoretical enquiries.
Curriculum evaluation in nursing education: a review of the literature
Authors: Chavasse Judith
Published: February 2006

Most curriculum evaluations in the literature have been reported by nurse evaluators; aims, criteria and methods are drawn chiefly from sociology, general education or management. There is an absence of studies exploring relevance to national health care need, nurses' accountability to their clients and outcomes of curricula. There appears to be much interest in innovatory programmes, students' experiences and sociological understandings, with some concern for specific aspects of curricula generally recognized as being problematic. The number of qualitative or mixed methodology studies is compatible with process curricula and with academic and professional validation.
Aggression in psychiatry: a qualitative study focusing on the characterization and perception of patient aggression by nurses working on psychiatric wards
Authors: Finnema Evelyn J. , Dassen Theo , Halfens Ruud
Published: February 2006

The present study focuses on the characterization and perception of patient aggression by nurses working in a psychiatric hospital in The Netherlands. Data have been collected by interviewing nurses working on open and closed wards. The results have been compared and related to the existing literature on aggression. An expert panel has collaborated in the assessment of part of the research findings. Nurses perceive and describe aggression in different ways. Since the descriptions of aggression varied considerably, it was not possible to formulate a general definition of aggression on the basis of the results of the study. Despite the fact that on the whole the general public have a negative view of aggression, the descriptions nurses gave were not always negative. Most of the nurses acknowledged positive as well as negative aspects of aggressive behaviour by patients. Interventions in cases of aggressive behaviour depend on different factors, e.g. the individual nurse's perception of the situation, the (mostly unwritten) rules, and the type of ward (open or closed). The same interventions are often used both to prevent aggression and to stop it. The difference lies in the moment of execution. Most interventions are aimed at stopping aggressive behaviour by acting in a non‐restrictive way, e.g. by talking to the patient, touching the patient and giving unexpected responses. Nurses express the belief that aggression is mainly caused by a combination of patient‐related, situational and interactional factors. This is not in accordance with the opinion of the North American Nursing Diagnosis Association, who relate aggressive behaviour mainly to patient characteristics
Psychoneuroimmunology and cancer: an integrated review
Authors: Bauer Susan M.
Published: February 2006

The new field of psychoneuroimmunology (PNI) studies the measurable interaction between psychological and physiological processes. Specifically, PNI is the study of the intricate interaction of consciousness (psycho), central nervous system (neuro), and the body's defence against external infection and abherrant cell division (immunology). Over the last 30 years, the body of knowledge in PNI has emerged and in the last 10 years has flourished. PNI has many implications for clinical nursing practice. This study provides supportive empirical evidence to systems theories, which have played a major role in nursing's attempt to comprehend the interaction between the mind and the body. Nurses are ideal candidates to take a lead in this new field because it reinforces the holistic perspective which is the essence and uniqueness of our discipline. Although a variety of clinical populations have been used in PNI research, the scope of this integrated review will be limited to PNI and cancer. Research studies addressing psychosocial variables' effect on aetiology, response to treatment, immunocompetence and overall survival in the oncology population will be examined.
Nurses' views of infection control: an interview study
Authors: Gould Dinah , Ream Emma
Published: February 2006

An interview study was conducted among 173 nurses in two hospitals to explore their views concerning infection risks to themselves and patients and to identify any problems they perceived in safely performing infection control precautions during routine activities. Subjects were interested in the topic of Infection control and keen to perform optimally, but perceived difficulties related to lack of expert guidance whether or not they had access to an infection control nurse. In one hospital subjects identified shortages of vital equipment (gloves, appropriate handwashing agents), and this was corroborated on a checklist used independently to document the availability of resources. When the opinions of nurses working in intensive care, surgical and medical units were compared, few differences emerged other than those explained by variation in supplies of equipment, except that intensive care unit nurses were more likely to rate their patients and themselves as particularly at risk of infection, Nurses who had been qualified longer, with more than 3 years experience in their speciality, were more conscious of infection risks.
The phenomenon of death: a study of Diploma in Higher Education nursing students' reality
Authors: Johnson Gillian R.
Published: February 2006

This study investigates Diploma in Higher Education nursing students' perceptions and experiences of the phenomenon of death. The sample size was eight students drawn from the adult branch. A phenomenological approach was used; data collection being via two focused group interviews/discussions. Four themes were identified which appeared to form the basis of the students' reality: knowing, reality, relationships and culture. The results suggest that self‐knowledge and theoretical knowledge are important in the formation of their reality. The need to develop relationships with patients was identified as an important aspect of caregiving. Relationships with staff who offered support and guidance was seen as desirable. This was sometimes compromised by conflicting philosophies, but the desire to implement holistic care was apparent. The students appeared able to reflect with insight, openness and objectivity. They also appeared to be developing the ability to take an active part in the development of their own conceptual notions and perceptions. They did not appear to be disillusioned or socialized into roles they did not feel were appropriate. The need to maintain the educational input and reflective ability for the students is recommended. Names given to students in this study are fictitious. The study refers to the students as Diploma in Higher Education nursing students. This is often referred to as Project 2000.
Illuminating dissertation supervision through reflection
Authors: Snowball Jan , Ross Kath , Murphy Kathy
Published: February 2006

This paper describes a small research study designed to explore the role of the dissertation supervisor and to examine the potential of using reflection as a tool for learning and for enhancing professional educational practice. The authors met to discuss and reflect upon the processes of supervision and the role of the supervisor throughout the period of supervising three dissertation students. Each author maintained individual reflective written accounts of supervisory meetings with students. These accounts and the transcribed tape‐recordings of the group meetings provided two sets of data which were analysed using qualitative techniques. From the data analysis the authors were able to identify various phases in dissertation supervision — partnership; setting the learning contract; signposting; ownership of the dissertation; letting go; the rush at the end; maintaining the balance — and also contextual issues of humanness; time; and energy, which were needed to sustain the supervisory processes. The role of the dissertation supervisor was illuminated and the potential of using reflection as a tool for developing professional educational practice was realized. The importance of constructive support while engaged in processes of reflection cannot be underestimated.
Chemokine receptor CCR6 as a prognostic factor after hepatic resection for hepatocellular carcinoma
Authors: UCHIDA HIROKI , IWASHITA YUKIO , SASAKI ATSUSHI , SHIBATA KOHEI , MATSUMOTO TOSHIFUMI , OHTA MASAYUKI , KITANO SEIGO
Published: February 2006

Background and Aims:  Chemokines and their receptors have recently been shown to have major roles in cancer metastasis. The aim of this study was to determine whether the interaction between chemokine receptor 6 (CCR6) and its ligand, macrophage inflammatory protein‐3 alpha (MIP‐3α), correlates with metastasis of hepatocellular carcinoma (HCC).

Methods:  To observe the reaction of CCR6 expressed cancer cells to MIP‐3α stimulation, chemotactic and actin polymerization assays for both CCR6 high cells (HepG2) and CCR6 low cells (MCF‐7) were performed. CCR6 mRNA levels in tumor specimens from 30 HCC patients were quantified by real‐time polymerase chain reaction. Patients were classified into two groups, high (≥ 20 copies; n = 10) CCR6 and low (<20 copies; n = 20) CCR6 on the basis of CCR6 expression, and the groups were compared with respect to clinicopathological features.

Results:  When HepG2 cells (CCR6 high) were stimulated with MIP‐3α, they migrated in a dose‐dependent manner, and formation of pseudopodia was observed. These phenomena were not observed in the CCR6 low cells. The incidence of intrahepatic metastasis was higher in the high CCR6 expression group than in the low CCR6 expression group (P < 0.05). Disease‐free survival was significantly poorer in the high CCR6 expression group than in the low CCR6 expression group (P < 0.05).

Conclusions:  It was indicated that CCR6 might be associated with intrahepatic metastasis of HCC and might be able to become one of the prognostic factor after hepatic resection for HCC.
Survey of consent practices for inpatient colonoscopy and endoscopic retrograde cholangiopancreatography at a tertiary referral center
Authors: Seow Cynthia H , Leber Jacqueline M , Ee Hooi C , Yusoff Ian F
Published: February 2006

Background:  The purpose of the present paper was to determine informed consent practices for inpatient, open‐access colonoscopy and endoscopic retrograde cholangiopancreatography (ERCP) at a tertiary referral center.

Methods:  A two‐part prospective study incorporating (i) an audit of consent practices for colonoscopy and ERCP; and (ii) a questionnaire directed at gastroenterologists and interns regarding information imparted to patients in the process of acquiring informed consent, was undertaken at Sir Charles Gairdner Hospital, Western Australia. Study subjects consisted of inpatients undergoing open‐access colonoscopy and/or ERCP at the study center commencing May 2003; and gastroenterologists and interns at the study center.

Results:  Written consent was obtained by junior medical staff in 89% of cases. Response rates for the questionnaire was 100% from interns, and 91% from gastroenterologists. Of interns surveyed, 93% had witnessed a colonoscopy, and 59% had witnessed an ERCP. For 12% of interns, colonoscopic bleeding or perforation were not always mentioned. Colonoscopy failure rate and perforation were overestimated by 51% and 63% of interns, respectively. Only 56% of interns always mentioned pancreatitis as a complication of ERCP. The rate of post‐ERCP pancreatitis was overestimated by 25% of interns. Only 40% of gastroenterologists always provided additional information to patients whose consent was obtained by someone else. Written material was not routinely provided for patients. Consent was usually obtained on the day of the procedure.

Conclusions:  Written consent for inpatients undergoing open‐access colonoscopy and ERCP is rarely obtained by the proceduralist. There is substantial variability in the information provided to patients. Guidelines are required to ensure best practice in this area.
Vascular endothelial growth factor protects hepatoma cells against oxidative stress‐induced cell death
Authors: Osada Shinji , Imai Hisashi , Tomita Hiroyuki , Tokuyma Yasuharu , Okumura Naoki , Sakashita Fumio , Nonoka Kenichi , Sugiyama Yasuyuki
Published: February 2006

Background:  The aim of the present study was to examine coordination of the vascular endothelial growth factor (VEGF) and VEGF receptor (Flk‐1) system and to study control of VEGF expression by oxidative stress, which is considered a model for chronic liver disease.

Methods:  Cell viability was determined by test method with 3‐[4, 5‐dimethylthiazol‐2‐yl]‐2, 5‐dephenyl tetrazolium bromide (MTT). Expressions of cellular proteins were evaluated by western blot analysis.

Results:  The c‐Met tyrosine phosphorylation in PLC/PRF/5 hepatoma cells was increased by treatment with 20 ng/mL hepatocyte growth factor (HGF), and extracellular signal‐regulated kinase (ERK) was also activated. Although Flk‐1 was phosphorylated in response to VEGF (>50 ng/mL), phosphorylated ERK was not detected at these concentrations. A total of 5.0 and 10 µmol/L hydrogen peroxide (H2O2) caused cell death in a dose‐dependent manner after 24 h. On western blot analysis at 1 h with H2O2, rapid phosphorylation of both ERK1/2 and c‐Jun NH2‐terminal kinase (JNK) was observed. In the first 6 h, H2O2 induced cell death for 58.4 ± 6.8%, whereas the presence of 100 ng/mL VEGF improved the survival rate to 77.2 ± 4.2%. The VEGF significantly decreased H2O2‐induced cell death after 12 h, whereas HGF (20 ng/mL) did not have a similar effect. When cells were incubated with 5 µmol/L H2O2, expression of VEGF protein was detected. Furthermore, H2O2‐induced phosphorylation of ERK and JNK was also reduced by VEGF (100 ng/mL). In contrast, HGF did not induce phosphorylation of ERK and JNK.

Conclusion:  Hepatoma cells might be able to survive under continuous oxidative stress through expression of VEGF.
Low number of omental preadipocytes with high leptin and low adiponectin secretion is associated with high fasting plasma glucose levels in obese subjects
Authors: Bakker A. H. F. , Nijhuis J. , Buurman W. A. , Van Dielen F. M. H. , Greve J. W. M.
Published: February 2006

Objective:  This study investigates whether fasting plasma glucose (FPG) levels in obese subjects are associated with the number of preadipocytes and their adipokine‐secretion capabilities.

Design:  Abdominal subcutaneous and omental adipose tissues were obtained from 10 female and four male obese subjects (age 37 ± 8 years; BMI 48 ± 13 kgm2) with a wide range of FPG (range: 4.3–10.6 mm). Stromal vascular cells (SVC) were isolated and cultured and the number of attached SVC (aSVC) per gram adipose tissue determined. The aSVCs were differentiated in vitro to become adipocytes, and the secretion of the adipokine leptin and adiponectin in the culture media was determined. Spearman rank correlation coefficients were calculated between FPG and preadipocyte number and adipokine secretion.

Patients:  Subject‐inclusion criteria: BMI >40 kg/m2 and for severe comorbid conditions BMI >35 kg/m2. Subject‐exclusion criteria: severe cardiopulmonary pathology (ASA class 3), history of bariatric surgery, manifest psychopathology, 18 years < age > 60 years and for upper‐abdominal surgery, age >50 years. All females in the study had regular menstrual periods. None of participants received glucose‐lowering medication.

Results:  No association was observed between BMI and fasting glucose levels. More than 90 ± 20% of the cultured aSVC fraction was able to store fat droplets, indicating the presence of preadipocytes. A strong negative association was observed between omental preadipocyte number and FPG. A strong association was observed between adipokine secretion by the omental preadipocytes and FPG. No association was observed between subcutaneous preadipocyte number and adipokine secretion and FPG.

Conclusions:  In morbid obese subjects, low number of omental preadipocytes with high‐leptin‐ and low‐adiponectin‐secretion profiles is associated with high FPG.
12  Outcomes of radical prostatectomies and HDR brachytherapy in patients with intermediate and high risk prostate cancer
Authors: MACEK P. , STRICKER P. , STEVENS M. , JAGAVKAR R. , CHALASANI V. , HAYNES A.M. , MATTHEWS J. , BRENNER P. , GOLOVSKY D. , KOONER R. , O'NEILL G.
Published: February 2006

We present a comparison of 5‐year outcomes of three groups of patients with intermediate and high risk prostate cancer treated with radical prostatectomy (RP) and high‐dose rate brachytherapy (HDRB). A retrospective analysis of patients undergoing RP during periods 1990–1994 and 1998–2000 and patients undergoing HDRB between 1998 and 2000 was performed. Inclusion criteria were: PSA > 20, or GS > 7, or clinical stage ≥T2b. We also calculated 5‐year progression free probability (PFP) based on Kattan nomograms and compared them to actual outcomes.

Results:  For RP 1990–1994 group, data were available from 134 patients. Median PSA was 16, median age 65 years, median 5‐year PFP after RP 65%. 28 patients received adjuvant treatment – hormones 20, orchiectomy one, radiotherapy four, radiotherapy plus hormones three. Actual 5‐year progression free survival was 46% and mean time to recurrence 22.5 months. For RP 1998–2000 group, there were 138 patients available. Median PSA was 8, median age 63 years, median 5‐year PFP after RP 66%. 27 patients received adjuvant treatment – hormones nine, radiotherapy nine, radiotherapy plus hormones nine. Actuarial 5‐year progression free survival was 72% and mean time to recurrence 26.5 months. HDRB group consisted of 86 suitable patients. Median PSA was 13, median age 69 years, median 5‐year PFP after RP was 38% and median 5‐year PFP after external beam radiation therapy with 80 Gy was 60%. 81 patients received adjuvant hormonal treatment. Actuarial 5‐year progression free survival was 81% and mean time to recurrence 30.4 months.
14  Early experience with positron emission tomography (PET) in the management of urological malignancies
Authors: O'MALLEY P.J. , HUGHES O. , REES J. , KYNASTON H.
Published: February 2006

Objective:  To demonstrate management alterations in patients with urological malignancies by the addition of PET.

Patients and Methods:  Ten patients with primary urological malignancies were included in this initial series (eight urothelial transitional cell and two penile squamous cell). Conventional imaging of computerised tomography (CT) and / or magnetic resonance imaging (MRI) yielded equivocal staging results pertaining to definitive management. Each patient underwent PET for further staging. Management alterations with respect to PET findings are outlined.

Results:  Of the 10 patients, five were downstaged and five upstaged with PET. Management changes are tabulated.

Conclusion:  We demonstrated in this series the role of PET in staging urological malignancies in those patients with equivocal conventional findings. Also, more accurate physiological staging allows better oncological treatment decisions and eventual patient outcome. These points highlighted need further clarification with larger series addressing the positive predictive value of PET.

  Downstaged  
  TABLE1: for 14  

Diagnosis
CT / MRI
PET
Management

G2T3 Bladder
Pelvic LN
Negative
Surgery

G3T2 Ureter
LN at primary
Negative
Surgery

G3T2® UO
Pelvic LN
Negative
Surgery

T2 Penis
Pelvic LN
Negative
Surgery

T2 Penis
Pelvic LN
Negative
Surgery

  Upstaged  
  TABLE2: for 14  

Diagnosis
CT / MRI
PET
Management

G3T2 Ureter
Pelvic LN
Metastatic
Chemotherapy

G3T2 Bladder
Pelvic LN
Metastatic
Chemotherapy

G3T2 Bladder
Pelvic LN
Metastatic
Radiotherapy

G3T4 Bladder
N0 M0
Metastatic
Chemotherapy

G3T3 Bladder
Pelvic LN
Metastatic
Radiotherapy
17  DD3 expression in metastatic prostate cancer
Authors: NGO T. , BURGER M. , LANDERS K. , SCELLS B. , SAMARATUNGA H. , LAVIN M. , GARDINER R.A.
Published: February 2006

Introduction:  There is currently a deficiency of predictive markers for prostate cancer (PCa). We therefore need to identify more sensitive and specific markers of this disease. Molecular markers are proving to be most useful. There are many genes whose expression patterns are altered in malignant tissues and one such gene is DD3, which is a non‐coding mRNA transcript, shown to be highly over‐expressed in localised prostate cancer. This is a pilot study to identify and quantitate the expression of the DD3 gene in metastatic prostate cancer lymph node specimens.

Methods:  Quantitative real‐time PCR (RT‐PCR) was performed on 35 benign prostatic hypertrophy (BPH) specimens, 21 localised PCa specimens and 11 hormone escape metastatic PCa lymph node specimens. All statistical analyses were performed using the Statistical Package for Social Science (SPSS; version 10.00).

Results:  DD3 was over‐expressed 140‐fold (P = 0.007) in the localised PCa samples compared to BPH. However, the results for the metastatic tissue samples were more variable, some samples expressed the gene in great quantities while others did not express the gene at all. The over‐expression of DD3 in metastatic PCa tissue was not statistically significant in the samples studied when compare to the localised PCa group (P = 0.19).

Conclusions:  Our study shows that the over‐expression of DD3 gene does appear to increase from localised to metastatic prostate cancer. Future applications of this study are to correlate our findings with the expression of DD3 transcripts in the blood and to utilise the DD3 gene as a possible target for vaccine therapies.
23  DNA promoter methylation in urothelial cancer: a feature of the invasive phenotype and a novel therapeutic target
Authors: CATTO J.W.F. , DHAWAN D. , MEUTH M. , CUSSENOT O. , AZZOUZI A.R. , HAMDY F.C.
Published: February 2006

Many molecular events in cancer occur at the epigenetic rather than genetic level. The best studied of these is DNA cytosine methylation. This occur most frequently in DNA promoter regions and results in loss of gene expression. Tumour suppressor gene silencing by aberrant hypermethylation has been demonstrated in several carcinogenic pathways. Here we present the latest results of our studies regarding promoter methylation in urothelial cancer (UC). Firstly, using 280 UC of the upper and lower urinary tracts we show that promoter methylation (at 11 tumour suppressor genes) occurs frequently (86%) and in an anatomically distinct pattern. Higher methylation levels are seen in the upper (94%) than lower urinary (76%) tracts (P < 0.0001), explaining the distinct pattern of microsatellite instability seen in UC. Furthermore, when tumour grade, stage and behaviour analysed, aggressive tumours (rapidly progressing and poorest differentiation, P = 0.001) have the highest levels of methylation. Secondly, studying 196 corresponding samples from 104 patients with invasive UC, we show that methylation occurs early in the invasive pathway and can be detected in both carcinoma in situ and normal urothelial samples from these patients. Once again the presence of methylation in either CIS or normal urothelium predicts rapid tumour progression (T test P < 0.0001). Finally, we use bladder cancer cell lines to show that epigenetic treatment (with 5‐azacytidine) removes the methyl groups from methylated cytosine residues and allows the re‐expression of previously silenced tumour suppressor genes. This induces cell apoptosis and reduces growth rates, suggesting a novel therapeutic role.
4  Audit of androgen deprivation therapy (ADT) register in Auckland region
Authors: ZARGAR H. , BEAVEN T.
Published: February 2006

Aim:  To determine the indications for therapy and disease state of men with prostate cancer on Luteinizing Hormone Releasing Hormone (LHRH) analogue treatment entered in the Auckland regional ADT register.

Method:  Patients were identified from ADT register and further information was obtained using hospital electronic databases (Concerto and CRIS) and general practitioner records.

Results:  Two hundred and eleven patients were registered from Jan 2000 to June 2005 on ADT register. The median age at diagnosis was 73 (45–91). 151 patients (71%) were alive at the time of audit. 118 of patients (56%)had a bone scan, 60 of which confirmed bony metastases (28% of all patients). Based on PSA score at diagnosis (>20), Gleason score (8,9,10) and stage of clinical disease (T3 or higher), high‐risk patients were identified.

The most common indication for LHRH analogue therapy as first line therapy was advanced local/metastatic disease (39%). 81 (38%) of patient developed hormone refractory disease while on treatment. The patients in high‐risk group were more likely to develop hormone refractory disease (Chi Square test P = 0.009). PSA Doubling Time (PSADT) of less than 10 months was associated with significance risk of developing local/bony complications (Chi Square test P = 0.002) and mortality (Chi Square test P = 0.034). Presence of metastatic disease was associated with increased mortality (Chi Square test P = 0.012).

Conclusion:  Patients in high‐risk group are more likely to develop hormone refractory disease. PSADT can be used as an indicator for identifying patients with increased risk of developing complications. Presence of metastatic disease at the time of diagnosis is associated with increased mortality.
41  Retrograde intrarenal stone surgery in ESWL resistant kidney stones
Authors: JUNG H.J. , NOERBY B.N. , OSTHER P.O.
Published: February 2006

Introduction:  The newer flexible ureteroscopes, 150–200 micron Holmium laser fibres and superflexible Dormias have made stone treatment in all parts of the kidney possible. This evaluation concerns the outcome of Retrograde Intrarenal Stone Surgery (RIRS) in ESWL‐resistant kidney stones.

Material and methods:  Thirty‐eight consecutive patients (18 males/20 females) were followed. All patients had undergone ESWL without success. Calculi ranged from 3 to 20 mm (mean 9 mm). In 32 cases stones were fragmented using Holmium laser, and in 6 cases stones were extracted with a zero tip Dormia without fragmentation. Sixteen patients had lower calyceal calculi and eight had abnormal upper tract anatomy. Follow‐up: IVP was performed 6–8 weeks posttreatment.

Results:  In all cases the stones were reached and fragmented to some extend. Complete stone freedom was found in 22/38 (58%) patients after one RIRS procedure and 4 (11%) had residual fragments <4 mm which were expected to pass spontaneously. In the remaining 12 patients, who initially had larger stones (mean 11.3 mm), the residual fragments ranged from 5 to 15 mm. Three patients underwent an additional RIRS following which they were stone free. The overall success rate was 76%. There were no major complications.

Conclusions:  RIRS is a safe procedure with high success rate and low complication rate. Patients with stones >1 cm, stones in the lower pole and with abnormal renal abnormality may require more than one sitting.
47  Comparison between open and laparoscopic live donor nephrectomy
Authors: KALOUCAVA S. , MARK S. , DAVIDSON P. , ROAKE J. , ARMSTRONG S.
Published: February 2006

Introduction:  Renal replacement therapy is the best management for end stage renal failure. Laparoscopic Donor Nephrectomy (LDN), which is considered safe and effective, began in our unit in July 2003 with an average transplant rate of 12 per year. The aim of this study is to compare the donor morbidity, recovery and costs between Open Donor Nephrectomy (ODN) and LDN.

Method:  A retrospective consecutive series of all Donor Nephrectomies since June 2002 were included in this study. Operative details, postoperative donor recovery, donor and recipients renal functions were reviewed. The total costs will also be calculated and compared.

Results:  There were 18 LDN and 18 ODN (Total 36 cases) included in this series and equal number of male to female cases.

Average operative time for ODN was 2.07 h and LDN was 3.36 h. There was no intra‐operative conversion from LDN to ODN and no peri‐operative morbidities in either group. The transplanted renal vessel lengths were also compared which showed an average artery length of 40 mm and vein length of 50 mm in the LDN group versus an average of 35 mm artery length and 30 mm vein length in the ODN group. The outcome of the recipient's renal function was not affected whether the donor had OPD or LDN. Average length of hospital stay was 6 days in ODN and 4.5 days in LDN. Costs data to follow.

Conclusion:  Laparoscopic Donor Nephrectomy (LDN) is safe and effective in a smaller renal transplant unit.
49  Helical CT 3D reconstruction of renal vessels. Is it accurate? Does it aid hilar dissection in transperitoneal (non‐hand assisted) laparoscopic nephrectomy and nephro‐ureterectomy
Authors: TAN A.F.
Published: February 2006

Introduction:  Laparoscopic Nephrectomy is increasingly accepted as the choice of treatment in patients who are undergoing nephrectomies. Current indications include renal cell carcinoma (T1 and T2), TCC of upper tract and non‐functioning kidneys. It remains a technically challenging procedure. The dissection of the hilum can be quite demanding, time consuming and stressful to the urologist. We explore the possible advantage of preoperative 3D‐CT reconstruction images of the renal vessels.

Method:  The prospective study involved 46 consecutive patients who were undertaking laparoscopic nephrectomies. All the patients had preoperative 3D‐CT and data were collected regarding location, number, anomalies and spatial inter‐relationship of the renal artery and vein. These were then correlated with intra operative data. Other information included peri operative blood loss, transfusion, conversion, hilar dissection time and operative time. These were compared with 26 patients who had previously undergone nephrectomies without the 3D‐CT.

Results:  The 3D‐CT was accurate in predicting the location and the anatomical relationship of the vessels in all the cases. However, it predicted the accurate number of arteries and veins in 90% and 80% respectively. With the imaging we were able to reduce the hilar dissection time (20 min), overall operative time (75 min) and blood loss. There was no conversion in the 46 patients.

Conclusion:  3D‐CT is an invaluable tool preoperative for patient considered for laparoscopic nephrectomies. It aids hilar dissection by predicting the inter‐relationship of the vessels. However, the surgeon must remain vigilant, as there may be more unsuspected vessel around the corner.
57  The impact of prostate size in laparoscopic radical prostatectomy
Authors: CHANG C.M. , MOON D. , GIANDUZZO T. , EDEN C.G.
Published: February 2006

Introduction:  Removal of a large prostate can be challenging during open or laparoscopic radical prostatectomy (LRP). Although gland size has been shown not to influence functional outcome in open radical prostatectomy (ORP) (Foley, 2003), longer operating times have been reported for transperitoneal LRP (El‐Feel, 2003; Rassweiler, 2001). The aim of this study was to investigate the influence of prostate size on LRP outcomes.

Patients and Methods:  Four hundred cases of LRP were performed. 111 LRP were performed using a transperitoneal approach and 289 using an extraperitoneal approach. 319 patients had a prostate weight ≤75 g and 81 patients had a prostate weight ≥75 g on final histology.

Results:  Patients’ age, weight, PSA, Gleason sum and clinical stage were all similar. Values are mean; 1independent samples test; 2Chi‐square test.

Conclusion:  Larger prostates were associated with a longer operating time (15 min) but shorter hospitalisation and fewer positive surgical margins. Blood loss and complication rates were similar. Prostate size should not be a factor determining a patient's suitability for LRP. Longer follow‐up is needed to assess the effect of prostate size on functional and oncological results.

1Gland weight (g)
1Op time (min)
1Blood loss (ml)
1Hosp stay (days)
2Compl
2+ margins

Prostate <75 g
46.8
192
259
3.2
4.5%
21.5%

Prostate >75 g
97.8
207
289
2.9
10.5%
9.3%

P
<0.0001
0.03
0.25
0.04
0.07
0.03
6  Can prostatic biopsy predict insignificant disease in Western Australia (WA)
Authors: VIVIAN J.B. , COHEN R. , GARRETT K.
Published: February 2006

Introduction:  Numerous criteria for predicting insignificant disease based on PSA density, Gleason score, number of and extent of involvement of each core with cancer have been described. Epstein et al have used this to attempt to delay or prevent surgery for low risk or insignificant disease. Epstein's criteria were applied to prostatic biopsies from the WA Uropath database.

Method:  The database was searched to identify cases of Gleason score 6 or less, less than 3 cores involved with cancer, and PSA density less than 0.15. Using these criteria 37 cases were identified. All of these cases went on to have a radical prostatectomy.

Results:  Nineteen had Tumour Gleason 6 or less and/or volume <=0.5cc at radical (insignificant disease). Eighteen had tumour Gleason 7 or greater and/or volume >0.5cc.

Conclusion:  Epstein's criteria when applied to the WA database was inefficient at predicting insignificant disease.
63  Stapling devices: a technical advance in radical retropubic prostatectomy
Authors: HEATHCOTE P.S.
Published: February 2006

Introduction:  This paper describes the use of a ‘thick tissue’, 3.5 ml staple, six row, articulated endoscopic linear cutting stapling gun in Radical Retropubic Prostatectomy (RRP).

Patients and Methods:  One hundred and ninety four consecutive RRPs performed by a single surgeon were analysed. The first 97 were performed without the stapler and the second 97 performed using an identical surgical technique apart from using the Linear cutting stapler.

Results:  Groups were of similar age, preop PSA, T stage and Gleason score. There were no staple gun failures. The dorsal venous complex was more safely secured and anastomotic sutures more easily placed especially in the presence of difficult anatomy. Limited division of the puboprostatic ligaments permitted better support of the continence mechanism. Larger pedicles were better secured without distortion of anatomy. Average operative time was reduced from 1.9 to 1.6 h (P = 0.0005). Average blood loss was reduced from 488 to 380 ml (P = 0.03). Positive surgical margins in the absence of extra capsular extension were reduced from 9% to 5% mainly due to better apical dissection. Mean time to return of urinary continence (no pads) improved from 4.6 to 4.0 months and urinary continence at twelve months improved from 88 to 92% (P = NS).

Conclusion:  The stapler is reliable and easy to use. It improved surgical access and decreased blood loss and operative time improving the overall safety of the operation. It did not compromise cancer control and may improve urinary continence.
78  Use of a rabbit model to investigate the feasibility of using an innervated neosphincter transplant for the treatment of stress urinary incontinence.
Authors: SHAFTON A.D. , O'CONNELL H.E. , FURNESS J.B.
Published: February 2006

Aim:  To examine the feasibility of using an innervated smooth muscle wrap as a neosphincter in a rabbit model of urinary incontinence.

Methods:  Rabbits were rendered incontinent surgically by lesion of the proximal urethral wall to the level of the submucosa (n = 20). In twelve animals a strip of dartos smooth muscle was wrapped around the lesioned urethra to create a new urethral sphincter and stimulating electrodes were inserted into the muscle. After a recovery period of at least one‐week cystometrograms were established for control (urethra intact), lesioned and lesion plus neosphincter animals.

Results:  Infusion of saline into the bladder of control animals caused a slow rise in bladder pressure until, at approximately 20–30 ml, there was an increase in pressure that rose steeply and was associated with bladder emptying. The threshold for this reflex emptying was 2–3 cm H2O, and the maximum pressure during the reflex was 6–15 cm H2O. After the bladder emptied, the pressure dropped to 0–2 cm H2O. In rabbits with lesioned sphincters, it was not possible to obtain a normal cystometrogram because there was leakage of fluid from the urethral opening before a volume and pressure sufficient to elicit a reflex was achieved. The loss of the majority of fluid often occurred without a significant pressure increase, that is, there was no true emptying reflex. Similar results were observed in animals in which the urethra had been lesioned and implanted with the smooth muscle neosphincter. Prior to electrical stimulation of the neosphincter, with constant current pulses at 2 Hz, substantial leak occurred at 11.4 ± 2.5 ml, whereas during stimulation voiding occurred at 17.8 ± 1.4 ml. At void or emptying, the peak pressure was 6.1 ± 0.1 cm H20 in control, 0.7 ± 0.2 in operated but not stimulated and 3.5 ± 0.6 in the same animals during stimulation. A satisfactory improvement of continence was observed for a period of up to 6½ months postsurgery. At the end of the study, histological examination confirmed the neosphincter to be both healthy and viable.

Conclusion:  Smooth muscles of the dartos display contractile properties which make them suitable for use as transplantable sphincters. A smooth muscle neosphincter, controlled by electrical stimulation, can restore continence after urethral damage.
81  Botulinum toxin for treatment of non‐neurogenic bladders in children – a case series
Authors: RAO R. , BARKER A.
Published: February 2006

Objective:  Several studies have shown that intradetrusor injections of botulinum neurotoxin type A may effectively treat intractable spinal neurogenic detrusor overactivity, but fewer reports exist on the use of Botulinum toxin in children with non‐neurogenic detrusor overactivity. The purpose of this study was to investigate the effect of Botulinum injections in the treatment of non‐neurogenic bladders in children.

Methods:  Six children with overactive bladder symptoms were treated. Their disorder had been refractory to anticholinergics, bladder training and neuromodulation. Urodynamic studies confirmed idiopathic detrusor overactivity. Total of 300 U Botox A was injected into the dome of the bladder as 30 × 10 U injections. For follow up a bladder diary and validated urgency and incontinence charts were completed by patients at 1, 3 6 months.

Results:  Bladder diaries indicated clear reduction in daytime frequency and nocturia and reduction in pad use. Maximal voiding volume increased significantly. All 6 patients were dry after 6 months. No side effects occurred specifically urinary tract infections or retention.

Time
Dry
Partial Response
Nil Response

2 weeks
1
4
1

4 weeks
3
3
0

12 weeks
6

Conclusions:  Botox A injection has positive effects in treating non‐neurogenic bladder overactivity in children.
84  One year results of a French, multicentre, prospective clinical study of act® (adjustable continence therapy) for the treatment of female of stress urinary incontinence due to intrinsic sphincter deficiency
Authors: CHARTIER KASTLER E. , HAAB P. , NORMAND L. , COSTA P. , NAOUM B.
Published: February 2006

Introduction:  This Prospective, multicentre clinical investigation sought to assess the feasibility and efficacy of the adjustable balloons ACT® for treatment of female Stress Urinary Incontinence SUI with ISD.

Materials and Methods:  The ACT® implant consists of a two‐lumen conduit of variable length with an expandable silicone balloon (0.5–8 cc) on the proximal end and a distal subcutaneous titanium port. Two balloons were placed periurethrally at the bladder neck. Continence rate (no leakage during direct visual stress test with 250 ml placed in the bladder), improvement, failures, quality of life (I‐QoL) and morbidity were assessed.

Results:  Sixty‐seven patients (62 ± 9.8‐years‐old) were implanted in France during 75 procedures (8 revisions). Average follow‐up was 12 months. At baseline, urethral closure pressure was 22.5 ± 10.8 cm H2Oand 39 patients (58%) had previously undergone at least one surgery for SUI. Continence increased from 0% at baseline to 57% at1 year and I‐QoL improved from 39.4 ± 19 at baseline to 63.7 ± 23.3 at one year. Balloon adjustment was required in 64% of patients. Complications included erosion (11%), spontaneously resolved retention (2%) and infection (4%).

Conclusion:  ACT® offers a viable alternative for the treatment of SUI in female with ISD. The implantation is a minimally invasive and efficient procedure and stable over time therapy for patients with severe SUI with ISD. Implantation can be done under local anaesthesia. The positioning of ACT® treatment versus artificial urinary sphincter still needs to be determined.
88  The adjustable continence therapy (PROACT™) for the treatment of post‐prostatectomy stress urinary incontinence: a comparison of two techniques
Authors: GILLING P.J. , KENNETT K.M. , WESTENBERG A.M. , FRAUNDORFER M.R. , WILSON L.M. , BELL D.F.
Published: February 2006

Introduction:  The Adjustable Continence Therapy (ProACT™) consists of two postoperatively adjustable balloons placed either at the level of bladder neck in postradical prostatectomy patients or, more recently, at the level of the apex in patients with residual prostate tissue. We compared the efficacy of ProACT in post radical and benign surgery patients.

Materials and Methods:  Thirty postradical prostatectomy (RP) and seven postbenign surgery have been evaluated beyond 6 months follow up. Three of the RP and one in the benign group had also undergone radiation therapy. Baseline assessment of pad usage; Quality of Life questionaries and assessment of adverse events were repeated at 6, 12, 24 and 36 months.

Results:  Mean follow‐up was 18.9 months in the RP group and 27.8 months in the benign group. Pad usage in the RP and postbenign group decreased from 2.6 and 3.8 at baseline to 0.7 and 1.2 at 6 months; 0.5 and 1 at 12 months; 0.6 and 1 at 24 months and 0.4 and 0.7 at 36 months respectively. Quality of Life increased in the RP and benign group from 49.6 and 49.7 at baseline to 71.7 and 77.9 at 6 months; 74.9 and 78.6 at 12 months; 70.6 and 76.1 at 24 months and 88 and 86.5 at 36 months respectively. Adverse events including balloon migration (two) and infection (three) were managed by outpatient removal and further re‐implantation.

Conclusions:  The results appear similar in both groups, though different techniques are required.
82  Mixed incontinence in women with spinal cord injury (SCI) can be successfully treated with concomitant intradetrusor (ID) botulinum toxin (BTX) injections and suburethral sling
Authors: PATKI P. , WOOD S. , ARUMUGAM K. , HAMID R. , SHAH P.J.R.
Published: February 2006

We prospectively assessed the efficacy of simultaneous ID BTX injections and transobturator (TOT) and tension free vaginal tapes (TVT) in SCI women refractory or intolerant to anticholinergics. Five SCI women with urodynamically proven mixed incontinence were treated with simultaneous suburethral sling and BTX injections. TVT or TOT followed ID injection of 1000 units of English BTX in the same sitting. Patient demographics, pre and postoperative quality of life score, clinical and videocystometrogram (VCMG) parameters were recorded. Continence was assessed at 6 weeks (voiding diary and pad test), 3 months (VCMG) and then yearly. There were no immediate or long‐term complications. TVT was performed in three (two thoracic and one lumbar SCI) and TOT in two (one thoracolumbar and one lumbar SCI). Sustained improvement was seen in all clinical parameters starting from 6 weeks till the last follow up at a mean of 13.8 months. All patients were dry with improved quality of life. Corresponding changes were seen on VCMG. (Table). Mixed incontinence in SCI women refractory or intolerant to anticholinergics can be treated with simultaneous ID BTX injections and TOT or TVT with high cure and satisfaction rates.

Pt. No.
MCC (ml)
MDP (cm of water)
Detrusor hyperreflexia
USI

Pre
Post
Pre
Post
Pre
Post
Pre
Post

1
110
420
33
16
Yes
No
Yes
No

2
260
450
38
18
Yes
No
Yes
No

3
500
700
93
20
Yes
No
Yes
No

4
225
412
74
42
Yes
No
Yes
No

5
350
625
46
15
Yes
No
Yes
No
Comparing clinical and lay accounts of the diagnosis and treatment of back pain
Authors: Ong Bie Nio , Hooper Helen
Published: February 2006

This paper builds on the body of knowledge concerning clinician‐patient relationships, patient‐centred care and concordance. It extends the analysis to directly comparing patient and professional accounts of diagnosis, treatment and outcomes over time. Comparisons will be made between lay and clinical perspectives, but also between different professional approaches and patients’ assessment of those differences. The paper is based upon an in‐depth qualitative analysis of two case studies: first, one patient who established concordant relationships with the health professionals who treated her back pain; second, one patient who had both concordant and discordant relationships with health professionals. The issues explored centre on the determinants of concordant/discordant therapeutic relationships and whether greater attention given to the meaning of illness leads to improved care.
The body as interactive display: examining bodies in a public exhibition
Authors: Von Lehm Dirk
Published: February 2006

‘Body Worlds’ is an exhibition of human bodies that is currently touring Europe, the Far East and the USA. The public display of ‘real’ human bodies has caused public controversy and debate about the moral and educational value of the exhibition. Relatively little academic research, however, has been undertaken to explore how visitors see and reflect on the exhibits. In this journal, Tony Walter recently examined messages people left in the exhibition's comment‐books to reveal how people saw the bodies. His investigation provides interesting insights into people's understanding of and attitude to Body Worlds. This paper complements Walter's findings by analysing video‐recordings of visitors looking at the ‘plastinated’ bodies at the showing of Body Worlds in London in 2002/03. The analysis reveals how people anatomise the exhibits and consider them in the light of their knowledge and experience of ‘real’ human bodies, such as those of other people and their own. The paper concludes with a discussion of how the observations and findings from the analysis bear upon debates on Body Worlds and in the sociology of health and illness.