bluuebunny/crossref_metadata_2025 huggingface dataset:
Growth hormone response to GHRH, GHRP‐6 and GHRH+GHRP‐6 in patients with polycystic ovary syndrome
Authors: Micić Dragan , Kenderesˇki Aleksandra , Popović Vera , Sˇumarac Mirjana , Zorić Svetlana , Macut Djuro , Dieguez Carlos , Casanueva Felipe
Published: November 2003

OBJECTIVE Despite improved diagnostic facilities and advanced in vitro studies, the primary causes of the polycystic ovary syndrome (PCOS) have not been resolved. A defect in the regulation of GH secretion has been suggested in PCOS but the available data are limited and the underlying mechanisms remain unknown. In recent years considerable attention has been devoted to non‐classic GH secretagogues and, in particular, to the series of hexapeptides of which GH‐releasing peptide (His‐D‐Trp‐Ala‐Trp‐D‐Phe‐Lys‐NH2, known as GHRP‐6) is the most representative. GHRP‐6 seems to be a promising tool for exploring GH secretory mechanisms and it has been reported that GHRH+GHRP‐6 is a powerful stimulus to GH secretion. Our aim was to investigate the GH responses to GHRH, GHRP‐6 and the administration of GHRH+GHRP‐6 in two groups of patients (normal weight and obese) with PCOS in comparison with matched control groups.

DESIGN All subjects were studied three times on different days with GHRH (100 μg i.v.), GHRP‐6 (90 μg i.v.) and GHRH+GHRP‐6 (100μg+90μg).

PATIENTS Sixteen women with PCOS and 22 healthy controls were studied. They were divided into four groups according to BMI: Group A (non‐obese PCOS, n=6, age 21.8±1.7 years, BMI 22.1±0.8 kg/m2); Group B: (obese PCOS, n=10, age 12.7±1.3 years, BMI 32.9±2.1 kg/m2); Group C (non‐obese healthy women, n=13, age 26.8±1.5 years, BMI 21.8±0.6 kg/m2) and Group D (obese healthy women, n=9, age 29.4±4.2 years, BMI 35.7±1.3 kg/m2).

MEASUREMENTS Serum GH was measured using a time‐resolved fluoroimmunoassay (Delphia, Pharmacia).

RESULTS After GHRH administration significant differences were found between GH peaks in Groups A and B (82.4±16.4 vs 20±4.8 mU/l P<0.05) and in AUC for GH between Groups A and B (4667±1061 vs 847±236, P<0.05) while there were no differences between the same groups in GH peak or AUC after GHRP‐6 administration. There were no significant differences in peaks or AUC for GH after GHRH between Groups A and C, nor between Groups B and D. There were significant differences in GH peaks after combined administration of GHRH+GHRP‐6 between Groups A and B (211±26.4 vs 108±17.6, P<0.05) as well as between GH AUC in Groups A and B (12068±2323 vs 5997±1342, P<0.05). There were no differences in GH peaks or AUC for GH after GHRH+GHRP‐6 administration between Groups A and C or Groups B and D.

CONCLUSIONS The impaired GH response to GHRH found in obese PCOS patients is a consequence of obesity and could be a functional defect, since it can be overridden with GHRP‐6 administration.
Differential stimulation of corticol and dehydropiandrosterone levels by food in obese and normal subjects: relation to body fat distribution
Authors: Korbonits Márta , Trainer Peter J. , Nelson Marcia L. , Howse Iain , Kopelman Peter G. , Besser G. Michael , Grossman Ashley B. , Svec Frank
Published: November 2003

BACKGROUND It has been previously shown that food intake elevates circulating ACTH and cortisol levels, but no report has been published regarding the changes in circulating dehydroepiandrosterone (DHEA). DHEA was originally described as a weak androgen, but more recently it has been associated with a wide range of metabolic functions. In addition, previous studies have described a hyper‐responsive hypothalamo‐pituitary‐adrenal axis in obese subjects in response to various stimuli, but the specific response to food has not been studied.

SUBJECTS AND DESIGN We studied the effect of food on the hypothalamo‐pituitary‐adrenal axis in 20 subjects of normal body mass index (BMI range 18–25) and also in a group of 12 obese subjects (BMI range 34–61). Levels of glucose, insulin, ACTH, cortisol and dehydroepiandrosterone were measured every 20 minutes.

RESULTS A small rise in DHEA accompanies the rise in circulating ACTH and cortisol in response to food in both lean and obese subjects, but DHEA rose independently of cortisol and ACTH on the fasting day. In the obese subjects, food induced a significantly greater change in serum cortisol (peak cortisol rise (mean±SEM); normal‐weight group, 169±14%; obese group, 294±23%) and in the cortisol/DHEA ratio (area under the curve; normal‐weight group, 202±15%; obese group, 292±29%) than in the normal‐weight subjects. This difference was particularly notable in those with central‐type obesity (waist/hip ratio>0.80). A group of the normal, lean female subjects showed no cortisol rise after food intake.

CONCLUSION Our results suggest that DHEA may vary independently of circulating cortisol, and that the cortisol response to food is enhanced in obese subjects, particularly in those with central obesity. We speculate that there may be a caused connection between the cortisol response to food in normal subjects, and the subsequent distribution of fat if such subjects overeat sufficiently to become obese.
Bone mineral density in relation to glucocorticoid substitution therapy in adult patients with 21‐hydroxylase deficiency
Authors: Jääskeläinen Jarmo , Voutilainen Raimo
Published: November 2003

OBJECTIVE There are only limited data on bone mineral density (BMD) in adult patients with 21‐hydroxylase deficiency (21‐OHD). We have defined the effects of different glucocorticoid substitution therapies on BMD and body composition in these patients.

DESIGN Cross‐sectional.

PATIENTS Thirty‐two adult patients with 21‐OHD.

MEASUREMENTS Patients were examined auxologically and biochemically. BMD was examined in the left femoral neck and lumbar vertebrae 2–4 (L2–4) with dual X‐ray absorptiometry. The results were compared with national reference data.

RESULTS Mean height was 170.1 cm (−1.36 standard deviation scores (SDS) for the men and 156.3 cm (−1.68 SDS) for the women. These were significantly less (P<0.001) than the mean national final heights. Mean BMD Z‐score ((raw score − population reference mean)/SD) was −0.52 in L2–4 and −0.83 in the left femoral neck. Both these values were significantly less than the reference mean values (P=0.045 and <0.001, respectively). Both current and long‐term mean glucocorticoid doses showed significant negative correlations with BMD in the left femoral neck as well as in L2–4. Patients substituted with hydrocortisone were less often over‐treated and had better BMD Z‐score means than patients substituted with prednisone, prednisolone or dexamethasone.

CONCLUSIONS In the follow‐up of patients with 21‐hydroxylase deficiency, care needs to be exercised to keep the glucocorticoid substitution dose to a minimum. In most cases decreased bone mineral density is a result of over‐substitution.
Disorder–order transition of λ CII promoted by low concentrations of guanidine hydrochloride suggests a stable core and a flexible C‐terminus
Authors: Datta Ajit B. , Roy Siddhartha , Parrack Pradeep
Published: November 2003

The CII protein of bacteriophage λ, which activates the synthesis of the λ repressor, plays a key role in the lysis–lysogeny switch. CII has a small in vivo half‐life due to its proteolytic susceptibility, and this instability is a key component for its regulatory role. The structural basis of this instability is not known. While studying guanidine hydrochloride‐assisted unfolding of CII, we found that low concentrations of the chaotrope (50–500 mm) have a considerable effect on the structure of this protein. This effect is manifest in an increase in molar ellipticity, an enhancement of intrinsic tryptophan fluorescence intensity and a reduction in ANS binding. At low concentrations of guanidine hydrochloride CII is stabilized, as reflected in a significant decrease in the rate of proteolysis by trypsin and resistance to thermal aggregation, while the tetrameric nature of the protein is retained. Thus low concentrations of guanidine hydrochloride promote a more structured conformation of the CII protein. On the basis of these observations, a model has been proposed for the structure of CII wherein the protein equilibrates between a compact form and a proteolytically accessible form, in which the C‐terminal region assumes different structures.
Bilayer localization of membrane‐active peptides studied in biomimetic vesicles by visible and fluorescence spectroscopies
Authors: Sheynis Tanya , Sykora Jan , Benda Ales , Kolusheva Sofiya , Hof Martin , Jelinek Raz
Published: November 2003

Depth of bilayer penetration and effects on lipid mobility conferred by the membrane‐active peptides magainin, melittin, and a hydrophobic helical sequence KKA(LA)7KK (denoted KAL), were investigated by colorimetric and time‐resolved fluorescence techniques in biomimetic phospholipid/poly(diacetylene) vesicles. The experiments demonstrated that the extent of bilayer permeation and peptide localization within the membrane was dependent upon the bilayer composition, and that distinct dynamic modifications were induced by each peptide within the head‐group environment of the phospholipids. Solvent relaxation, fluorescence correlation spectroscopy and fluorescence quenching analyses, employing probes at different locations within the bilayer, showed that magainin and melittin inserted close to the glycerol residues in bilayers incorporating negatively charged phospholipids, but predominant association at the lipid–water interface occurred in bilayers containing zwitterionic phospholipids. The fluorescence and colorimetric analyses also exposed the different permeation properties and distinct dynamic influence of the peptides: magainin exhibited the most pronounced interfacial attachment onto the vesicles, melittin penetrated more into the bilayers, while the KAL peptide inserted deepest into the hydrophobic core of the lipid assemblies. The solvent relaxation results suggest that decreasing the lipid fluidity might be an important initial factor contributing to the membrane activity of antimicrobial peptides.
Interactions of the peripheral subunit‐binding domain of the dihydrolipoyl acetyltransferase component in the assembly of the pyruvate dehydrogenase multienzyme complex of Bacillus stearothermophilus
Authors: Jung Hyo‐Il , Cooper Alan , Perham Richard N.
Published: November 2003

The enzymes pyruvate decarboxylase (E1) and dihydrolipoyl dehydrogenase (E3) bind tightly but in a mutually exclusive manner to the peripheral subunit‐binding domain (PSBD) of dihydrolipoyl acetyltransferase in the pyruvate dehydrogenase multienzyme complex of Bacillus stearothermophilus. The use of directed mutagenesis, surface plasmon resonance detection and isothermal titration microcalorimetry revealed that several positively charged residues of the PSBD, most notably Arg135, play an important part in the interaction with both E1 and E3, whereas Met131 makes a significant contribution to the binding of E1 only. This indicates that the binding sites for E1 and E3 on the PSBD are overlapping but probably significantly different, and that additional hydrophobic interactions may be involved in binding E1 compared with E3. Arg135 of the PSBD was also replaced with cysteine (R135C), which was then modified chemically by alkylation with increasingly large aliphatic groups (R135C ‐methyl, ‐ethyl, ‐propyl and ‐butyl). The pattern of changes in the values of ΔG°, ΔH° and TΔS° that were found to accompany the interaction with the variant PSBDs differed between E1 and E3 despite the similarities in the free energies of their binding to the wild‐type. The importance of a positive charge on the side‐chain at position 135 for the interaction of the PSBD with E3 and E1 was apparent, although lysine was found to be an imperfect substitute for arginine. The results offer further evidence of entropy–enthalpy compensation (‘thermodynamic homeostasis’) − a feature of systems involving a multiplicity of weak interactions.
IS THE REVISED TRAUMA SCORE STILL USEFUL?
Authors: Gabbe Belinda J. , Cameron Peter A. , Finch Caroline F.
Published: November 2003

The revised trauma score (RTS) has been embraced by the trauma community worldwide. Although originally developed as a triage tool, the use of the RTS has since been expanded to include the prediction of outcome following traumatic injury. Through a critical review of the literature, evidence for use of the RTS is discussed along with the limitations of this commonly used tool. In summary, the RTS is a well‐established predictor of mortality in trauma populations, but there is a lack of definitive evidence supporting its use as a primary triage tool and as a predictor of outcomes other than mortality. Difficulty in collecting the components of the RTS creates issues for data validity and the use of the RTS as a research tool. Although the weighted RTS has been developed to improve the prediction capacity of the RTS, studies reporting its use are few and there is debate regarding the applicability of the published coefficients for broad use. Overall, further studies are warranted to clearly establish the usefulness of the RTS as a triage tool in the field, to further evaluate the weighted version of the RTS, and to determine the ability of the RTS to predict functional outcome and quality of life. In particular, future research is needed to address these issues in Australian trauma populations.
LAPAROSCOPIC DONOR NEPHRECTOMY: MEETING THE CHALLENGE OF CONSUMERISM?
Authors: Siddins Mark , Hart Gabrielle , He Bulang , Kanchanabat Burapa , Mohan Rao M.
Published: November 2003

Background:  Despite the increasing adoption of laparoscopic donor nephrectomy, no study has examined donor perceptions following this procedure. In particular, it has been tacitly assumed that a less invasive procedure might in itself provide a more satisfactory donor experience. The present study reviews the experience of donors undergoing laparoscopic nephrectomy, and examines the extent to which contemporary management practice addresses issues relevant to consumerism.

Methods:  Forty‐two donors participated in a structured telephone interview, and 33 (79%) returned a written questionnaire.

Results:  Coming through the survey was a strong sense of commitment to donation, and most respondents were satisfied with the experience. The main criticisms related to hotel services, the duration of the preoperative investigations, the perceived quality of nursing care on the general wards, medical communication and the duration of postoperative follow up. The self‐reported time to meet recovery goals was extremely broad.

Conclusions:  Considering the nature of criticisms offered by the respondents, it is concluded that the expectations of donors as health‐care consumers will only be met through modification of existing protocols.
WAITING TIME THRESHOLDS: ARE THEY APPROPRIATE?
Authors: MacCormick Andrew D. , Parry B. R.
Published: November 2003

Background:  The introduction of health reforms in New Zealand included the setting of an arbitrary waiting time threshold of 6 months for surgery. The aim of the present study was to investigate the differences in waiting times for different diagnoses in elective general surgery, and the interplay between diagnoses and waiting time thresholds.

Methods:  A survival curve analysis of 918 patients placed on the elective general surgical waiting lists was conducted. This was undertaken in a tertiary level hospital in New Zealand before the implementation of the waiting time thresholds. The difference between diagnoses of time waited for elective surgery (plotted on survival curves), and hazard function for patients waiting at 180, 360 and 540 days, was investigated.

Results:  Survival curves for malignancy, cholelithiasis, hernias and anorectal disease were different on log−rank test (P < 0.001). Those with a diagnosis of malignancy show that at 180 days the hazard function was 0.0049 but by 360 days had dropped to zero. With hernias and anorectal disease, the drop to zero appeared to be delayed until 540 days; however, the confidence intervals at 360 days included zero. In the case of cholelithiasis, the hazard functions indicate surgery occurring until 540 days.

Conclusions:  There are different waiting time thresholds for different surgical illnesses. Setting a universal waiting time for elective surgery is not supported.
Factors influencing the service‐like thermomechanical fatigue test cycle endurance of 1% CrMoV rotor steel
Authors: MASSEREY B. , COLOMBO F. , MAZZA E. , HOLDSWORTH S.
Published: November 2003

Service‐like thermomechanical fatigue tests have been performed in order to characterize the endurance of 1% CrMoV rotor steel under such transient thermal conditions. The key features of these tests are low strain rates (≤10−5 s−1) and longer hold periods. In all testpieces, ratcheting with progressive section reduction is observed in the central portion of the gauge length accompanied by local amplification of the strain range. The finite‐element‐based analysis of this phenomenon allows the measured endurances to be rationalized with those determined from isothermal tests. Post‐test inspection has revealed the development of two concurrent damaging mechanisms in the testpieces: (i) fatigue at the surface and (ii) creep in the interior. Different methods of damage calculation for creep–fatigue interaction are applied and compared in their predictive capabilities.
Probabilistic evaluation of leak rates through multiple defects: the case of nuclear steam generators
Authors: CIZELJ L. , ROUSSEL G.
Published: November 2003

A probabilistic approach aimed at predicting the probability of excessive leakage through flaws in tubes is proposed in the paper. The excessive leakage is assumed to occur when the sum of all individual leak rates through degraded tubes exceeds the predefined acceptable value. Additionally, a brief description of some estimators used in the field to obtain conservative estimates of the 95th percentile (e.g., upper limit) of the total leak rate is given. The conservatism of those estimators is quantified through failure probability in the two numerical examples. The leak rates through the individual flaws were evaluated using models developed by EPRI for assessment of outside diameter stress corrosion cracks (ODSCC) in tubes of steam generators in nuclear power plants assuming postulated hypothetical accidental conditions. The distributions of flaw sizes are based on inspection data obtained from Slovene and Belgian plants with 3/4 inch tubes made of Alloy 600 Mill Annealed. The numerical examples analyse the behaviour of the model for both small and large flaw sizes. The results include: prediction and discussion of the probability of excessive leakage; the conservatism of approximate estimators; comments on the sensitivity of the probability of excessive leakage to the major uncertainties inherent to data and models used.

As a conclusion, some suggestions to improve both the efficiency of the numerical estimators and models used to estimate the leak rates through individual defects are given.
Crack propagation in notched specimens of porous silicon carbide under cyclic loading
Authors: TANAKA K. , AKINIWA Y. , KITA Y. , SEGAWA M.
Published: November 2003

Notched specimens of porous silicon carbide with porosity 37% were fatigued under four‐point bending at frequencies of 30 and 0.3 Hz. The fatigue life expressed in terms of time was rather insensitive to the test frequency, while that expressed in terms of cycles was much shorter for the case of 0.3 Hz than for 30 Hz. A time‐dependent mechanism of stress corrosion cracking was mainly responsible for crack propagation, and stress cycling enhanced the crack‐propagation mechanism. The crack length was estimated from the change in compliance of the specimen. The crack‐propagation curve was divided into stages I and II. In stage I, the crack‐propagation rate decreased even though the applied stress intensity factor became larger with crack extension, and then turned to increase in stage II. The transition from stage I to II took place at a crack extension of around 0.8 mm. This anomalous behaviour is caused by crack‐tip shielding due to microcracking and asperity contact. Fractographic observations showed that the fracture path was along the binder phase between silicon carbide particles, or more precisely along the interface between particles and binders.
Pre‐operative short‐course radiotherapy is associated with faecal incontinence after anterior resection
Authors: Welsh F. K. S. , McFall M. , Mitchell G. , Miles W. F. A. , Woods W. G. A.
Published: November 2003

Objective  To determine the contribution of total mesorectal excision (TME), short‐course pre‐operative radiotherapy (SCRT), the level of the anastomosis and other putative contributory factors to the incidence and degree of faecal incontinence after anterior resection of the rectum.

Patients and methods  Survivors of anterior resection of the rectum performed between February 1996 and February 2001, with a functioning anastomosis, were asked to complete a telephone questionnaire regarding their current bowel habit. Faecal incontinence was scored using the St. Mark's Incontinence Score.

Results  The median age of 124 patients who completed the questionnaire was 76 years. Of these, 104 patients had neoplastic disease, 66 (53%) patients exhibited some degree of incontinence, median St. Marks' Score 6, interquartile range 3–10. There was a significant association between the anastomotic level, and the St. Mark's Score (P < 0.0001, linear regression). Male sex (P = 0.047), SCRT (P = 0.0014) and an anastomotic leak (P = 0.038) were associated with significantly higher incontinence scores. Age, splenic flexure mobilization, TME, anastomotic configuration or use of a temporary stoma had no detectable independent effect on incontinence scores.

Conclusions  Poor functional outcome following anterior resection was associated with a low anastomosis, SCRT or an anastomotic leak. The finding that SCRT was a predictor of postoperative incontinence emphasizes the need for stringent patient selection for this treatment modality.
Surveillance of individuals at intermediate risk of colorectal cancer – the impact of new guidelines
Authors: Clark S. K. , Carpenter S. , Broughton C. I. M. , Marks C. G.
Published: November 2003

Objective  Individuals with two first degree relatives, or one diagnosed at age < 45 years, with colorectal cancer are at sufficient risk to merit surveillance. Most undergo colonoscopy four to five yearly, starting 10 years before the youngest case. The aim of this study was to assess the impact of a proposed new surveillance protocol.

Subjects and methods  We identified individuals with these risk criteria seen in our clinic from 1989 to 2001 and reviewed their notes with respect to colonoscopy.

Results  Colonoscopy (n = 295) was performed on 186 patients in accordance with current recommendations. Cancer was detected in three and adenoma in 21 individuals. Applying the proposed protocol, 123 (42%) fewer colonoscopies would have been performed. No cancers would have been missed, but in five cases a small adenoma would not have been detected.

Conclusions  Proposed new guidelines for surveillance of those at intermediate risk reduce the burden of colonoscopy without compromising identification of significant neoplasia.
A snapshot of MDT working and patient mapping in the UK colorectal cancer centres in 2002
Authors: Kelly M. J. , Lloyd T. D. R. , Marshall D. , Garcea G. , Sutton C. D. , Beach M.
Published: November 2003

Objectives  To ascertain the position nationally of Colorectal Multi‐Disciplinary Team (MDT) implementation as part of the NHS cancer plan. Also to define nationally patterns of ‘bottlenecks’ in the patient journey from referral to treatment.

Methods  A simple questionnaire was sent to the lead clinician at all 183 cancer networks asking about their current MDT organization, and whether they had undertaken a mapping exercise of the patient journey.

Results  Ninety‐one percent (n = 166) of the questionnaires were returned, and of these 90% (n = 150) stated that their MDT meeting was up and running. Sixty‐two percent (n = 102) stated they were having problems running their MDT meeting and of these 32% (n = 33) did not have a dedicated MDT clerk. Several of the Calman‐Hine identified ‘core personnel’ are attending infrequently. Sixty‐four percent (n = 107) of respondents have carried out a patient mapping process with 65% (n = 70) claiming it was a success, leaving 27% (n = 32) with no immediate plans to undertake the process.

Conclusions  Although MDT activity is near‐universal, the survey has highlighted a wide variation in MDT meeting implementation across England, with the same problems being experienced by most centres. Organizational problems are common, and we feel that a dedicated MDT clerk is essential for smooth running. Further areas that require development have been identified by most respondents as radiological, oncological and endoscopic services. It is anticipated that true collaboration nationally will develop, and contact with the nine pilot sites is encouraged to explore solutions to difficulties.
Surgical treatment of haemorrhoids according to Longo and Milligan Morgan: an evaluation of postoperative tissue response
Authors: Krška Z. , Kvasnièka J. , Faltýn J. , Schmidt D. , Šváb J. , Kormanová K. , Hubík J.
Published: November 2003

Objectives  To compare by prospective randomised trial the postoperative tissue reaction of stapled vs. conventional haemorrhoidectomy.

Patients and methods  Fifty patients with stage III haemorrhoids underwent surgery for haemorrhoids. Group 1 (n = 25) had the Milligan‐Morgan procedure; Group 2 (n = 25) had a stapled haemorrhoidectomy. All patients underwent measurements of endothelial dysfunction markers including E‐selectin, P‐selectin and intercellular adhesion molecule (ICAM). Acute‐phase proteins including C‐reactive protein, orosomucoid and fibrinogen were also measured. Estimations were made prior to surgery, immediately afterward surgery and on the first and fifth postoperative days. Assessment of clinical outcome was made one month after the surgery.

Results  There was a postoperative increase of acute‐phase reactants in both groups. The patterns of the cures of the monitored parameters appeared similar in both groups. Lower values were found in Group 1, but the difference was not statistically significant except the level of fibrinogen on day 5, which was significantly higher in Group 2. E‐selectin, P‐selectin and ICAM showed similar time curves. Statistical analysis found the differences to be significant only when individual days were compared and not for the types of surgery. Raised ICAM and P‐selectin on the fifth postoperative day was found in both groups. In Group 1, pain assessment by patients remained in the lower part of the pain rating scale, while in Group 2 it did not start declining until one week after surgery and became normal in the third to fourth weeks. In Group 1, the duration of hospitalization and the duration of incapacity for work were 50% of the values in Group 2.

Conclusion  Patients having stapled haemorrhoidectomy have less pain and experience more rapid recovery when compared to classical haemorroidectomy. This was mirrored by the acute‐phase protein CRP and fibrinogen levels postoperatively. There was no significant difference in other acute‐phase reactants monitored, nor was there any difference in parameters of endothelial dysfunction. The techniques differ in extent of pain and duration of hospital stay and incapacity for work.
Abnormal prostatic cells in ejaculates from men with prostatic cancer — a preliminary report
Authors: Gardiner R.A. , Samaratunga M.L.T.H. , Gwynne R.A. , Clague A. , Seymour G.J. , Lavin M.F.
Published: November 2003

Objective To relate findings from a novel approach, ejaculate cytology, to the established reference, histopathology from transrectal ultrasonography (TRUS)‐guided prostatic biopsies, in patients at risk of having prostatic cancer on the basis of an abnormal digital rectal examination (DRE) and/or an elevated serum prostate specific antigen (PSA).

Patients subjects and methods Thirty‐seven men suspected of having prostatic carcinoma provided ejaculate specimens which were collected in Hanks solution. The specimens were centrifuged to form a pellet from which smears were made for cytological examination. Immunohistochemical staining for PSA and prostatic acid phosphatase (PAP) were performed on embedded blocks of these cells. TRUS‐guided sextant biopsies were performed for histological specimens using standard clinical procedures. A control group of 32 men <30 years of age, with no family history of prostatic cancer, also produced specimens of ejaculate which were processed similarly.

Results Frankly malignant and atypical prostatic cells were identified in ejaculate specimens from 14 of the 37 patients. Of 12 patients with TRUS biopsies positive for malignancy, nine (75%) had abnormal cells in their ejaculates. Furthermore, five of 25 patients with negative biopsies for adenocarcinoma also had abnormal ejaculate cytology; two of these five patients had high‐grade prostatic intra‐epithelial neoplasia (PIN). In the control group, no PSA‐ or PAP‐positive prostatic epithelial cells were identified. Normal prostatic cells were not seen in any of the ejaculate specimens examined.

Conclusions These results indicate that ejaculate cytology, which is a non‐invasive and easily repeated investigation, may prove to be a useful approach in the early detection of cancer of the prostate. However, its value in this role, together with the clinical significance of cytological findings, needs to be established, especially in relation to PSA and TRUS biopsy.
The influence of temperature on changes in pH, lactate and morphology during testicular ischaemia
Authors: Kallerhoff M. , Gross A.J. , Bötefür I.C. , Zöller G. , Weidner W. , Holstein A.F. , Ringert R.‐H.
Published: November 2003

Objective To examine the role of temperature in the irreversible changes that occur within 4–6 h as ischaemic atrophy develops in the testis during testicular torsion, by determining effects on testicular pH, lactate accumulation and morphology.

Materials and methods Tissue acidification (pH), tissue lactate and structural changes were measured at temperatures of 35, 25, 15 and 5°C in 34 human testes obtained as orchidectomy specimens from patients with metastatic prostatic cancer, and in 19 testes taken from young dogs.

Results At a normal testicular temperature of 35°C, the pH decreased to 6.0 within 2 h of the onset of ischaemia; cooling to 15°C extended this delay to 6 h. Tissue lactate increased from 25 μmol/g dry weight to about 200 μmol/g at 35°C. Semi‐thin sections of the canine testes showed swelling of the intratubular tissue with loss of interstitial space; lower temperatures delayed these changes.

Conclusions In the present study, 6 h of torsion was relatively prolonged, in that the pH decreased to 5.8 and testicular tissue was destroyed. Acidification and histological damage can be prevented by cooling. The critical pH of the testis beyond which irreversible changes occur is unknown; a pH of <6.0 is likely to provoke such changes.
Incidentally detected renal cell carcinoma: pathological features, survival trends and implications for treatment
Authors: Sweeney J.P. , Thornhill J.A. , Grainger R. , McDermott T.E.D. , Butler M.R.
Published: November 2003

Objectives To compare treatment outcomes in symptomatic and incidental renal cell carcinoma (RCC) with specific interest in the role of radical nephrectomy.

Patients and methods The records of 189 patients with a clinical diagnosis of RCC were reviewed. The mode of presentation, tumour size, grade and stage at presentation were correlated with final outcome, as measured by the disease‐free and overall survival of the patients.

Results The rate of incidental detection was 15%; incidental tumours were of a lower stage and patients with incidentally detected tumours had a significantly longer disease‐free and overall survival than had those with symptomatic tumours (P<0.05).

Conclusions The increased detection of incidental tumours should further improve survival in RCC. We continue to advocate radical nephrectomy for incidentally detected tumours, as it offers the best outcome and simplifies the follow‐up.
Effect of finasteride on free and total serum prostate‐specific antigen in men with benign prostatic hyperplasia
Authors: Matzkin H. , Barak M. , Braf Z.
Published: November 2003

Objective To examine changes in the free‐to‐total (f/t) serum prostate‐specific antigen (PSA) ratio among men treated with finasteride for benign prostatic hypertrophy.

Patients and methods Blood samples were taken from 20 men (mean age 71 years, range 61–87) before and after a minimum of 9 months of treatment with finasteride and the f/tPSA ratio determined using the Immulite assay system.

Results Although mean total and free PSA levels decreased significantly, the mean f/tPSA ratio increased only slightly and not significantly; the ratios remained unchanged in men with an initially low or high (<>10%) ratio.

Conclusions Concern has been expressed over the loss of the discriminatory power of serum PSA in a patient receiving treatment with finasteride. The f/tPSA ratio, currently used to help differentiate benign from malignant processes in the prostate, remains valid during treatment with finasteride; it does not affect the f/tPSA ratio.
Effect of l‐cysteine on some urinary risk factors in experimental hyperoxaluric rats
Authors: Saravanan N. , Senthil D. , Varalakshmi P.
Published: November 2003

Objective To study the effect of l‐cysteine on urinary risk factors in hyperoxaluric urolithiasis in rats.

Materials and methods Twenty‐four rats were divided into four groups of six rats each; those in Group I served as controls, those in Group II had hyperoxaluria induced using sodium glycollate, those in Group III were given cysteine alone and those in Group IV were given sodium glycollate and cysteine. Samples of 24 h urine were collected and analysed to determine the content of calcium, oxalate, phosphorus and magnesium, and the organic acids, glycollic, glyoxylic and citric acid.

Results Hyperoxaluric rats treated with cysteine had significantly lower excretion rates of calcium, oxalate, phosphorus, glycollic and glyoxylic acid than the glycollate fed rats. When cysteine was given, the excretion of urinary citric acid and magnesium were also increased.

Conclusion Cysteine may be a useful agent in preventing oxalate urolithiasis.
A comparison between histological grade and nuclear morphometry for predicting the clinical outcome of localized renal cell carcinoma
Authors: Nativ O. , Sabo E. , Bejar J. , Halachmi S. , Moskovitz B. , Miselevich I.
Published: November 2003

Objectives To determine the interrelationship of histological grade and nuclear morphometry and to compare their prognostic significance in patients with localized renal cell carcinoma (RCC).

Patients and methods A retrospective prognostic study of 39 patients with localized (pT1, pT2) RCC was performed. Conventional histological grade and nuclear morphometry were assessed independently and the correlation between these grading systems and their impact on the patients' outcome were evaluated.

Results Histological grade and the nuclear morphometric variables were significantly correlated; the strongest association was that between grade and the nuclear regularity factor. The best predictor of disease‐free interval and survival (by univariate analysis) was the combination of nuclear area and nuclear elongation factor, followed by conventional tumour grade, nuclear elongation factor, nuclear regularity factor and nuclear area. However, a multivariate analysis showed that the only independent prognosticator for survival was the combination of nuclear area and nuclear elongation factor.

Conclusions This study indicates that nuclear morphometry is prognostically superior to histological grade in patients with localized RCC.
Recurrent graft pain following renal autotransplantation for loin pain haematuria syndrome
Authors: Parnham A.P. , Low A. , Finch P. , Perlman D. , Thomas M.A.B.
Published: November 2003

Objective To review retrospectively the Perth experience of autotransplantation for loin pain haematuria syndrome and identify possible factors associated with its failure.

Patients and methods The medical records of 11 women patients (median age 42 years, range 29–48) who had 12 autotransplantations were reviewed. All patients were then interviewed and asked whether they considered the operation a success.

Results All patients initally had complete relief of symptoms. Three patients who had four transplants are still symptom‐free with a follow‐up of 24–46 months. Five patients have had partial relief with marked variability in their patterns of recurrent pain. Three patient have symptoms as severe as those before operation. One kidney was lost because of acute thrombosis and another developed a urinoma. No patient had deterioration in renal function.

Conclusion Renal autotransplantation is a treatment option of last resort, with acceptable morbidity in patients with intractable, functionally disabling renal pain, but three‐quarters of these patients may develop recurrent pain in the transplant site. A current or past history of depression or absence of haematuria may represent risk factors for a poor post‐operative prognosis. Treatment failure is predictable by a poor response to sympathetic neurolytic block.
Acid‐base metabolism after bladder substitution with
Authors: Poulsen A.L. , Steven K.
Published: November 2003

Objectives To assess acid‐base metabolism after bladder substitution with the ileal Kock reservoir, using capillary blood‐gas analysis, measurement of the renal excretion of ammonium and titratable acid and the evaluation of renal function by plasma clearance of 51Cr‐labelled ethylenediamine tetra‐acetic acid (51Cr‐EDTA).

Patients, subjects and methods The investigation comprised both a cross‐sectional study, with initial measurements after surgery, and a longitudinal study, with pre‐operative measurements, both groups of patients being followed for 2 years after inclusion. The cross‐sectional study included 26 patients (median age 66 years, range 44–75), with a median post‐operative follow‐up of 1.2 years (range 0.3–3.7), and 16 control subjects (median age 62 years, range 34–80), and the longitudinal study comprised seven patients (median age 57 years, range 42–68).

Results The median values for capillary blood pH, carbon dioxide pressure, standard bicarbonate and standard base excess were significantly lower in patients with a bladder substitute than in the control subjects. An acid‐base chart showed that the values for 44% of patients and none of the controls were within the area representing mild metabolic acidosis. This difference could not be attributed to differences in renal function because the 51Cr‐EDTA clearance was normal and similar in the two groups of patients and among patients and controls. Nevertheless, the median values for each of the variables measured by blood‐gas analysis were within the reference interval of the normal population. Net acid excretion was similar in patients with a bladder substitute and control subjects, but urinary pH was significantly higher in the patients. Accordingly, the renal excretion of ammonium was significantly higher and the excretion of titratable acid significantly lower in patients after ileal bladder substitution.

Conclusions The results are consistent with the hypothesis that bladder substitution with the ileal Koch reservoir results in an acid load to the body, caused mainly by ammonium reabsorption in the reservoir. The acid load is compensated by an increased renal excretion of ammonium but causes a mild metabolic acidosis in about half the patients.
Evaluation of asymptomatic microscopic haematuria—influence and clinical relevance of osmolality and pH on urinary erythrocyte morphology
Authors: Georgopoulos M. , Schuster F.X. , Porpaczy P. , Schramek P.
Published: November 2003

Objective

 To determine whether the morphological distinction between ‘dysmorphic’ and ‘eumorphic’ erythrocytes in urinary sediment differentiates microscopic haematuria (MH) from reno‐parenchymal and post‐renal bleeding.

Materials and methods

 The erythrocyte morphology of 2145 urinary sediments from 1391 patients with MH was evaluated by interference‐contrast microscopy and compared with the osmolality, pH and specific gravity of the urine samples.

Results

 Compared with more concentrated urine specimens, samples of <700 mOsmol/kg showed significantly lower percentages of dysmorphic erythrocytes; there was a similar reduction in this percentage at a pH≥7. In addition, erythrocytes lysed in diluted or alkaline urine and therefore, under these conditions, no diagnosis could be made.

Conclusion

 The assessment of erythrocytes in urinary sediment should be performed only under ‘standard conditions’, i.e. in concentrated and acidic urine, ≥700 mOsmol/kg and a pH<7. The presence of ≥90% dysmorphic erythrocytes in patients with asymptomatic MH, the absence of proteinuria, a normal blood pressure and normal radiological examination indicates ‘reno‐parenchymal MH’, requiring a long‐term follow‐up with a routine evaluation twice a year, but no immediate treatment in most cases. In contrast, the presence of ≥90% eumorphic erythrocytes or even ‘mixed’ results (10–90% eumorphic erythrocytes) indicates ‘post‐renal MH’, requiring a complete urological evaluation.
The benefits of a shared‐care prostate clinic
Authors: Booth C.M. , Chaudry A.A. , Smith K. , Griffiths K.
Published: November 2003

Objective To establish a hospital based shared‐care clinic to investigate and manage benign prostatic hyperplasia (BPH) with general practitioners (GPs).

Patients and methods During one year, 330 patients referred with suspected prostatic obstruction were investigated in an outreach clinic in a rural cottage hospital by urology department nurses according to a protocol. After this, they were referred directly back to their GPs with recommendations for their management or seen in the urologist's clinic. A questionnaire was completed by the GPs to assess their satisfaction with and attitudes to the clinic.

Results One‐third of the patients were referred directly back to their GP, a third were seen routinely and a third seen urgently in the urologist's clinic, usually because a prostate‐specific antigen assay indicated the possibility of latent prostatic cancer. A survey confirmed that GP support for the clinic was unanimous whilst patients were reassured by the thoroughness and sensitivity of the clinic's nursing staff.

Conclusion The clinic reduced the workload of the GPs and urologists whilst providing a speedy and comprehensive assessment of patients presenting with suspected prostatic obstruction.
Bilateral orchidectomy and flutamide versus orchidectomy alone in newly diagnosed patients with metastatic carcinoma of the prostate — an Australian multicentre trial
Authors: Zalcberg J.R. , Raghaven D. , Marshall V. , Thompson P.J.
Published: November 2003

Objectives To investigate the hypothesis that maximal androgen blockade improves the outcome of patients with metastatic prostate cancer.

Patients and methods A total of 222 previously untreated patients with metastatic prostatic cancer were entered into a randomized, double‐blind, placebo‐controlled trial of bilateral orchidectomy with or without androgen blockade (112 receiving flutamide and 110 a placebo) which commenced in 1985 in four Australian centres. The characteristics of the patients, e.g. age, performance status, the presence of bone pain, duration of disease and the use of prior radiation, were well balanced between the groups. Patients commenced the protocol therapy with flutamide or placebo within the 7 days preceding surgery and continued this medication for a minimum of 2 years, unless there was unequivocal evidence of tumour progression.

Results Apart from a difference in grade 3 or 4 gastrointestinal toxicities between the flutamide and placebo arms (13% and 3%, respectively), serious or life‐threatening toxicities were uncommon and equally balanced. The assessment of response in six patients (three in each arm) was inevaluable. The objective response rates were 45% and 56% in the flutamide and placebo arms, respectively. There was no difference in survival between the treatments.

Conclusions This study was not sufficiently powerful to detect small differences in outcome (although the trend in survival favoured the placebo arm) but nevertheless failed to show any benefit for maximal androgen blockade over orchidectomy in this group of patients.
A review of antegrade stenting in the management
Authors: Sharma S.D. , Persad R.A. , Haq A. , Appleton D.S. , Doyle P.T. , Bullock K.N. , Doble A.
Published: November 2003

Objective To review experience in the management of the obstructed ureter using antegrade stenting in a variety of conditions.

Patients and methods Between 1984 and 1993, 41 patients (mean age 57 years, range 9–83) had antegrade stents placed by an experienced interventional radiologist. The causes of obstruction were urological in 27, gynaecological in eight, colorectal in three and miscellaneous in three.

Results The overall success rate for antegrade stent insertion was 83% and the failure rate was greatest (four of six) in cases of ureteric injury following gynaecological procedures. There were no immediate complications.

Conclusion Antegrade stenting can be used as a temporary or permanent solution to ureteric obstruction. The technique is safe, acceptable to patients and avoids the need for a general anaesthetic.
Laparoscopic dismembered pyeloplasty in children: preliminary results
Authors: Tan H.L. , Roberts J.P.
Published: November 2003

Objectives To investigate the technique of laparoscopic pyeloplasty in children with pelvi‐ureteric junction (PUJ) obstruction.

Patients and methods Six children, aged between 2.5 and 15 years, were treated by laparoscopic pyeloplasty in a prospective study. The outcome was assessed by post‐operative isotopic renography. Four of the children underwent a Y/V plasty of the PUJ structure and one a Hynes‐Anderson dismembered pyeloplasty.

Results One case (the first in this series) was converted to open pyeloplasty due to adhesions around the PUJ from previous surgery. One patient developed an abdominal haematoma at the trocar site, which resolved without treatment. All anastomoses were completed without complication. Five of the children had normal or significantly improved drainage times on post‐operative renography. In one patient, the drainage time deteriorated post‐operatively, although differential function of the operated kidney improved.

Conclusions These early results suggest that laparoscopic pyeloplasty in children is feasible, safe and effective; a longer term follow‐up is awaited.