bluuebunny/crossref_metadata_2025 huggingface dataset:
Urinary retention after hysterectomy for benign disease: extended diagnostic evaluation and treatment with sacral nerve stimulation
Authors: Everaert K. , De Muynck M. , Rimbaut S. , Weyers S.
Published: December 2004

The problem of urinary retention after hysterectomy for benign disease is extensively evaluated by authors from Ghent. Their interesting results show that it is associated with the de‐afferentiation of the bladder wall and with Fowler's syndrome. These findings help our understanding of a troublesome condition.

Further work is reported into the use of the tension‐free vaginal tape procedure, particularly into its positive effect on quality of life. Another study reported here found that in patients with BOO associated with BPH, there is a focal compromise of the blood‐urine permeability barrier, with an increase in expression of inducible nitric oxide synthase.

Objective

To detect prospectively neurogenic damage in patients with urinary retention responding to sacral nerve stimulation (SNS) after hysterectomy for benign disease.

Patients and methods

From August 1995 to February 2002, 13 of 15 patients (mean age 43 years, sd 7) with urine retention for a mean (sd, range) of 25 (22, 6–240) months after hysterectomy for benign disease, were prospectively evaluated and treated with SNS. They were assessed using urodynamics at baseline and during the test stimulation. Sensory evoked potentials (SEPs), electrical sensory threshold (EST) measurements of the pudendal nerve, bladder neck and the bladder (2 Hz, 0–300 V), and needle electromyography of the external urethral sphincter (EUS) were undertaken in all patients.

Results

De‐afferentiation (EST ≥ 200 V) was limited to the bladder in four of the 13 patients and extended to the bladder neck in one other, and was matched by no response at the SEP. Relative ESTs of the bladder neck correlated inversely with residual urine (r = − 0.76, P = 0.01, x = 546, fx = 1.22) and bladder capacity (r = − 0.77, P = 0.01, x = 611, fx = 1.26) at diagnosis. Complex repetitive discharges and decelerating bursts of the EUS were seen in these five patients. Unilateral SNS was applied in 10 patients (bilateral in three). A revision was needed in six patients. Uroflowmetry at the last follow‐up showed a mean (sd) maximum urinary flow rate of 22 (18) mL/s (not significantly different from during trial stimulation) with residual urine of 50–100 mL in two and 200–400 mL in three patients. Intermittent catheterization was needed in four patients.

Conclusion

Urinary retention after hysterectomy for benign disease is associated with de‐afferentiation of the bladder wall in some patients and is correlated inversely with the relative EST of the bladder neck. A Fowler syndrome was detected in five patients. For residual urine, about half the patients have a good and a third a partial long‐term effect; we now offer SNS as a further treatment option.
Outcome and survival with nonsurgical management of renal cell carcinoma
Authors: Baird A.D. , Woolfenden K.A. , Desmond A.D. , Fordham M.V.P. , Parsons K.F.
Published: December 2004

OBJECTIVE

To document long‐term survival in patients with renal cell carcinoma (RCC) in whom the primary tumour was left in situ and treatment limited to palliative and symptomatic measures.

PATIENTS AND METHODS

All patients with a diagnosis of RCC from January 1994 to January 1999 and in whom the primary tumour was left in situ were identified from hospital records (nine women and 16 men, mean age 69 years). The tumour stage was T1–T4.

RESULTS

The mean survival overall was 19.3 months; patients with locally advanced disease, i.e. stage ≥ T3a, had a mean survival of 16.9 months.

CONCLUSIONS

There is renewed interest in the management of advanced RCC, with data supporting cytoreductive nephrectomy with systemic biological therapy. These results confirm that such patients with or without metastatic disease can survive for a considerable period with no aggressive surgical or systemic measures, and such intervention may offer no significant advantage in outcome and survival over supportive treatment alone.
Increased urinary 8‐hydroxy‐2′‐deoxyguanosine excretion after ileal neobladder replacement
Authors: Miyake H. , Eto H. , Takechi Y. , Kamidono S. , Hara I.
Published: December 2004

OBJECTIVES

To examine whether orthotopic neobladder replacement using either ileum or colon segments results in increased oxidative stress, by measuring urinary 8‐hydroxy‐2′‐deoxyguanosine (8‐OHdG), one of the most commonly used markers for evaluating oxidative DNA damage.

PATIENTS, SUBJECTS AND METHODS

Urinary levels of 8‐OHdG and creatinine, urine analysis, nutritional status, and acid‐base and electrolyte balances, were assessed in 22 patients with an ileal neobladder, 28 with a colon neobladder, 37 with an ileal conduit and 22 healthy volunteers. The results from both types of orthotopic neobladder, the ileal conduit and in the healthy controls were compared.

RESULTS

The mean (sd) ratios of urinary 8‐OHdG to urinary creatinine in patients with an ileal neobladder, colon neobladder, ileal conduit and in controls were 20.4 (7.8), 15.2 (4.3), 15.9 (5.1) and 15.2 (5.4) ng/mg, respectively. The urinary 8‐OHdG ratio in the first group was significantly higher than in the other three groups. Among patients with a neobladder, the urinary 8‐OHdG ratio was closely associated with the degree of pyuria, but not age, gender, the interval from surgery, body weight, height, serum creatinine or the degree of metabolic acidosis.

CONCLUSIONS

These findings suggest that creating an ileal neobladder caused significantly greater oxidative stress than a colon neobladder, ileal conduit, or that in healthy controls. Therefore, it is recommended to conduct a careful long‐term follow‐up considering the possible development of malignant disease after urinary diversion, especially by an ileal neobladder.
Innervation of the detrusor muscle bundle in neurogenic detrusor overactivity
Authors: Drake M.J. , Gardner B.P. , Brading A.F.
Published: December 2004

OBJECTIVE

To evaluate the peripheral anatomical distribution of innervation within muscle bundles of the detrusor and the changes arising in neurogenic detrusor overactivity (DO).

PATIENTS AND METHODS

Full‐thickness samples from the bladder dome of three cadaveric transplant organ donors and four people with neurogenic DO caused by spinal cord injury were compared. Systematic serial cryostat sections were stained using Masson trichrome and elastin techniques, and vimentin immunohistochemistry. A coherent image stack was generated for three‐dimensional image reconstructions, which were displayed using mixed rendering (i.e. differing graphics for separate tissue components) to show peri‐ and intra‐bundle innervation against the muscle fascicle framework.

RESULTS

Control specimens had a dense nerve supply. Muscle bundle innervation was derived by dichotomous branching from peri‐bundle nerve trunks in the inter‐bundle connective tissue. Transverse interfascicular branches entered bundles perpendicular to the long axis at the midpoint of the bundle. They gave rise to axial interfascicular branches, which distributed to the pre‐terminal and terminal nerve fibres. All samples from patients with neurogenic DO had patchy denervation. The primary deficit was predominantly at the level of the terminal axial innervation and was cross‐sectionally consistent along the longitudinal axis of the muscle bundle.

CONCLUSION

Patchy denervation may reflect a deficit at the level of the peripheral ganglia. Any contraction in the areas of denervation either occurs out of co‐ordination with the rest of the bladder, or is co‐ordinated by means of non‐neural structures. The observation of fine muscle strands running between fascicles, and connective tissue anchoring structures, represent two hypothetical mechanisms by which such co‐ordination might be effected.
Technique of laparoscopic (endoscopic) radical prostatectomy
Authors: Stolzenburg J.‐U. , Truss M.C.
Published: December 2004

During the last decade laparoscopy has become a standard technique available to the urologist, through constant technological advances and refinements. The progress of laparoscopic/endoscopic techniques allows the indications for this surgery to include complex oncological procedures like radical prostatectomy. Since the first description of laparoscopic radical prostatectomy (LRP) in the early 1990s the technique has undergone significant technical modifications. Transperitoneal LRP is now a standard procedure and can be used successfully and reproducibly, giving results comparable with those from the open retropubic procedure. Despite many advantages, transperitoneal laparoscopy is associated with potential intraperitoneal complications. Because of the limitations inherent in the transperitoneal route, a totally extraperitoneal endoscopic radical prostatectomy (EERPE) has been developed. The totally extraperitoneal endoscopic access provides a safe and minimally invasive approach to various urological procedures, including prostatectomy. This technical improvement completely obviates intra‐abdominal complications. EERPE combines the advantages of minimally invasive laparoscopy and the open retropubic approach. We review the surgical techniques of LRP and EERPE, and highlight the indications, contraindications and outcomes.
Epidemiology and medical management of stone disease
Authors: Tiselius H.‐G.
Published: December 2004

Recurrent stone formation in the urinary tract is a common and important problem that must be considered in daily urological practice. With a prevalence of> 10% and an expected recurrence rate of ≈ 50%, stone disease has an important effect on the healthcare system. It is generally agreed that patients with uric acid/urate, cystine or infection stones always should be treated pharmacologically. For calcium stone formers the treatment should be chosen according to the severity of the disease. Recurrence in patients with calcium‐stone disease can be prevented with general or specific dietary and drinking advice, and with pharmacological therapy. For idiopathic calcium stone formers the most convincing therapeutic effects have been reported with thiazide and alkaline citrate.
Prostate cancer cell growth is modulated by adipocyte‐cancer cell interaction
Authors: Tokuda Y. , Satoh Y. , Fujiyama C. , Toda S. , Sugihara H. , Masaki Z.
Published: December 2004

OBJECTIVE

To assess whether adipocytes (mesenchymal stromal cells thought to affect the proliferation and differentiation of epithelial cells) affect the behaviour of prostate cancer cells in vitro, as prostate cancer metastasizes to the bone, which is an adipocyte‐rich environment.

MATERIALS AND METHODS

The human bone‐metastatic prostate carcinoma cell line PC3 was cultured with or without adipocytes in a three‐dimensional collagen gel matrix. Histological and immunohistochemical assays were used to evaluate the proliferation and differentiation of PC3 cells. The cytokine expression of this culture assembly was also examined by reverse transcription‐polymerase chain reaction (RT‐PCR).

RESULTS

The proliferation and differentiation of cancer cells were clearly changed on co‐culture with adipocytes compared with the control cultures. The mean (range) bromodeoxyuridine (BrdU) indices estimated (according to uptake) to evaluate the growth of the cultured cells were 36.3 (8.55)% in the co‐culture and 26.95 (10.50) in the control (P < 0.02). PC3 cells in co‐culture formed larger clusters than in the control, at 16.0 (11.0) vs 14.0 (10.0), respectively (P < 0.01). Cancer cells also showed pleomorphism, varying from cuboidal to spindle‐shaped. The expressions of vascular endothelial and platelet‐derived growth factor were greater in co‐culture than in the control.

CONCLUSION

These findings suggest that adipocytes modulate the growth, morphology and cytokine expression of prostate cancer cells. This specific mesenchymal stromal cell type is important in the biological behaviour of prostate cancer cells.
Pelvi‐ureteric junction obstruction by crossing renal vessels: clinical and imaging features
Authors: Rigas A. , Karamanolakis D. , Bogdanos I. , Stefanidis A. , Androulakakis P.A.
Published: December 2004

OBJECTIVE

To present the characteristic clinical and imaging findings of pelvi‐ureteric junction (PUJ) obstruction caused by crossing renal vessels (CRV), as it presents particular features within the spectrum of congenital hydronephrosis.

PATIENTS AND METHODS

Between April 1982 and December 2000, 384 children underwent surgery for PUJ obstruction. In 71 (18.5%; mean age 8.5  years, range 2 months to 14 years; 49 aged> 5 years), the obstruction was caused by CRV. The data collected from the medical records of these patients were analysed for their clinical presentation and imaging findings, i.e. ultrasonography (US), intravenous urography (IVU) and diuretic renography.

RESULTS

The main presenting symptom was recurrent renal colic (pain, nausea, vomiting) in 59%, followed by urinary infection (UTI) in 20%, gross haematuria in 11% and an incidental diagnosis in 10%. By contrast, in the 313 children with intrinsic PUJ obstruction, renal colic was present in only 10.5%. Moreover, from 1991 to 2000, when the use of prenatal US became widespread, hydronephrosis was detected prenatally in 42 of 212 children (20%) with intrinsic PUJ obstruction, but in only two of 31 (6%) with obstruction by CRV. However, in 10 children with CRV operated on during this period, prenatal US had shown mild hydronephrosis (< 15 mm), which during the follow‐up decreased until the children became symptomatic after 5–9 years (eight renal colic, two UTI). US during acute symptoms showed significant hydronephrosis (> 25 mm), and colour Doppler US of two patients directly showed the CRV. In all 71 children with CRV obstruction diuretic IVU and renography during the acute symptoms had an obstructive pattern, and in 24 renal colic was reproduced during the examination. The differential kidney function was < 40% in 11 children who presented with UTI; two required nephrectomy and in the remaining 69 an Anderson‐Hynes pyeloplasty, after which none had an episode of renal colic or UTI during a mean (range) follow‐up of 10.2 (2–20) years.

CONCLUSIONS

PUJ obstruction by CRV should be suspected in older children presenting with recurrent renal colic and hydronephrosis. Good kidney function is expected in most of these children, despite their age, because the vascular obstruction is intermittent. Mild prenatal hydronephrosis that could decrease postnatally does not exclude the possibility of vascular obstruction, which may later become symptomatic. Imaging (US, diuretic IVU and renography) during an episode of pain is essential and colour Doppler US could help to establish the diagnosis in these cases. Knowing that a child has a CRV is important for choosing an open surgical approach rather than endoscopic pyelotomy, to avoid potential complications
A novel surveillance protocol for stage I nonseminomatous germ cell testicular tumours
Authors: Atsü N. , Eskiçorapçi S. , Üner A. , Ekici S. , Güngen Y. , Erkan I. , Uygur M.C. , Özen H.
Published: December 2004

OBJECTIVES

To report the results of a novel surveillance policy for stage I nonseminomatous germ cell tumours (NSGCTs).

PATIENTS AND METHODS

Between 1978 and 2000, 132 patients (median age 28 years, range 16–52) who were regularly followed were included in a new surveillance policy. All pathology specimens were studied retrospectively by the same pathologist for embryonal carcinoma, yolk sac tumour and lymphovascular invasion components. A loose surveillance protocol was designed in which computed tomography (CT) was used only for the first year.

RESULTS

The median (range) follow‐up was 38 (6–265) months; the relapse rate was 24% and all occurred before 23 months, with 87% diagnosed within the first year. Platinum‐based chemotherapy was given to patients with relapse, and surgery used after chemotherapy in seven. Among all the risk factors, an embryonal carcinoma component was the only significant predictor of relapse. The overall survival rate was 99%.

CONCLUSION

The presence of embryonal carcinoma in the primary pathology is the only risk factor determining the relapse rate of the present surveillance policy for stage I NSGCTs. The overall survival was no different from those reported for retroperitoneal lymph node dissection and primary chemotherapy. Decreasing the frequency of CT in the first year and totally eliminating it after 1 year reduces the cost of surveillance. The possible compliance problems of patients are also minimized, without changing the overall survival. This surveillance protocol for patients with stage I NSGCT has reduced costs and provided a better quality of life for the patients, without jeopardizing the final outcome.
Partin tables: past and present
Authors: Khan M.A. , Partin A.W.
Published: December 2004

This is the start of a new section in the BJU International. The intention is to provide the reader with a series of review articles that are more focused than the traditional papers addressing wider topics. In the first of these two mini‐reviews, the development of the Partin tables is examined, which is in effect a self‐audit. Nomograms are becoming more frequently used in urological cancer and are of help to urologists to assess the likelihood of operative success and long‐term clinical outcomes. The authors review the necessary updating of the original Partin tables, given the changes which have taken place in the stage of prostate cancer at presentation over the last decade. Most patients with bladder cancer present with superficial disease, which presents its own problems. However, a very significant number present with invasive disease, which if left untreated is associated with an extremely high mortality in a relatively short period. In the second mini‐review the authors, who have long been associated with an approach which combines radical surgery with innovative reconstruction, assess their rationale for an aggressive treatment approach.

It is to be hoped that both of these mini‐reviews will provide prognostic information for urologists treating prostate and bladder cancer.
Cardiovascular risk factors correlate with prostate size in men with bladder outlet obstruction
Authors: Sandfeldt L. , Hahn R.G.
Published: December 2004

OBJECTIVE

To study whether the risk profile for cardiovascular disease correlates with prostate size in elderly men seeking medical attention for lower urinary tract symptoms (LUTS), by assessing physiological, biochemical and personality traits.

PATIENTS AND METHODS

Fifty‐two men (mean age 68 years, range 52–85) with bladder outlet obstruction, as verified by urodynamic testing, had their prostate size measured by transrectal ultrasonography. Their blood and urine was also examined, and their personality and heart rate variability tested. The measured variables were assessed statistically in relation to whether the prostate volume was smaller (22 men) or larger (30 men) than 50 mL.

RESULTS

Patients with a large prostate (mean 104 mL) had a higher mean arterial pressure (105 vs 95 mmHg, P < 0.01), and serum glucose (5.3 vs 4.8 mmol/L, P < 0.01) and serum cortisol (423 vs 362 nmol/L, P = 0.06) concentrations than those with a small gland (mean 31 mL). The personality test showed that they were also less assertive than the others (P < 0.03). The components of the heart rate variability indicated that men with a large prostate had increased sympathetic activity.

CONCLUSION

Men with LUTS caused by a very large prostate have more risk factors for cardiovascular disease than those with a smaller gland.
Positron emission tomography for urological tumours
Authors: Hain S.F. , Maisey M.N.
Published: December 2004

For urological tumours, positron emission tomography (PET) is currently most useful in testicular cancer. In patients with residual masses or raised marker levels after treatment, PET is both sensitive and specific for detecting recurrent disease, at suspected and unsuspected sites. Although fewer studies are available it also appears to be useful for staging at diagnosis, although this requires further investigation. Prostate cancer imaging has been more variable, with studies showing that PET cannot reliably differentiate between tumour and hypertrophy. It is not as good as a bone scan for defining bone metastases. In renal cancer, PET can be used to define the primary tumour, providing better staging of local recurrence than computed tomography (CT), and to define metastatic disease. There are few studies in bladder cancer, and despite excretion of the tracer via the bladder in early studies, it has better results than CT or magnetic resonance imaging for local staging; again it can detect metastases. Overall, the place of PET in urological tumours is developing, with the strongest areas undoubtedly being testicular and renal cancer. Tracers other than fluorodeoxyglucose are being examined and are providing further information.
The effect of photodynamic therapy on rat urinary bladder with orthotopic urothelial carcinoma
Authors: Grönlund‐Pakkanen S. , Wahlfors J. , Talja M. , Kosma V.‐M. , Pakkanen T.M. , Ala‐Opas M. , Alhava E. , Moore R.B.
Published: December 2004

OBJECTIVE

To assess the effect of whole‐bladder photodynamic therapy (PDT) on a rat model with orthotopic superficial bladder cancer, as PDT is an alternative intravesical therapy for treating superficial bladder cancer, based on an interaction between a photosensitizer and light energy to induce oxygen radicals that destroy tissue by lipid peroxidation.

MATERIALS AND METHODS

In all, 76 female Fischer F344 rats were inoculated intravesically with AY‐27 tumour cells. After establishing superficial tumour, 24 rats were treated with PDT using aminolaevulinic acid (ALA)‐induced protoporphyrin IX as a photosensitizer, and a continuous‐wave argon pumped‐dye laser (638 nm). At 4 h after intravenous (300 mg/kg) or intravesical (100 mg/mL) administration of ALA the bladders were intravesically exposed to a 40 J/cm2 light dose; 12 rats received no ALA but were exposed to the same light dose. Before administering ALA, urine cytology samples were taken for analysis. At 3 or 21 days the treated rats were killed and morphological changes in the bladder walls analysed by light microscopy. Forty rats served as controls to examine the presence of tumour.

RESULTS

The tumour established in 33 of 40 rats (83%) in the controls, but after PDT with intravesical ALA there was carcinoma in only in one of 12 (P < 0.001, Pearson's χ2 test). After PDT with intravenous ALA there was carcinoma in five of 11 rats (P = 0.063, Pearson's χ2 test). In the control group of 12 rats receiving only light energy there was carcinoma in three (P = 0.001, Pearson's χ2 test). Histologically, at 3 days after PDT there was only mild superficial damage in all six rats treated intravesically. Bladder wall destruction reached the muscular layer, with an abscess in one of six rats treated intravenously. After 3 weeks of PDT there was muscular necrosis with perforation and abscess from catheterization two of six rats treated intravesically and in three the bladder wall totally recovered. In the intravenous group the bladder walls were normal or had only mild superficial damage. Cytology of the urine sediment failed to detect half the tumours in the treatment groups.

CONCLUSION

These results support the use of PDT with intravesical ALA‐induced protoporphyrin X for treating superficial bladder carcinoma. Intravesical was better than intravenous ALA in eradicating bladder carcinoma with PDT.
Fluorodeoxyglucose positron emission tomography studies in the diagnosis and staging of clinically advanced prostate cancer
Authors: Sung J. , Espiritu J.I. , Segall G.M. , Terris M.K.
Published: December 2004

OBJECTIVE

To determine the value of 18F‐fluoro‐2‐deoxyglucose (FDG) positron‐emission tomography (PET) studies in evaluating patients with advanced prostate cancer.

PATIENTS AND METHODS

FDG‐PET scans were taken in 30 patients with advanced prostate cancer 1 h after an injection with 555 MBq of FDG. Patients were scanned from the base of the skull to the inguinal region (including the pelvis). They were also assessed by computed tomography (CT) of the abdomen and pelvis, and bone scintigraphy, to evaluate them for metastases.

RESULTS

Thirteen patients had locally extensive prostate cancer and 17 had metastatic disease. Twenty of the 30 patients were positive for radioisotope uptake in the prostate or extraprostatically. The patients with PET‐detected prostate cancer were untreated (seven), treated hormonally while they had rising PSA levels (eight), or treated hormonally with a detectable but stable PSA (five). The remaining 10 patients were negative for FDG uptake in the prostate or any metastatic sites; these 10 patients were receiving hormone therapy, with undetectable PSA levels.

CONCLUSION

FDG‐PET imaging is not a useful test in evaluating advanced prostate cancer in patients being treated and who have an undetectable PSA level. Staging of advanced prostate cancer may be enhanced by FDG‐PET imaging in patients who are untreated, who have had an incomplete response to therapy, or who have a rising PSA level despite treatment.
Testicular tumours (nonseminomatous)
Authors: Oosterhof Gosse O.N. , Verlind Johan
Published: December 2004

In view of the excellent results of multimodal therapy for nonseminoma testicular tumours, with chemotherapy and surgery, attempts have been made to reduce the side‐effects of treatment in patients with a good prognosis, while maintaining efficacy. It is now generally accepted that surveillance after orchidectomy is suitable in patients with low‐risk stage I disease. Nerve‐sparing retroperitoneal lymph‐node dissection as a primary treatment is a good alternative to primary chemotherapy in low‐stage disease, i.e. high‐risk stage I and stage IIa–b, enabling chemotherapy to be reduced by at least half, and decreasing the long‐term side‐effects of chemotherapy, especially cardiovascular, neuro‐, nephro‐ and pulmonary toxicity. However, in patients with advanced disease and a poor prognosis, conventional chemotherapy is more likely to fail, and improving the treatment results by new schedules of chemotherapy (although more toxic) remains the main goal.
Robotic surgery in urology: fact or fantasy?
Authors: Binder Jochen , Bräutigam Ronald , Jonas Dietger , Bentas Wassilios
Published: December 2004

Advanced robotic surgery was first introduced into urology in 2000. The first studies showed the feasibility and safety of the daVinci (Intuitive Surgical Inc., Sunnyvale, CA) telemanipulator assistance in radical prostatectomy, pelvi‐ureteric junction obstruction, and radical cystectomy and neobladder formation. The miniature endowristed tools offer a potential advantage over standard laparoscopy in the accuracy of preparation and suturing. Other features are a three‐dimensional vision system and unimpaired hand‐eye coordination. Complex laparoscopic tasks are learned faster by using the robot, which may also explain the shorter training required for radical prostatectomy than for manual laparoscopy. This new and expensive technology has spread rapidly over the last 4 years. By 2004, ≈ 10% of radical prostatectomies in the USA will be robot‐assisted. Data on the functional and oncological outcomes are accruing but not yet conclusive. There will be a further spread of robotic surgery, routine telesurgery, smaller and more affordable systems, the introduction of virtual reality, all developments which have the potential to urological surgeons to improve.
Social Functioning in First Grade: Associations With Earlier Home and Child Care Predictors and With Current Classroom Experiences
Authors:   National Institute of Child Health and Human Development Early Child Care Research Network
Published: December 2004

Family and child care factors from birth to 54 months, achievement and social outcomes at entry to school, and qualities of first‐grade classrooms were used to predict first‐grade social functioning for 864 children from the NICHD Study of Early Child Care. Child gender, mothers' partner status, maternal education and depressive symptoms, sensitivity of mothering, and amount of time spent in nonmaternal child care were significant predictors. Home and child care variables predicted social functioning through associations with prior social functioning rather than directly. More teacher‐led structured activities in first‐grade classrooms predicted mother's reports of more internalizing behavior. Classrooms rated as more emotionally supportive predicted lower levels of mother‐reported internalizing behavior and concurrently observed indicators of competence.
Patterns of use of hormone replacement therapy in one million women in Britain, 1996–2000
Authors:   Million Women Study Collaborators,   The collaborators are listed on page 1329
Published: December 2004

Objective
To describe national patterns of use of hormone replacement therapy (HRT) in 1996–2000.

Design
Population‐based study of women aged 50–64.

Setting
England and Scotland.

Population
A total of 1,091,250 women were recruited between May 1996 and December 2000.

Methods
Women invited for screening at 66 NHS breast screening units were sent a questionnaire to complete before they were screened; 71% of women screened participated.

Main outcome measures
Prevalence of use of HRT.

Results
Overall, 33% of women reported that they were currently using HRT, the average duration of use being 5.8 years; 50% were ever‐users. Current use of HRT was about twice as common at age 50–54 than 60–64, but varied little by time or region, the prevalences being 33%–34% in each year from 1996 to 2000; 30% in Scotland and 35% in southeast England. The prevalence of current use of HRT varied substantially depending on the woman's history of gynaecological surgery and past health, and was as follows in women with a history of: bilateral oophorectomy (66%); hysterectomy without bilateral oophorectomy (48%); neither hysterectomy nor bilateral oophorectomy (27%); breast cancer (6%); other cancer (25%); stroke (24%); venous thromboembolism (24%); diabetes (25%); heart disease (31%); or hypertension (31%). There was considerably less variation in the prevalence of use of HRT according to deprivation index, education, parity, body mass index, exercise, smoking or alcohol consumption.

Conclusions
HRT is currently used by around one‐third of women aged 50–64 in Britain and appears to be influenced considerably more strongly by a woman's medical and surgical history than by socio‐economic or lifestyle factors.
Fetal short femur length in the second trimester and the outcome of pregnancy
Authors: Todros T. , Massarenti I. , Gaglioti P. , Biolcati M. , Botta G. , De Felice C.
Published: December 2004

We reviewed 86 consecutive cases with fetal femur length (FL) below the 10th centile of our reference ranges at midtrimester ultrasonography. Three groups were identified based on perinatal outcome: normal infants (n= 28), newborns with structural and/or chromosomal anomalies (n= 40), small‐for‐gestational age (SGA) newborns (n= 18). Fetuses with skeletal dysplasias (n= 13) had significantly shorter FL. Aneuploidies were only found in fetuses with malformations other than skeletal dysplasias. The diagnosis of SGA, based on ultrasound abdominal circumference measurement <10th centile, was made 9 weeks (range 5–14) after the finding of a short FL. Half of these cases also developed pre‐eclampsia.
Safety of birth centre care: perinatal mortality over a 10‐year period
Authors: Gottvall Karin , Grunewald Charlotta , Waldenström Ulla
Published: December 2004

Objective  To study perinatal mortality in women booked for birth centre care during pregnancy.

Design  Retrospective cohort study.

Setting  In‐hospital birth centre and standard maternity care in Stockholm.

Population  Two thousand and five hundred and thirty‐four women (3256 pregnancies) admitted to an in‐hospital birth centre over 10 years (1989–2000) and 126,818 women (180,380 pregnancies) who gave birth in standard care during the same period and who met the same medical inclusion criteria as in the birth centre. Multiple pregnancies were excluded.

Methods  Data were collected from the Swedish Medical Birth Register. Information on all cases of perinatal death in the birth centre group was retrieved from the medical records.

Main outcome measure  Perinatal mortality.

Results  No statistically significant difference in the overall perinatal mortality rate was observed between the birth centre group and the standard care group (odds ratio [OR] 1.5, 95% CI 0.9–2.4), but infants of primiparas were at greater risk (OR 2.2, 95% CI 1.3–3.9). Infants of multiparas tended to be at lower risk, but this difference was not statistically significant (OR 0.7, 95% CI 0.3–1.9). These figures were adjusted for maternal age and gestation in multiple regression analyses.

Conclusion  Birth centre care may be less safe for infants of first‐time mothers.
Premature ovarian failure: frequency and risk factors among women attending a network of menopause clinics in Italy
Authors:   Progetto Menopausa Italia Study Group,   The list of participants indicated at the end of this article
Published: December 2004

Objective To determine the frequency and causes of preterm ovarian failure (menopause before 40 years of age) and early menopause (menopause between 40 and 45 years).

Design Cross sectional study.

Setting Menopause clinics in Italy.

Population Women attending menopause clinics in Italy.

Methods Between 1997 and 1999 we conducted a large cross sectional study on the characteristics of women around menopause attending a network of first‐level outpatient menopause clinics in Italy for general counselling about menopause or treatment of menopausal symptoms. Eligible for the study were all women aged 45–75 years consecutively observed for the first time at the participating centres on randomly selected days during the study period.

Main outcome measure Factors associated with preterm ovarian failure.

Results Out of 15,253 women aged 55 years or more with spontaneous menopause who entered the study, 269 (1.8%) reported preterm ovarian failure, and 1085 (7.1%) reported spontaneous menopause at age 40–45 years. The risk of preterm ovarian failure and of early menopause was higher in women reporting lifelong irregular menstrual cycles: in comparison with women reporting menopause at age ≥45 years, the OR (irregular vs regular mestrual cycles) of preterm ovarian failure was 1.3 (95% CI 1.0–1.7) and of early menopause of 1.2 (95% CI 1.0–1.5). Parous women reported less frequently preterm ovarian failure (

χ2 trend

P < 0.05) and early menopause (OR 0.8, 95% CI 0.7–1.0). No significant association emerged between risk of preterm ovarian failure or menopause at age 40 to <45 and education, age at menarche, oral contraceptive use and smoking habits.

Conclusion Nulliparity and lifelong irregular menstrual cycles are associated with an increased risk of preterm ovarian failure.
Cysteinyl leukotrienes as common mediators of asthma and allergic disease
Authors: Dahlén S‐E.
Published: December 2004

The cysteinyl leukotrienes (CysLTs) induce a number of pro‐inflammatory effects including smooth muscle contraction, an increase in blood flow, plasma exudation, mucous secretion, and activation of inflammatory cells. They play a key role in asthma and allergy, and can be recovered from different body fluids (e.g. bronchoaleveolar or nasal lavage and urine) during allergen‐induced hypersensitivity reactions. The advent of antileukotriene agents (i.e. leukotriene receptor antagonists or leukotriene synthesis inhibitors) has helped clarify how the different mechanisms contribute to inflammation, as well as offer new treatment options for both asthma and allergy. It is now clear that the release of leukotrienes is the final common path for the many different factors causing airway obstruction and inflammation. In asthma, clinical studies have shown that treatment with antileukotrienes can improve pulmonary function, alleviate symptoms, reduce asthma exacerbations, and decrease the need for bronchodilator therapy. Similarly, in patients with allergic rhinitis, improvements have been seen in nasal symptoms, eye symptoms and quality of life. Antileukotrienes provide a new opportunity for simultaneous management of allergic diseases of the upper and lower respiratory tract, and are a rational treatment approach to the concept of ‘one airway’ disease. In future, their utility may also extend to inflammatory disorders of other organ systems (e.g. skin).
Influence of implant microstructure on the osseointegration of immediate implants placed in periodontally infected sites
Authors: Novaes Arthur B. , Papalexiou Vula , Grisi Márcio F. M. , Souza Sérgio S. L. S. , Taba Mário , Kajiwara João K.
Published: December 2004

Abstract: The aim of this study was to evaluate the influence of implant microstructure on the osseointegration of immediate implants placed into infected sites. During 12 weeks, periodontitis was induced in six dogs in the areas of the first to fourth mandibular premolars of both sides. The teeth were extracted and the implants were placed immediately. Implant placement was randomly assigned so that for each side in the mandible a different implant surface, a new grit‐blasted/acid‐etched group 1 or titanium plasma spray surface group 2 was used, totaling 36 implants in the experiment. The animals were killed 12 weeks after implant placement. Two histomorphometric analyses were performed: percentage of bone/implant contact (BIC) and analyses of the bone density in adjacent and distant areas from the implant surface. The results showed that the percentages of BIC were 52.7% and 42.7% for groups 1 and 2, respectively. The bone density analysis revealed that the percentages of bone in the adjacent areas were 66.6% and 58.8%, and in the distant areas from the implants were 58.7% and 55.8% for groups 1 and 2, respectively. The mean differences of BIC were verified through the Mann–Whitney test and differences in bone density through the Kruskal–Wallis test. The differences were not statistically significant (P>0.05). In conclusion, osseointegration of implants placed into a more challenging healing situation such as immediate implants into periodontally compromised sites was successful for both surfaces; however, the grit‐blasted/acid‐etched surface, although not statistically significant, had a slightly better performance when compared to the titanium plasma spray surface for all the parameters studied.
Clinical outcome of 103 consecutive zygomatic implants: a 6–48 months follow‐up study
Authors: Malevez Chantal , Abarca Marcelo , Durdu Françoise , Daelemans Philippe
Published: December 2004

Abstract: The purpose of this study was to evaluate retrospectively, after a period of 6–48 months follow‐up of prosthetic loading, the survival rate of 103 zygomatic implants inserted in 55 totally edentulous severely resorbed upper jaws. Fifty‐five consecutive patients, 41 females and 14 males, with severe maxillary bone resorption were rehabilitated by means of a fixed prosthesis supported by either 1 or 2 zygomatic implants, and 2–6 maxillary implants. This retrospective study calculated success and survival rates at both the prosthetic and implant levels. Out of 55 prostheses, 52 were screwed on top of the implants, while 3 were modified due to the loss of standard additional implants and transformed in semimovable prosthesis. Although osseointegration in the zygomatic region is difficult to evaluate, no zygomatic implant was considered fibrously encapsulated and they are all still in function. This study confirms that the zygoma bone can offer a predictable anchorage and support function for a fixed prosthesis in severely resorbed maxillae.
Effects of fibrin sealant protein concentrate with and without platelet‐released growth factors on bony healing of cortical mandibular defects
Authors: Fuerst Gabor , Gruber Reinhard , Tangl Stefan , Sanroman Fidel , Watzek Georg
Published: December 2004

Abstract: In this study, the effects of fibrin sealant protein concentrate (FSPC; from the Tissucol® Kit, Baxter, Vienna, Austria) with and without platelet‐released growth factors (PRGF) on bony healing of cortical mandibular defects were investigated. Defects made in the facial mandibular wall of eight adult minipigs with a hollow drill were filled with FSPC alone, a mix of FSPC+PRGF or left untreated as controls. The animals were killed 4 and 8 weeks later. Specimens were processed for histology with the Donath method (1988) and stained with the Levai–Laczko stain. On histology, periosteal osteoneogenesis exceeded endosteal bone formation. No difference was seen in bone formation between FSPC alone, FSPC+PRGF and the controls at 4 and 8 weeks. On histomorphometry, there was no significant difference between the three groups in terms of the percent of newly formed bone at 4 and 8 weeks (P=0.6977). This study showed that FSPC neither increased nor decreased the amount of newly formed bone vs. controls and that the addition of PRGF had no effects on bone regeneration of cortical minipig bone at 4 and 8 weeks.
The influence of a biomaterial on the closure of a marginal hard tissue defect adjacent to implants
Authors: Botticelli Daniele , Berglundh Tord , Lindhe Jan
Published: December 2004

Abstract: Objectives: The present experiment was performed to determine the influence of Bio‐Oss® on hard tissue formation at sites that, following implant installation, presented a 1–1.25 mm wide marginal defect.

Material and methods: Four Labrador dogs were used. The premolars and first molars on both sides of the mandible were extracted. After 3 months, mucoperiosteal flaps were elevated and three experimental sites were prepared for implant installation in each side of the mandible. A step drill was used to widen the marginal 5 mm of the canal. Thus, following the placement of the implant (3.3×10 mm, SLA surface, Straumann AG, Waldenburg, Switzerland) a circumferential gap, about 1–1.25 wide and 5 mm deep, remained lateral to the titanium rod. The test sites in the left side of the mandible were first filled with a deproteinized cancellous bone mineral (Bio‐Oss®). The defect sites in the right side of the mandible (control sites) were left for spontaneous healing. A resorbable barrier membrane (Bio‐Gide®) was placed to cover the implant and the bone tissue in two sites of each quadrant, while the third site was left without membrane placement. The flaps were repositioned to cover all defect sites and were sutured. After 4 months of healing, block biopsies of each implant site were dissected and processed for ground sectioning.

Results: It was demonstrated that at 4 months, all types of defects were filled with newly formed bone and that the biomaterial placed in the marginal defect in conjunction with implant installation during healing became incorporated in the newly formed bone tissue. A high degree of contact was established between the Bio‐Oss® particles and the newly formed bone.

Conclusion: Bio‐Oss® became integrated with the newly formed bone. In the model used, Bio‐Oss® did not enhance the process of bone formation and defect closure.
Simvastatin promotes osteogenesis around titanium implants
Authors: Ayukawa Yasunori , Okamura Akira , Koyano Kiyoshi
Published: December 2004

Abstract Objectives: Hydroxymethylglutaryl‐coenzyme A reductase inhibitors, the so‐called statins, have been widely used for hyperlipidemic patients, and it was recently reported that it promoted bone formation. In the present study, we examined the effect of simvastatin on the promotion of osteogenesis around titanium implants.

Materials and methods: Ten 30‐week‐old rats received pure titanium implants in both tibiae, and were then divided into experimental and control groups. The experimental group was administered simvastatin daily. Thirty days later, all animals were killed and then specimens were prepared. The bone contact ratio (BCR) to the implant and bone density (BD) around the implant, as well as histological findings, were obtained.

Results: In the control group, newly formed bone could be seen around the implants. It was seen to be in direct contact with the implant surface, but otherwise unmineralized connective tissue was occasionally interposed. In the medullary canal, a scanty amount of bone trabeculae was observed. In the experimental group, in contrast, thicker bone trabeculae were abundantly seen in the medullary canal and showed a mesh‐like structure. In the histometrical observations, both BCR and BD of the experimental group were significantly greater than those of the control group.

Conclusion: The administration of simvastatin increases the value of both BCR and BD. This drug may have the potential to improve the nature of osseointegration.
Mechanisms inducing compressive stress during electrodeposition of Ni
Authors: Hearne Sean J. , Floro Jerry A.
Published: December 2004

The evolution of stress during electrodeposition of Ni films on Au substrates has been investigated as a function of bath chemistry and deposition conditions to examine the microstructural origins of the compressive stress observed during deposition from an additive-free sulfamate bath. Three likely mechanisms for the generation of compressive stress in this system were investigated: interstitial hydrogen/impurity incorporation, capillarity stress, and a chemical-potential gradient driven atom incorporation model. Only the last model, the chemical-potential gradient model, could not be discounted as the active mechanism. However, further study is required to verify that this is the primary compressive stress generation mechanism.
Amorphization and decomposition of scandium molybdate at high pressure
Authors: Arora Akhilesh K. , Yagi Takehiko , Miyajima Nobuyoshi , Mary T. A.
Published: December 2004

The behavior of negative thermal-expansion material scandium molybdate Sc2(MoO4)3 is investigated at high pressure (HP) and high temperature (HT) using x-ray diffraction, Raman spectroscopy, and scanning electron microscopy. The compound exhibits unusually high compressibility (bulk modulus ∼6GPa) and undergoes amorphization at 12GPa. On the other hand, in situ laser heating of amorphous samples inside the diamond-anvil cell is found to result in crystalline diffraction pattern and Raman spectrum different from those of the original compound. Upon release of the pressure subsequent to laser heating, the Raman spectrum and the diffraction pattern remain unchanged. Matching of several of the diffraction lines and Raman peaks in the laser-heated samples with those of MoO3 suggests a solid-state decomposition of the parent compound under HP-HT conditions into MoO3 and other compounds. Other diffraction lines are found to correspond to Sc2Mo2O9, Sc2O3, and the parent compound. Quantitative analysis of the characteristic x-ray emission from different regions of the sample during scanning electron microscopic observations is used for obtaining the compositions of the daughter compounds. The stoichiometries of two main phases are found to be close to those of MoO3 and Sc2Mo2O9. These results support the model that the pressure-induced amorphization occurred in this system because a pressure-induced decomposition was kinetically constrained.