bluuebunny/crossref_metadata_2025 huggingface dataset:
Attitudes of Level II obstetricians towards the care of the extremely premature infant: A national survey
Authors: Gooi A , Oei J , Lui K
Published: August 2003

Objective:  To explore the opinions of non‐tertiary obstetricians towards the care and outcome of extremely premature infants.

Methods:  A structured questionnaire was mailed nationally to 232 obstetricians affiliated to maternity facilities with Level II nurseries.

Results:  The overall response rate was 75% (n = 174) after two mailings. This included 14 obstetricians who declined to participate. The median birthweight and gestation for active resuscitation was 500 g (350−800) and 24 weeks (22−26), respectively. Factors influencing decision to transfer were: better outcomes for infants born at perinatal centres (74%), paediatric advice (10%), personal beliefs (5%), parental wishes (4%), hospital policy (3%), legal repercussions (2.5%) and past history of infertility (2%). Obstetricians in Victoria and Western Australia (WA) would transfer at 22 weeks whilst the median gestation for transfer in other states was 24 weeks (P = 0.001). Most respondents underestimated intact and infant survival rates but WA and Victorian obstetricians were less pessimistic.

Conclusions:  Most obstetricians in non‐tertiary facilities who responded to our survey considered 500 g and 24 weeks to be the median birthweight and gestation for active resuscitation. This is similar to recent surveys of neonatologists and obstetricians in perinatal centres. There is significant underestimation of intact and infant survival at the extremes of prematurity when compared to available Australian data. Differences towards antenatal transfer between States may represent influences of local perinatal centres.
Screening for intestinal parasites in recently arrived children from East Africa
Authors: Rice Je , Skull SA , Pearce C , Mulholland N , Davie G , Carapetis JR
Published: August 2003

Background:  Intestinal parasitic carriage is common in East African populations with a wide spectrum of clinical severity. There are scant data on the rates of carriage in East African immigrants to Australia. This study describes the prevalence of and risk factors for intestinal parasite carriage among children recently arrived from East African countries.

Methods:  Children aged 0−17 years, who attended an outpatient clinic, were born in East Africa and had immigrated since 1998 were eligible to participate. A single preserved stool specimen was collected for faecal microscopy, and blood tests were conducted for Strongyloides and Schistosoma serology, full blood examination and serum ferritin.

Results:  One hundred and thirty‐five children (median age 8.1 years, range 1.0−17.5) participated, of whom 133 (99%) provided a stool specimen. Parasites were detected in 50% of samples, and 18% of children carried a possibly pathogenic species. No child was symptomatic at diagnosis. Positive or equivocal serology occurred in 11% of children for Strongyloides and 2% for Schistosoma. Anaemia and iron deficiency were detected in 16% of all children. Those carrying an intestinal parasite were older (mean age 9.8 vs 7.4 years, P= 0.002) and less likely to be anaemic (odds ratio 0.37, 95% confidence interval 0.14−0.96) than those who were not carriers.

Conclusions:  Carriage of intestinal parasites is common among children from East Africa. Those carrying pathogenic organisms require treatment and follow up to ensure eradication. The results of this survey support the need for routine assessment of newly arrived immigrants from East Africa for intestinal parasites, anaemia and iron deficiency.
Sociodemographic and atopic factors affecting breastfeeding intention in Chinese mothers
Authors: Leung TF , Tam WH , Hung ECW , Fok TF , Wong GWK
Published: August 2003

Objective:  The factors accounting for the low ‘ever breastfeeding’ rate in Hong Kong remain unclear. The objective of this survey was to study the intention and planned duration of breastfeeding in Chinese women in Hong Kong, and to investigate the sociodemographic and atopic factors affecting the intention to breastfeed.

Methods:  All Chinese mothers who were Hong Kong residents and who delivered their babies in a University teaching hospital were given a self administered and anonymous Chinese questionnaire within 1 day postpartum. The questionnaire included items on sociodemographic data, the presence of allergic diseases in the families, and the intention and planned duration of breastfeeding for their newborn babies.

Results:  A total of 1374 eligible questionnaires were collected. About one‐third of mothers were born outside Hong Kong and the majority (78%) of them were aged between 25 and 40 years. Logistic regression revealed that only socioeconomic factors, namely older maternal age (odds ratio (OR) 2.10, 95% confidence interval (CI) 1.14−3.89), parity (OR 3.08, 95% CI 1.02−9.27) and higher educational background (OR 2.87, 95% CI 1.92−4.27), significantly affected the intention to breastfeed. In addition, mothers born outside Hong Kong and those with first babies, had a longer intended duration of breastfeeding (P‐values < 0.001 and 0.033, respectively). A family history of atopic disorders in parents or siblings did not influence the breastfeeding intention of these Chinese mothers.

Conclusion:  Several sociodemographic factors, rather than a history of atopic disorders, of Chinese mothers in Hong Kong affected their intention to breastfeed and the planned duration of breastfeeding.
Primary pulmonary hypoplasia: A case report and review of the literature
Authors: Odd DE , Battin MR , Hallam L , Knight DB
Published: August 2003

Abstract:  A case of primary pulmonary hypoplasia in a term female neonate presenting with severe respiratory distress at birth is reported. Respiratory failure persisted and she died at 12 days of age. Primary pulmonary hypoplasia is a rare condition not associated with other maternal or fetal disorders.
Fracture and fortified breast milk in an extremely preterm infant
Authors: Sharp Mj , Simmer K
Published: August 2003

Abstract:  Metabolic bone disease (MBD) in the newborn predominantly affects preterm infants. The risk of MBD is inversely proportional to gestational age and birthweight, and directly related to postnatal complications. Poor bone mineralization has been shown in 55% of infants born at less than 1000 g. Optimal nutrition for very preterm infants is thought to be mother's own milk but supplementation is required to meet dietary requirements. However, there is insufficient evidence to determine that supplementation of human milk with commercial fortifiers has an effect on bone mineral content. We report a case of severe MBD with fractures in an extremely preterm infant who was fed with fortified mother's milk.
Congenital arhinia
Authors: McGlone L
Published: August 2003

Abstract:  Congenital absence of the nose or arhinia is a rare defect of embryogenesis, often associated with other anomalies. It is potentially a life‐threatening condition and requires the presence of a highly skilled neonatal resuscitation team at the time of delivery. The associated anomalies often have a significant impact on the immediate as well as long‐term outcome of the neonate. Parental counselling is thus vital and a multidisciplinary team approach is required to optimise the neonatal outcome. A neonate with congenital arhinia is reported and the literature reviewed to suggest guidelines for the management of such cases.
Laryngeal foreign bodies in children: First stop before the right main bronchus
Authors: Robinson PJ
Published: August 2003

Abstract:  Laryngeal foreign bodies may produce either complete or incomplete airways obstruction. In complete airways obstruction the presentation is with calamitous respiratory difficulty. However incomplete laryngeal obstruction may present with less severe symptoms, resulting in possible misdiagnosis and confusion with other causes of upper airway obstruction such as infectious croup. This report describes three cases of incomplete laryngeal obstruction secondary to inhaled foreign bodies. In each case, the diagnosis of an inhaled foreign body was initially missed, resulting in delay in diagnosis and in one case prolonged recovery. The importance of considering laryngeal foreign bodies, both in cases of suspected foreign body inhalation and clinical cases of incomplete laryngeal obstruction are discussed.
Behavioural state affects saccadic eye movements evoked by microstimulation of striate cortex
Authors: Tehovnik Edward J. , Slocum Warren M. , Carvey Christina E.
Published: August 2003

We examine how behavioural conditions affect the manner in which electrical stimulation of striate cortex (V1) influences the generation of saccadic eye movements. Monkeys were trained (i) to acquire a fixation spot and remain fixated for juice reward and (ii) to acquire a fixation spot and generate a saccade to a visual target for reward. Electrical stimulation was delivered at various times during the execution of these tasks. For stimulation trials, pulses were delivered at 200 Hz using a 100‐ or 200‐ms train duration. Currents as high as 1500 µA were not sufficient to evoke saccades from V1 when monkeys were actively fixating a visual target, whereas current < 100 µA was sufficient to evoke saccades when monkeys were not actively fixating. By interleaving trials in which a visual target was presented in the receptive field of stimulated neurons with nontarget stimulation trials, saccades could be evoked from V1 during the nontarget stimulation trials with currents as low as 2 µA. The position of the visual target on the interleaved trials affected the probability of saccade evocation on the nontarget stimulation trials. Additional factors that affected the evoked saccades were time of reward delivery, ratio of stimulation to nonstimulation trials, and whether stimulation was delivered on the interleaved trials in which a target was positioned in the receptive field of the stimulated neurons. We argue that the behavioural state of an animal acts on the nigra–collicular pathway to lower the current threshold for the elicitation of saccades from V1.
Methylenendioxyamphetamine produces serotonin nerve terminal loss and diminished behavioural and neurochemical responses to the antidepressant fluoxetine
Authors: Harkin Andrew , Shanahan Eamonn , Kelly John P. , Connor Thomas J.
Published: August 2003

The effect of prior exposure to methylenedioxyamphetamine (MDA) on behavioural and neurochemical responses to fluoxetine were assessed in a rat model of antidepressant action. MDA (7.5 mg/kg, i.p.) was administered to rats twice daily for 4 consecutive days, and 4 weeks later the behavioural effect of fluoxetine (5 or 20 mg/kg; i.p. × 3) was examined in the modified rat forced‐swimming test. In addition, the ability of fluoxetine to reduce serotonin (5‐HT) metabolism was measured as an index of its efficacy in inhibiting 5‐HT reuptake in vivo. In vehicle‐treated rats, fluoxetine (5 and 20 mg/kg) produced a characteristic increase in swimming behaviour in the forced‐swimming test. In contrast, fluoxetine‐induced swimming was markedly attenuated in MDA‐treated rats. MDA pretreatment resulted in 5‐HT nerve terminal degeneration, indicated by reduced 5‐HT and 5‐HIAA concentrations in the frontal cortex, amygdala and hippocampus, and reduced [3H]paroxetine binding in the frontal cortex. In vehicle‐treated rats, fluoxetine (5 and 20 mg/kg) decreased 5‐HT metabolism (5‐HIAA : 5‐HT ratio) in the frontal cortex, amygdala and hippocampus. MDA pretreatment attenuated the ability of fluoxetine to reduce 5‐HT metabolism in all brain regions examined. These findings are the first to demonstrate that prior exposure to the methylenedioxy‐substituted amphetamine MDA results in diminished responsiveness to the antidepressant fluoxetine.
Pre‐ and postsynaptic contribution of GABAC receptors to GABAergic synaptic transmission in rat collicular slices and cultures
Authors: Kirischuk Sergei , Akyeli Jan , Iosub Radu , Grantyn Rosemarie
Published: August 2003

The mammalian superior colliculus (SC) is reported to contain γ‐aminobutyric acid (GABA)C receptors (GABACRs) at high concentration. However, their role in GABAergic synaptic transmission is not yet known. The aim of the present study was: (i) to clarify whether GABACRs are activated by endogenous GABA; and (ii), to determine whether GABACRs play a role in inhibitory synaptic transmission. Experiments were performed on acute horizontal slices from the postnatal rat SC or on collicular neurons in dissociated cell culture. In both preparations, bicuculline‐resistant current responses to exogenous GABA and currents elicited by cis‐4‐aminocrotonic acid (CACA) were blocked by (1,2,5,6‐tetrahydropyridine‐4‐yl) methylphosphinic acid (TPMPA), a GABACR antagonist. The CACA‐induced currents exhibited a linear current‐voltage relationship and reversed at the Cl− equilibrium potential. These results indicate that functional GABACRs are present in the somato‐dendritic membrane of collicular neurons. Miniature inhibitory postsynaptic currents (mIPSCs) were recorded using the whole‐cell patch clamp technique. TPMPA significantly decreased mIPSC amplitudes in slices, but not in cultured neurons. As TPMPA decreased also the coefficient of variation of mIPSCs, we suggest that somatodendritic GABACRs are located extrasynaptically but can be involved in the generation of IPSCs if GABA diffusion is constrained. In cultures, individual connections were activated by focal electrical stimulation of single neurons, and evoked inhibitory postsynaptic currents (eIPSCs) were recorded. Paired‐pulse stimulation revealed that TPMPA significantly decreased the paired‐pulse ratio at short (50 ms) interstimulus intervals, and this effect was inversely dependent on the amplitude of the first eIPSC. We conclude that presynaptic GABACRs are activated by endogenous GABA and can alleviate the short‐term depression resulting from a preceding episode of GABA release. Thus, in GABAergic synapses of the SC GABACRs are involved in pre‐ and postsynaptic functions and may therefore contribute to the activity‐dependent adjustment of GABAergic inhibition.
Intravenous Administration of Class I Antiarrhythmic Drug Induced T Wave Alternans in an Asymptomatic Brugada Syndrome Patient
Authors: OHKUBO KIMIE , WATANABE ICHIRO , OKUMURA YASUO , YAMADA TAKESHI , MASAKI RIKO , KOFUNE TATSUYA , OSHIKAWA NAOHIRO , KASAMAKI YUJI , SAITO SATOSHI , OZAWA YUKIO , KANMATSUSE KATSUO
Published: August 2003

A 53‐year‐old man with an abnormal ECG was referred to the Nihon University School of Medicine. The 12‐lead ECG showed right bundle branch block and saddleback‐type ST elevation in leads V1–V3 (Brugada‐type ECG). Signal‐averaged ECG showed positive late potentials. Double ventricular extrastimuli (S1: 500 ms, S2: 250 ms, S3: 210 ms) induced VF. Amiodarone (200 mg/day) was administered for 6 months and programmed ventricular stimulation was repeated. VF was induced again by double ventricular stimuli (S1: 600 ms, S2: 240 ms, S3: 170 ms). Intravenous administration of class Ic antiarrhythmic drug, pilsicainide (1 mg/kg), augmented ST‐T elevation in leads V1–V3, and visible ST‐T alternans that was enhanced by atrial pacing was observed in leads V2 and V3. Visible ST‐T wave alternans disappeared in 15 minutes. However, microvolt T wave alternans was present during atrial pacing at a rate of 70/min without visible ST‐T alternans. (PACE 2003; 26:1900–1903)
Global Repolarization Sequence of the Right Atrium:
Authors: LI ZHEN , HERTERVIG EVA , KONGSTAD OLE , HOLM MAGNUS , GRINS EDGARS , OLSSON S. BERTIL , YUAN SHIWEN
Published: August 2003

The aim of the study was to explore the global sequence of atrial repolarization and its correlation to that of activation. Endocardial monophasic action potentials (MAPs) were sequentially recorded from

51 ± 14

sites in the right atrium of ten healthy pigs using the CARTO electroanatomic mapping system. Local activation time (AT), MAP duration, and 90% repolarization time (RT) were obtained, and from these data, color coded three‐dimensional maps of AT and RT sequences and spatial distribution of MAP duration were reconstructed. The results of the study were: (1) An activation sequence was recognizable in all maps, starting from the posterosuperior wall and ending in the posteroinferior wall near the tricuspid annulus. (2) The repolarization sequence was also recognizable in all maps, and mainly followed the sequence of activation. (3) A significant positive correlation between the RT and AT was observed in all maps with an average r value being

0.571 ± 0.159 (P < 0.01 – 0.0001)

, suggesting that progressively later AT associates with progressively longer RT. (4) No consistent correlation between the MAP duration and AT was found. In conclusion, repolarization gradients exist over the atrial endocardium in healthy pigs. The repolarization sequence follows the same sequence as the activation, suggesting that the spatiotemporal pattern of activation is an important determinant of the characteristics of the repolarization sequence. (PACE 2003; 26:1803–1808)
Basal Asynchrony and Resynchronization with Biventricular Pacing Predict Long‐Term Improvement of LV Function in Heart Failure Patients
Authors: TOUSSAINT JEAN‐FRANÇOIS , LAVERGNE THOMAS , KERROU KHALDOUN , FROISSART MARC , OLLITRAULT JACKY , DARONDEL JEAN‐MARC , ALONSO CHRISTINE , DIEBOLD BENOÎT , LE HEUZEY JEAN‐YVES , GUIZE LOUIS , PAILLARD MICHEL
Published: August 2003

Biventricular pacing (BiV) is emerging for patients with dilated cardiomyopathy (DCM) and asynchrony. We measured basal asynchrony and early resynchronization by radionuclide angioscintigraphy (RNA) in order to predict long‐term evolution of ventricular function after BiV. Thirty‐four patients (NYHA Class III–IV,

65.4 ± 11 years

) with large QRS

(179 ± 18 ms)

were implanted with BiV and studied by RNA before (D0), at day 8 (D8), and during follow‐up

(20 ± 7 months)

. We calculated left and right ejection fractions, the interventricular dyssynchrony (TRVLV), and the apicobasal dyssynchrony (Tab). LVEF improved from

20.2 ± 8.1%

(D0) to

27.1%± 12.6%

(follow‐up,

P < 0.003

vs D0) and RVEF from

28.6%± 13%

(D0) to

34.3 ± 11.5%

(follow‐up,

P < 0.03

vs D0). Inter‐ (ΔTRVLV) and intraventricular resynchronization was immediate and remained stable: TRVLV decreased from

68.3 ± 38 ms

(D0) to

13.4 ± 48.5 ms

(D8) and

1.8 ± 39.2 ms

(follow‐up,

P < 0.0001

vs D0); and Tab from

45.8 ± 64.1 ms

to

−18 ± 68

(D8) and

−28.3 ± 53.6 ms

(follow‐up,

P < 0.0001

vs D0). Early inter‐ and intraventricular resynchronization (ΔTab) at D8 were related to late LVEF and RVEF improvement. Together, an LVEF > 15% and a significant interventricular dyssynchrony (TRVLV > 60 ms) at D0 have a sensitivity of 79% and a positive predictive value of 83% to predict an improvement of LVEF superior to 5% at follow‐up. In DCM patients, BiV resynchronizes ventricles early and in the long‐term, while RVEF and LVEF improve progressively. Patients with large electromechanical dyssynchrony benefit most from BiV. (PACE 2003; 26:1815–1823)
Simple Access to the Coronary Venous System for Left Ventricular Pacing
Authors: SAYAD DANY E. , SAWAR ASAD , CURKOVIC VLADIMIR , GALLARDO IGNACIO , BAROLD S. SERGE
Published: August 2003

Implantation of the LV lead for biventricular pacing can be challenging, time consuming, and often requires extensive fluoroscopy time. A conventional diagnostic 5 Fr left Amplatz catheter was used to cannulate the coronary sinus in 15 consecutive patients undergoing implantation of a biventricular pacemaker. When the coronary sinus was cannulated, the proximal end of the Amplatz catheter was cut and the coronary sinus sheath was passed over the Amplatz catheter that was then removed. Coronary sinus cannulation was achieved in all 15 patients with a mean fluoroscopy time of

3.34 ± 1.9 minutes

. Subsequent implantation of a biventricular pacemaker was successful and free of complications in all the 15 patients. (PACE 2003; 26:1856–1858)
Marine reserves and optimal harvesting
Authors: Neubert Michael G.
Published: August 2003

Advocates of no‐take marine reserves emphasize their conservation benefits. Critics counter that reserves would decrease fisheries yield. Analysis of a spatially explicit harvesting model, however, shows that no‐take marine reserves are always part of an optimal harvest designed to maximize yield. The optimal harvest generates a spatial source–sink structure with source populations placed in reserves. The sizes and locations of the optimal reserves depend on a dimensionless length parameter. For small values of this parameter, the maximum yield is obtained by placing a large reserve in the centre of the habitat. For large values of this parameter, the optimal harvesting strategy is a spatial ‘chattering control’ with infinite sequences of reserves alternating with areas of intense fishing. Such a chattering strategy would be impossible to actually implement, but in these cases an approximate yet practicable policy, utilizing a small number of reserves, can be constructed.
Autumn colouration and herbivore resistance in mountain birch (Betula pubescens)
Authors: Hagen Snorre B. , Folstad Ivar , Jakobsen Stein W.
Published: August 2003

We explored Hamilton and Brown's autumn signalling hypothesis in mountain birch (Betula pubescens). As predicted by the hypothesis, early autumn colour change (i.e. high degree of autumn colouration in September) was negatively correlated with insect damage the following season. Furthermore, as expected, indices of physiological stress (i.e. leaf fluctuating asymmetry) and reproductive investment (i.e. catkin production) were positively correlated with insect damage the following season. Indirectly, we also found support for the idea that the proposed handicap signal (i.e. early autumn senescence) might be associated with an honesty ensuring cost in terms of lost primary production. Further work is, however, required to determine whether the link between autumn colours and insect damage observed in this study is causal.
Parasite establishment in host communities
Authors: Holt Robert D. , Dobson Andrew P. , Begon Michael , Bowers Roger G. , Schauber Eric M.
Published: August 2003

Many pathogens and parasites attack multiple host species, so their ability to invade a host community can depend on host community composition. We present a graphical isocline framework for studying disease establishment in systems with two host species, based on treating host species as resources. The isocline approach provides a natural generalization to multi‐host systems of two related concepts in disease ecology – the basic reproductive rate of a parasite, and threshold host density. Qualitative isocline shape characterizes the threshold community configurations that permit parasite establishment. In general, isocline shape reflects the relative forces of inter‐ and intraspecific transmission of shared parasites. We discuss the qualitative implications of parasite isocline shape for issues of mounting concern in conservation ecology.
Avian egg colour and sexual selection: does eggshell pigmentation reflect female condition and genetic quality?
Authors: Moreno Juan , Osorno José Luis
Published: August 2003

Avian egg colour has been explained as mainly serving crypsis or mimetism, although the function of certain colours (e.g. blue and green) has not yet been demonstrated. We interpret egg colour as a sexually selected signal of the laying female's genetic quality to its mate in order to induce a higher allocation of paternal care. The blue–green pigment biliverdin is an antioxidant, the deposition of which may signal antioxidant capacity whereas the deposition of the brown pigment protoporphyrin, a pro‐oxidant, may signal tolerance of oxidative stress. Egg ground colour is presumably heritable and phylogenetically labile. The hypothesis can be applied to animals with colourful eggs and paternal care.
The urethral Kock pouch: long‐term functional and oncological results in men
Authors: Shaaban A.A. , Mosbah A. , El‐Bahnasawy M.S. , Madbouly K. , Ghoneim M.A.
Published: August 2003

The Department of Urology in Mansoura has a well‐known experience in, among many things, urinary tract reconstruction in patients with bladder cancer. They review their results in 338 male patients who had a radical cystectomy and Kock pouch. They found good functional and oncological outcomes in properly selected patients. However, they also drew attention to several valve‐related complications.

OBJECTIVE

To evaluate our experience with men who underwent radical cystectomy and urethral Kock pouch construction between January 1986 and January 1996.

PATIENTS AND METHODS

Complications were classified as early (within the first 3 months after surgery) or late. Continence was assessed by interviewing the patient; they were considered continent if they were completely dry with no need of protection by pads, condom catheter or medication. The patients were followed oncologically and Kaplan‐Meier survival curves constructed. Urodynamic studies were used to define the possible causes of enuresis.

RESULTS

Three patients died after surgery from pulmonary embolism. There were 67 early complications in 63 patients. The mean (sd) follow‐up was 87.8 (49.1) months. There were 111 treatment failures from cancer; of these, four men only had an isolated local recurrence in the urethra. Late complications included 72 pouch stones in 55 patients, and 36 deteriorated renal units caused by reflux (17), uretero‐ileal stricture (11), nipple valve eversion (four) or stenosis (four). Interestingly, 65 renal units that were dilated before surgery improved significantly afterward. Ileo‐urethral strictures occurred in seven men and anterior urethral strictures in six. Nine patients were totally incontinent and two had chronic urinary retention. Daytime continence was complete in 94% of men, with nocturnal enuresis in 55; the latter had significantly more residual urine, and a higher amplitude and duration of phasic contractions.

CONCLUSIONS

Orthotopic bladder substitution after cystectomy for cancer is feasible, with good functional and oncological outcomes in properly selected patients. Nevertheless, the use of a hemi‐Kock pouch is associated with many valve‐related complications.
Urinary incontinence after radical retropubic prostatectomy: the outcome of a surgical technique
Authors: Moinzadeh A. , Shunaigat A.N. , Libertino J.A.
Published: August 2003

It is a reflection of the many manuscripts submitted on urological oncology in general, and prostate cancer in particular, that I am publishing 10 papers in this section this month. Seven of these relate to the latter subject.

The authors from the Lahey Clinic describe their technique of radial prostatectomy and include a novel method of posterior bladder plication. They report an early return to continence and conclude that the technique is important in achieving their excellent results.

In another study the group from Stockport show that patients often make decisions about types of treatment for prostate cancer having been strongly influenced by their partner, who in turn may have had pre‐existing conceptions about this. They recommend early involvement of the partner to help in this very important decision‐making.

The two papers on bladder cancer describe possible prognostic factors, both clinical and laboratory‐based, from a large experience in Hamburg and Mansoura.

OBJECTIVE

To analyse the incidence of incontinence after radical retropubic prostatectomy (RRP) and the time to return of continence, using an RRP technique including a novel posterior bladder plication

PATIENTS AND METHODS

We retrospectively reviewed the medical records of 200 consecutive patients who underwent RRP between September 1995 and February 1997, by one surgeon, at our institution. Patient characteristics including age, preoperative prostate‐specific antigen (PSA) level and Gleason grade, were assessed. Continence was assessed before and after RRP by either a third‐party patient interview or a prospective validated questionnaire. Continence was defined as not requiring the use of any sanitary pads or diapers. The continence rate was determined immediately after catheter removal, and at 3, 6, 12 and 15 months after RRP.

RESULTS

The mean age of the patients was 59.4 years, the preoperative PSA level 8.5 ng/mL and the Gleason grade 6.1. The time to continence and percentage of continent patients was 63.5% immediately, 82% at 3 months, 91% at 6 months, and 98.5% at 12 months after RRP. At 15 months, 199 of 200 consecutive patients were continent (99.5%).

CONCLUSION

With our technique there was an early return to continence and only a minor incontinence rate at 15 months. The cumulative effect of sequential technical manoeuvres in our RRP technique, including posterior bladder plication, is critical for continence after RRP.
Overexpression of the cytoprotective protein clusterin decreases radiosensitivity in the human LNCaP prostate tumour model
Authors: Zellweger T. , Kiyama S. , Chi K. , Miyake H. , Adomat H. , Skov K. , Gleave M.E.
Published: August 2003

The paper by Zellweger et al. builds on the continuing story of clusterin (TRPM‐2) in the development and progression of prostate cancer. This group have published a series of papers on this protein, showing that it correlates with progression to androgen‐independence and resistance to apoptosis. One of their recent papers has shown that ‘knocking out’ clusterin increases radiation sensitivity in prostate cancer cells. The current paper reports that increasing the expression of clusterin in LNCaP cells increases the cell's resistance to radiation‐induced apoptosis. Manipulating identified survival proteins has important implications in preventing androgen‐independent progression. Clusterin is such a survival protein and represents an important drug target in the near future.

OBJECTIVE

To evaluate the effect of clusterin overexpression on radiation‐induced tumour growth rates and apoptosis in human prostate LNCaP cells, as prostate cancer cells are relatively resistant to radiation‐induced apoptosis and local recurrences are common, but overexpression of the anti‐apoptotic protein clusterin can accelerate progression to androgen‐independence and to confer a chemoresistant phenotype in various prostate cancer models.

MATERIALS AND METHODS

Western blot analysis and immunohistochemistry were used to compare clusterin expression levels in parental (P) and clusterin‐transfected (T) LNCaP cells in vitro and in vivo. The effects of radiation on clusterin‐expression in both parental LNCaP/P and clusterin‐transfected LNCaP/T tumours were analysed by Northern blot analysis. The cellular response to radiation was determined up to 3 weeks after irradiation using tetrazolium and re‐growth assays, and cell‐cycle analysis by flow cytometry.

RESULTS

Clusterin mRNA expression increased from undetectable to low levels in LNCaP/P tumours after radiation and more than three‐fold in LNCaP/T tumours. Clusterin overexpression decreased the radiosensitivity in a time‐dependent manner, reducing the extent of growth arrest and apoptosis by up to 54%. Re‐growth assays showed that the improved survival rates of LNCaP/T cells after radiation did not change after 3 days, remaining constant over 3 weeks.

CONCLUSIONS

These results identify clusterin as a promoter of cell survival that may help mediate resistance to radiation‐induced apoptosis. Furthermore, clusterin overexpression seems to provide an extended protection against radiation‐induced cell cycle arrest and apoptosis.
One 10‐core prostate biopsy is superior to two sets of sextant prostate biopsies
Authors: Fink K.G. , Hutarew G. , Pytel A. , Esterbauer B. , Jungwirth A. , Dietze O. , Schmeller N.T.
Published: August 2003

OBJECTIVES

To compare the efficiency of different transrectal ultrasonography (TRUS)‐guided prostate biopsy techniques for detecting prostate cancer.

MATERIALS AND METHODS

In all, 81 prostates from radical prostatectomy were used and two consecutive sets of sextant biopsies and one 10‐core biopsy taken in each specimen. The 10‐core biopsy consisted of a sextant biopsy and four cores from the far lateral areas of the prostate. To simulate a transrectal biopsy procedure, all biopsies were taken under TRUS guidance.

RESULTS

In the first set of sextant biopsies 44 prostate cancers (54%) were detected and in the second set 51 (63%). Combining both sets of sextant biopsies 57 (70%) of the carcinomas were detected. One set of 10‐core biopsies detected 66 (82%) of all prostate cancers. Overall, with the 10‐core biopsies 16% more prostate tumours were diagnosed than with two consecutive sets of sextant biopsies. To find the same number of prostate cancers as with the 10‐core technique, 14% of patients undergoing sextant biopsy would require a second set and 11% at least a third set of biopsies.

CONCLUSIONS

The 10‐core prostate biopsy technique is superior to the commonly used sextant technique and could spare patients unnecessary repeated biopsy. Even after including a second set of sextant biopsies, the total detection rate with these 12 biopsies was inferior to the 10‐core technique.
Urodynamic verification of an overactive bladder is not a prerequisite for antimuscarinic treatment response
Authors: Malone‐Lee J. , Henshaw D.J.E. , Cummings K.
Published: August 2003

OBJECTIVE

To investigate the place of urodynamics in the evaluation of patients with symptoms of the overactive bladder by comparing the response to antimuscarinic therapy in those with and with no urodynamically verified symptoms.

PATIENTS AND METHODS

In a prospective observational study, 356 female patients with urinary frequency (≥ 8 voids/24 h) and urgency, with or without urge incontinence, underwent cystometry. Patients were diagnosed with detrusor instability if there were spontaneous, uninhibited increases in detrusor pressure during bladder filling. All patients, regardless of urodynamic findings, were subsequently treated with oxybutynin 2.5 mg twice daily and bladder retraining. The outcome was evaluated as the change in urinary frequency and incontinence episodes after 6–8 weeks of treatment.

RESULTS

Among 352 evaluable patients, 266 (76%) had detrusor instability on cystometry and the remainder did not. There was no significant between‐group difference in mean age, urinary frequency or the number of incontinence episodes at presentation. Both groups improved equally well during oxybutynin and bladder retraining therapy; after 6–8 weeks there was no significant between‐group difference for the mean change from baseline in urinary frequency or incontinence episodes. Tolerability profiles were comparable for the two groups.

CONCLUSION

Patients with symptoms of an overactive bladder, but apparently normal urodynamic findings, respond equally well to antimuscarinic therapy as those with urodynamically verified symptoms. Such findings cast further doubt on the clinical validity of using invasive urodynamic procedures to characterize patients with irritative lower urinary tract symptoms before starting antimuscarinic therapy.
Anionic and cationic drug secretion in the isolated perfused rat kidney after neonatal surgical induction of ureteric obstruction
Authors: De Gier R.P.E. , Feitz W.F.J. , Masereeuw R. , Wouterse A.C. , Smits D. , Russel F.G.M.
Published: August 2003

OBJECTIVE

To study the pathophysiological changes of renal tubular drug transport mechanisms in congenital renal obstruction, by developing a model for perfusing the isolated kidney (IPK) after neonatal surgical induction of partial ureteric obstruction in Hanover Wistar rats.

MATERIAL AND METHODS

Moderately severe obstruction of the right kidney of male rats was created by burying a segment of the right ureter under the psoas fascia at 5–7 days after birth. Different fluorescent substrates for renal organic anion and cation drug transport systems were added to the IPK, and the concentration of these substances with time analysed in perfusate and urine.

RESULTS

The reproducibility in all groups of the glomerular filtration rate (GFR) and drug excretion was remarkably good. GFR was significantly lower in obstructed kidneys than in unobstructed kidneys. 123Rhodamine, a marker for organic cation and P‐glycoprotein transport, had a significantly lower maximum excretion rate in the obstructed than in unobstructed kidneys. Renal fractional clearance (123rhodamine clearance corrected for diminished GFR) was also significantly lower in obstructed kidneys. There was no significant difference in maximum excretion (absolute and corrected GFR) for Lucifer Yellow, a marker for sodium‐dependent organic anion transport. The maximum excretion rate of calcein, a marker for sodium‐independent organic anion transport, was significantly lower in the obstructed than in the unobstructed kidneys, but significantly higher after correcting for reduced GFR.

CONCLUSION

The IPK is a good model for studying the effect of neonatal renal obstruction on tubular drug transport. These results show that organic anion and cation transport mechanisms are affected differently by obstruction.
A description of Ca2+ channels in human detrusor smooth muscle
Authors: Sui G.P. , Wu C. , Fry C.H.
Published: August 2003

OBJECTIVE

To characterize the Ca2+ channels in human detrusor smooth muscle and to investigate their contribution to spontaneous electrical activity.

MATERIALS AND METHODS

Isolated human detrusor smooth muscle myocytes were used to measure ionic currents under voltage‐clamp or membrane potential under current‐clamp. Membrane potential oscillations were analysed in terms of oscillation frequency and amplitude using fast Fourier transforms.

RESULTS

Under voltage‐clamp an inward current dependent on extracellular Ca2+ was recorded using Cs+‐filled patch electrodes. The current could be separated into two components on the basis of their sensitivity to Ni2+, verapamil or nicardipine, and their dependence on holding and clamp potential. A Ni2+‐sensitive component activated over a relatively negative range of potentials (−60 to −20 mV) comprised about a third of the total current and was designated a T‐type Ca2+ current. A verapamil/nicardipine‐sensitive component, activated at more positive potentials, was designated an l‐type Ca2+ current. Using K+‐based filling solutions spontaneous transient outward currents were recorded that had the characteristics of current flow through BK channels. Membrane potential oscillations, under current‐clamp increased in frequency but not amplitude as the mean membrane potential was made less negative. The voltage‐dependence of oscillation frequency was similar to that of the l‐type, but not T‐type, Ca2+ current activation curve. Furthermore oscillation frequency was slowed by verapamil but not Ni2+.

CONCLUSION

The study showed, for the first time, the presence of both T‐ and L‐type Ca2+ channels in human detrusor smooth muscle; we propose a role for these channels in spontaneous activity. The results suggest that the L‐type Ca2+ current can control membrane potential oscillation frequency. The significance of this finding for spontaneous contractions is discussed.
The management of stage T1 grade 3 transitional cell carcinoma of the bladder
Authors: Evans C.P. , Busby J.E.
Published: August 2003

The number of Mini‐Reviews per issue is being increased to three for the foreseeable future. As mentioned before, I believe they add to the reader‐friendliness of the journal, and are enjoyable and informative.

This month, the controversial topics of T1 G3 bladder cancer, surgery for penile fractures and managing patients on warfarin are dealt with. I hope that readers will feel free to write to me if they have strong feelings about these or any other subjects in the Journal.
A large prostate at radical retropubic prostatectomy does not adversely affect cancer control, continence or potency rates
Authors: Foley C.L. , Bott S.R.J. , Thomas K. , Parkinson M.C. , Kirby R.S.
Published: August 2003

OBJECTIVES

To determine the effect of a large prostate at radical retropubic prostatectomy (RRP) on the pathological outcome, biochemical recurrence rates, potency and continence.

PATIENTS AND METHODS

From a database of 440 patients treated with RRP, retrospective information was obtained on prostate weights, patient and tumour characteristics, and follow‐up. Potency and continence after RRP was obtained using a self‐reported validated questionnaire. Patients with prostates of > 75 or ≤ 75 g were compared.

RESULTS

The median (range) prostate size was 87  (76–182) and 42 (4.1–75) g in the two groups. The response rate to the questionnaire was 78% (344 men). Patients with prostates of > 75 g were older, with a median (range) age of 65 (51–74) years, than the other group, at 61 (40–76) years (P = 0.01), and had higher initial prostate‐specific antigen (PSA) levels, at 9.6 (3.4–37.8) and 7.6 (0.1–30.0) ng/mL, respectively (P = 0.001). Tumours within larger prostates were of a lower stage (P = 0.035), lower Gleason grade (median 6 and 7, P = 0.015), of smaller volume (median 1.0, 0.1–12.4; and 1.5, 0.1–21.1 mL; P = 0.04) and more often ‘clinically insignificant’ (23% and 6%, P = 0.001). There was no difference in the number or distribution of positive surgical margins. For a limited median follow‐up of 20–25 months, patients with prostates of > 75 g were less likely to have biochemical recurrence (5% vs 24%, P < 0.001). Potency and continence rates were similar between the groups.

CONCLUSIONS

Prostate size at RRP does not affect the risk of impotence or incontinence afterward. A prostate of > 75 g is associated with a lower likelihood of PSA‐relapse, potentially as a result of lead‐time bias. While an enlarged prostate may contraindicate other potentially curative cancer treatments, the outcomes of RRP appear to be unaffected.
Transurethral resection of the prostate as catheter‐free day‐care surgery
Authors: Chander J. , Vanitha V. , Lal P. , Ramteke V.K.
Published: August 2003

OBJECTIVE

To evaluate the feasibility of transurethral resection of the prostate (TURP) as catheter‐free day‐care surgery.

PATIENTS AND METHODS

The study comprised 64 patients (mean age 62.4 years) with a mean (range) American Urological Association symptom score of 21.4 (9–31) and prostate volume (by ultrasonography) of 32.8 (17–50) mL, and with no significant comorbidity. The patients were admitted on the morning of the surgery and, under brief spinal anaesthesia, underwent standard TURP. After surgery the urethral catheter was removed as soon as the effluent was clear. The patients were discharged after they could pass urine freely and with a good stream.

RESULTS

The mean duration of catheterization after TURP was 7.15 h; 59 patients (92%) had their catheter removed within 10 h (mean duration 6.42 h). There were no major complications during or after TURP. After removing the catheter, no patients required its reinsertion for failure to void or for clot retention. The mean hospital stay after TURP was 10.7 h and 98% of patients were discharged within 23 h of surgery.

CONCLUSION

TURP can be conducted safely in a day surgery setting in patients with mild to moderate benign prostatic enlargement and no coexisting medical illness.
An unrandomized prospective comparison of urinary continence, bowel symptoms and the need for further procedures in patients with and with no adjuvant radiation after radical prostatectomy
Authors: Hofmann T. , Gaensheimer S. , Buchner A. , Rohloff R. , Schilling A.
Published: August 2003

OBJECTIVE

To prospectively assess, using a questionnaire‐based study, the relative differences and changes in urinary continence and bowel symptoms, and the need for further surgery, within the first year after radical retropubic prostatectomy (RRP) in patients with and with no adjuvant radiotherapy (aRT).

PATIENTS AND METHODS

The study included 96 men with clinically organ‐confined adenocarcinoma of the prostate who underwent RRP between March 1998 and June 1999. A subset of 36 patients was recommended aRT of the prostatic fossa (median dose 54 Gy) because of positive surgical margins and/or seminal vesicle involvement. Using a mailed questionnaire all patients were prospectively assessed at 4‐month intervals for the first year after RRP.

RESULTS

Valid data were analysed from 83 patients (overall response rate 86%), of whom 30 (36%) had received aRT. At 4 months a significantly lower proportion used no pads and significantly more used 1 pad/day in the aRT than in the RRP group (both P < 0.05). Eight and 12 months after RRP there was no statistically significant difference between the groups in urinary incontinence. However, 53% of men in the aRT group had stool urgency and 13% reported fecal incontinence at 4 months, compared with 1.9% and none (both P < 0.01) of the RRP group. At 1 year after RRP bowel symptoms and fecal continence improved in the aRT group and there was no significant difference for these symptoms between the groups. Starting aRT early (≤ 12 weeks after RP) or late (> 12 weeks) had no significant effect on urinary continence, bowel symptoms and fecal incontinence. Apart from dilatation of urethral strictures in one patient in each group, no further procedures were reported during the follow‐up.

CONCLUSION

A moderate dose of aRT after RRP had a temporary effect on subjective urinary continence at 4 months but not at 8 and 12 months. More patients receiving aRT reported significant bowel symptoms at 4 and 8 months than those with RRP only, but at 1 year most of these symptoms had resolved and there were no significant differences between the groups.
The effect of urethral instrumentation on uroflowmetry
Authors: Issa M.M. , Chun T. , Thwaites D. , Bouet R. , Hall J. , Miller L.E. , Ritenour C.W.
Published: August 2003

OBJECTIVE

To evaluate in a prospective study the effect of urethral instrumentation (flexible cystoscopy) on uroflowmetry, and in particular the peak urinary flow rate (Qmax).

PATIENTS AND METHODS

Thirty‐two consecutive patients (median age 61.8 years, range 24–80) undergoing flexible cystoscopy were included in the analysis. Patients with active urethral stricture disease or urinary infection were excluded. The indications for cystoscopy included haematuria (44%), voiding symptoms (66%), history of bladder cancer (19%), and history of perineal trauma (3%). Patients underwent uroflowmetry immediately before instrumentation. The postvoid residual volume (PVR) was measured by bladder catheterization. After cystoscopy the bladder was completely emptied and then filled with the same volume of sterile normal saline (bladder volume = voided volume + PVR), and the patient underwent a second uroflowmetry.

RESULTS

Patients with voiding symptoms (21, 66%) had a median (range) American Urological Association symptom score of 17 (4–34), a Bother score of 16 (1–23), and Quality of Life score of 3 (1–6). The mean Qmax was 16.9 (4.5–36.9) and 13.3 (4.5–39.4) mL/s before and after cystoscopy, respectively (P = 0.029). The mean percentage difference in Qmax was + 27 (− 23 to 139)% higher before than after cystoscopy. After cystoscopy, up to 25% (eight) and 21% (seven) patients had a lower Qmax, from > 15 to < 15 mL/s and from > 12 to < 12 mL/s, respectively. There were no significant differences in the bladder volume and PVR (P = 0.914 and 0.984, respectively).

CONCLUSIONS

Urethral instrumentation by flexible cystoscopy significantly alters Qmax. A ‘false’ mean change in Qmax (favouring improvement) of +27% would result if uroflowmetry data after instrumentation were used at baseline. Therefore, study protocols for benign prostatic obstruction should exclude uroflowmetry data obtained after urethral instrumentation; failure to exclude such data will lead to disproportionately greater improvements in Qmax that are independent of the therapy delivered.