bluuebunny/crossref_metadata_2025 huggingface dataset:
Uroflowmetry in female voiding disturbances
Authors: Costantini Elisabetta , Mearini Ettore , Pajoncini Cinzia , Biscotto Sauro , Bini Vittorio , Porena Massimo
Published: September 2003

Aims

The clinical validity of uroflowmetry in women is attenuated by lack of absolute normal values. A peak flow <15 mL/sec and/or residual urine >50 mL with a minimum total bladder volume of 150 mL before voiding (volume voided+residual) (method A) and the 10th centile curve of the Liverpool Nomogram (method B) for the maximum urine flow rate have been identified as useful discriminants when diagnosing voiding difficulties in women. This study compares the two methods and analyses the validity of uroflowmetry in female voiding disturbances.

Methods

A total of 348 women underwent a full urogynaecologic work‐up. Evaluable results of uroflowmetry (229 with method A and 224 with method B) were analysed and compared in terms of the following clinical variables: age, parity, previous urogynaecologic surgery, prolapse grade, symptoms, postvoid residue, and incontinence. Uroflowmetry results were compared with pressure/flow study results as indicated by four different cut‐offs.

Results

The odds ratio that a subject with voiding difficulty has abnormal flow is 3.7 (95% CI, 1.9–7) in the patients analysed with method A and 2.8 (95% CI, 1.6–5.2) with method B. A good accordance emerged between the two methods in flowmetry results. Uroflowmetry has a specificity of >70% and a sensitivity of 50 to 100% depending on the cut‐offs. Uroflowmetry results in women can be analysed by using either of the methods.

Conclusions

Uroflowmetry has a good specificity, a high negative predictive value, and a good diagnostic capacity such as to make it useful as the first diagnostic approach in urogynaecologic patients. Neurourol. Urodynam. 22:569–573, 2003. © 2003 Wiley‐Liss, Inc.
Micturitional disturbance in a patient with a spinal cavernous angioma
Authors: Sakakibara Ryuji , Uchiyama Tomoyuki , Yoshiyama Mitsuharu , Aotsuka Akiyo , Mori Masahiro , Kanesaka Toshihide , Hattori Takamichi , Yamanishi Tomonori
Published: September 2003

A 58‐year‐old woman had a 3‐year history of numbness in the right leg, which developed into thoracic transverse myelopathy and urinary retention. After referral to our department, MRI scans revealed a lesion with a target appearance at the T10–11 spinal cord with multiple silent cerebral lesions, which confirmed the diagnosis of cavernous angioma. Gamma‐knife surgery was not indicated, considering the risk of adverse effects. The patient gradually became able to urinate, but had urge urinary incontinence. The first urodynamic studies (conducted 3 months after full clinical manifestations of transverse myelopathy) showed detrusor hyperreflexia (DH), decreased bladder sensation during bladder filling, detrusor‐sphincter dyssynergia (DSD), and weak detrusor on voiding. However, urinary retention appeared again without change of neurologic signs. The second urodynamic studies (conducted 2 months later) showed less marked DH during bladder filling, and equivocal DSD but marked weak detrusor on voiding. The patient started taking oral prazosin hydrochloride (6 mg/day), which gradually ameliorated her voiding difficulty. Lesions in the lateral and dorsal columns of the spinal cord seem to be responsible for the micturitional disturbance in our patient with spinal cavernous angioma. Neurourol. Urodynam. 22:606–610, 2003. © 2003 Wiley‐Liss, Inc.
Factors associated with voiding function in women with lower urinary tract symptoms: A mathematic model explanation
Authors: Yang Jenn‐Ming , Huang Wen‐Chen
Published: September 2003

Aims

The aim of this study was to explore the relationship between voiding function and factors such as age, gravidity, parity, menopause, and anterior vaginal wall relaxation.

Methods

One hundred twenty‐five women were identified from urodynamic records, 83 premenopausal and 42 postmenopausal. All had had a sonographic assessment of the lower urinary tract and a full urodynamic study, including a pressure‐flow study. None had diabetes mellitus, overt neurologic disease, pelvic surgery, anticholinergic medication or estrogen therapy, or voiding difficulty symptoms. Voiding parameters included the following urodynamic variables: maximum flow rate, average flow rate, residual urine, the ratio of residual urine to total bladder volume on spontaneous uroflowmetry, maximum flow rate, and detrusor pressure at maximum flow on a pressure‐flow study.

Results

Uroflow rates were significantly correlated with age, parity, and urethral mobility. As a whole, the scatter plots of maximum and average flow rates versus voided volume on uroflowmetry displayed a significant correlation (P < 0.0001 and P < 0.0001, respectively). But, there was no association between maximum flow rate and detrusor pressure at maximum flow in the pressure flow study (P = 0.132). Age, menopause, parity, and urethral mobility may have affected the correlation on uroflowmetry but have no effect on pressure‐flow plot. On subgroup analysis, significant correlation was identified only in women aged between 30 and 70, with parity greater than three, and urethral mobility greater than 70 degrees. These groups all had a reduced urethral pressure profile.

Conclusions

Age, menopause, parity, and urethral mobility may change the hydrodynamics of the lower urinary tract and have varying impact on the voiding function by altering urethral distensibility. Moreover, poor detrusor power in the postmenopausal women may complicate the analysis of voiding function. Neurourol. Urodynam. 22:574–581, 2003. © 2003 Wiley‐Liss, Inc.
Effect of one interval vaginal delivery on the prevalence of stress urinary incontinence: A prospective cohort study
Authors: Yip Shing‐Kai , Sahota Daljit , Chang Allan , Chung Tony
Published: September 2003

Aims

To analyze the effect of one interval vaginal delivery on the prevalence of stress urinary incontinence amongst a cohort of nulliparous women.

Methods

A cohort of 276 nulliparous women without incontinence was recruited consecutively in 1996, after they had vaginal delivery, and were followed‐up for urinary incontinence in 2000. The age, obstetric variables of the 1996 delivery (mode of delivery, genital tract trauma, birth weight, epidural analgesia, episiotomy, durations of labor, postpartum urinary retention), and the presence of interval vaginal delivery during the follow‐up period were recorded. The obstetric factors and the prevalence of urinary stress incontinence at follow‐up were then compared between women with and without interval vaginal delivery. Logistic regression analysis was performed to test the independence of the obstetric variables in the index pregnancy and the presence of one interval vaginal delivery, with urinary stress incontinence being the dependent variable.

Results

A total of 148 (53.6%) women were followed‐up. The prevalence of urinary incontinence was 28.6% in women without interval delivery and 21.1% in women with one interval delivery. There was no significant difference in the prevalence of urinary incontinence between the two groups (χ2 test, P = 0.31). Logistic regression showed that none of the obstetric variables or the presence of one interval vaginal delivery was significantly associated with urinary incontinence.

Conclusions

One interval vaginal delivery does not increase risk of urinary stress incontinence 4 years after the index vaginal delivery. Neurourol. Urodynam. 22:558–562, 2003. © 2003 Wiley‐Liss, Inc.
Urinary dysfunction in patients with systemic lupus erythematosis
Authors: Sakakibara Ryuji , Uchiyama Tomoyuki , Yoshiyama Mitsuharu , Yamanishi Tomonori , Hattori Takamichi
Published: September 2003

Aims

Nervous system involvement occurs in about half of patients with systemic lupus erythematosis (SLE). Seizures and psychiatric disorders are the most common manifestations; spinal cord lesions are uncommon. We had eight such patients who presented with urinary dysfunction.

Methods

The patients consisted of two men and six women, mean age 42 years, range 28–72 years. All patients were suffering from SLE for 2–25 years under immunosuppressant therapy. Their neurological manifestations were subacute encephalomyelopathy in three, subacute myelopathy in one, and chronic myelopathy in four. Urinary dysfunction included voiding difficulty in six (two of them had urinary retention initially) and urinary incontinence in four. Standard urodynamic studies were performed in the patients 2–3 weeks after admission.

Results

All patients had urodynamic abnormalities, including decreased urinary flow in five, increased post‐void residual urine in three (mean 97 ml), increased maximum urethral closure pressure in two, detrusor hyperreflexia (DH) in five, impaired detrusor contractility in five, detrusor‐sphincter dyssynergia in four, and neurogenic motor unit potentials of the external sphincter in two of four patients studied. DH was more common in patients with brisk deep tendon reflex (80%) than in those without (33%). Repeated studies showed that one had loss of bladder sensation, one developed a low compliance bladder, and one had decreased bladder capacity from 470 to 40 ml with marked DH during 2 months to 8 years follow‐up period.

Conclusions

Our results suggest that urinary dysfunction can be a feature in SLE patients is most commonly due to, and, in some patients there myelopathy, may be involvement of the spinal cord in a small group of the patients. Neurourol. Urodynam. 22:593–596, 2003. © 2003 Wiley‐Liss, Inc.
Afferent fibers of the pudendal nerve modulate sympathetic neurons controlling the bladder neck
Authors: Reitz André , Schmid Daniel M. , Curt Armin , Knapp Peter A. , Schurch Brigitte
Published: September 2003

Aims

Pudendal nerve stimulation is known to have a potential modulative effect on bladder function. However, even if its efficiency has been established for various neurogenic and non‐neurogenic bladder dysfunctions, the underlying neuronal mechanism, and the involved pathways in humans remain unknown. In this prospective study we focused on the effects of pudendal nerve stimulation in complete spinal cord injured patients to identify neuromodulative processes that occur on spinal level.

Methods

Twenty complete spinal male presenting with upper motor neuron lesion and neurogenic incontinence underwent pudendal nerve stimulation. Bladder, bladder neck (BN), and external urethral sphincter (EUS) pressures were continuously recorded with a three channel microtip pressure transducer catheter. Fifty six pudendal stimulations using biphasic rectangular impulses (0.2 ms, 10 Hz) with intensities up to 100 mA were applied to the dorsal penile nerve. In six patients, 18 stimulations were repeated after intravenous (i.v.) administration of 7 mg phentolamine.

Results

Mean BN and EUS pressure increased during stimulation significantly (P < 0.001). The latencies to the EUS responses range between 27 and 41 ms and those to the BN responses between 188 and 412 ms. Phentolamine decreased initial BN pressure and reduced the pressure rise during stimulation significantly (P < 0.05).

Conclusions

Pudendal nerve stimulation evoked somatic responses in the EUS and autonomic responses in the smooth muscle sphincter controlling the BN. Longer latencies of the BN responses and the sensitivity to the α‐blocking agent phentolamine suggest that sympathetic α‐adrenergic fibers are involved. Somatic afferent fibers of the pudendal nerve are supposed to project on sympathetic thoracolumbar neurons to the BN and modulate their function. This neuromodulative effect works exclusively at the spinal level and appears to be at least partly responsible for BN competence and at least continence. Neurourol. Urodynam. 22:597–601, 2003. © 2003 Wiley‐Liss, Inc.
Severe depression determines quality of life in urinary incontinent women
Authors: Stach‐Lempinen Beatas , Hakala Asta‐Leena , Laippala Pekka , Lehtinen Klaus , Metsänoja Riina , Kujansuu Erkki
Published: September 2003

Aims

The purpose of this study was to assess depression and anxiety in urinary incontinent women and to investigate factors influencing their self‐perception of urinary incontinence severity.

Methods

In this prospective study, 82 incontinent women estimated the severity of urinary incontinence using a visual analogue scale and completed a validated quality of life instrument: urinary incontinence severity score. Psychiatrists evaluated depression and anxiety using a structured interview of Hamilton Depression and Hamilton Anxiety Scales. Patients were classified on the basis of history and urodynamic evaluation into two diagnostic groups: stress urinary incontinence (n = 57) and idiopatic urge incontinence with or without stress incontinence (n = 25).

Results

Major depression occurred in 44.0% of women with idiopatic urge (±stress) incontinence and in 17.5% women with stress incontinence (odds ratio (OR 3.69), 95% confidence interval (95% CI 1.30–10.49)). Twenty two patients had severe incontinence defined as Urinary Incontinence Severity Score ≥14 points (upper quartile) and 23 patients defined as visual analogue scale ≥9 (upper quartile). In logistic regression analysis, major depression (OR 5.57; 95% CI 1.19–26.11), urge incontinence diagnosis (OR 23.13; 95% CI 1.90–282.11), parity (OR 2.33; 95% CI 1.16–4.60) and high Urgency Score (OR 1.94; 95% CI 1.32–2.85) predicted Urinary Incontinence Severity Score above the upper quartile. Only the pad‐test (OR 1.01; 95% CI 1.00–1.02) predicted visual analogue scale above upper quartile.

Conclusions

Major depression correlates with reduced incontinence specific quality of life. This data also suggests an association between depression and idiopatic urge incontinence. Neurourol. Urodynam. 22:563–568, 2003. © 2003 Wiley‐Liss, Inc.
Effects of a selective metabotropic glutamate receptor agonist on the micturition reflex pathway in urethane‐anesthetized rats
Authors: Tanaka Hiroshi , Kakizaki Hidehiro , Shibata Takashi , Ameda Kaname , Koyanagi Tomohiko
Published: September 2003

Aims

To determine a possible role of metabotropic glutamate receptors in the spinobulbospinal micturition reflex pathway in the rat.

Materials and Methods

A selective metabotropic glutamate receptor agonist, trans‐(±)‐1‐amino1,3‐cyclopentanedicarboxylic acid (trans‐ACPD) was administered to the lumbosacral spinal cord via an intrathecal catheter in urethane anesthetized rats. Amplitude of reflex bladder contractions evoked by bladder distension under isovolumetric condition as well as amplitude of bladder contractions elicited by electrical stimulation of the pontine micturition center (PMC) were examined before and after administration of trans‐ACPD. The effect of trans‐ACPD on the urethral activity during isovolumetric bladder contractions was also examined by monitoring urethral perfusion pressure and electromyography of the external urethral sphincter (EUS‐EMG).

Results

Trans‐ACPD (3–10 μg) completely inhibited reflex bladder contractions evoked by bladder distension and the duration of inhibition was dose dependent (3 μg: 11.4 ± 2.8 min, 5 μg: 13.2 ± 1.3 min, 10 μg: 36.2 ± 2.4 min). The mean amplitude of bladder contractions evoked by electrical stimulation of the PMC was reduced to 12.6 ± 2.3% of control by 10 μg of trans‐ACPD. In addition, bursting activity of EUS‐EMG and corresponding high frequency oscillations of urethral pressure during isovolumetric bladder contractions were completely abolished by 10 μg of trans‐ACPD.

Conclusions

These results indicate that intrathecal administration of a selective metabotropic glutamate receptor agonist to the lumbosacral spinal cord has an inhibitory effect on the spinobulbospinal micturition reflex pathway in urethane‐anesthetized rats. This pharmacological action is attributed at least to the inhibitory effect on the descending pathway from the PMC to the lumbosacral spinal cord. Neurourol. Urodynam. 22:611–616, 2003. © 2003 Wiley‐Liss, Inc.
Transabdominal ultrasound measurement of pelvic floor muscle activity when activated directly or via a transversus abdominis muscle contraction
Authors: Bø Kari , Sherburn Margaret , Allen Trevor
Published: September 2003

Aims

The purpose of the present study was to compare the effectiveness of instruction to contract the pelvic floor muscles (PFM), the transversus abdominis (TrA), and the TrA + PFM visualized as displacement of the pelvic floor by ultrasound.

Materials and Methods

Twenty female physical therapists, mean age 41.1 years (range 26–56) participated in the study. A 3.5 MHz 35 mm curved linear array ultrasound transducer (Dornier Medtech) was placed in the mid‐sagittal plane immediately suprapubically, angled at 15–30 degrees from the vertical depending on subcutaneous fat and anatomical variations, to image the pelvic floor. Six trials of three maneuvers in random order were performed: contraction of PFM, TrA, and TrA + PFM.

Results

In spite of correct contractions assessed by palpation and clinical observation, one subject demonstrated a downward movement of the pelvic floor during PFM contraction on ultrasound. Six subjects (30%) showed a downward movement during a TrA− contraction, and two during the combined TrA + PFM contraction. Instruction to contract PFM produced significantly greater mean displacement: 11.2 mm (95% CI 7.2–15.3) than TrA 4.3 mm (95% CI −0.2–8.8), P < 0.01, and combination: 8.5 mm (95% CI 5.2–12), P = 0.04. Hence, instruction of PFM contraction produced a 61.6% greater displacement of the pelvic floor in the correct direction than a TrA contraction.

Conclusions

It is concluded that ultrasound is a more valid method than palpation and clinical observation to assess PFM function, and that instruction to contract the PFM produces a significantly more effective pelvic floor muscle contraction than instruction to perform a TrA contraction. Neurourol. Urodynam. 22:582–588, 2003. © 2003 Wiley‐Liss, Inc.
Validation of the clinical bulbocavernosus reflex
Authors: Wester C. , FitzGerald M.P. , Brubaker L. , Welgoss J. , Benson J.T.
Published: September 2003

Aims

To validate the clinically obtained bulbocavernosus reflex (BCR) by comparing it to the results of clitoroanal reflex (CAR) electrodiagnostic testing.

Materials and Methods

Thirty three women with detrusor overactivity underwent clinical examination and electrodiagnostic testing including evaluation of CAR latency using a Nicolet Viking IIe electrodiagnostic instrument, stimulating the paraclitoral area on each side in turn with paired stimuli while recording anal sphincter compound muscle action potentials bilaterally using surface patch electrodes. The results of clinical and electrodiagnostic testing were compared.

Results

The BCR was clinically present on at least one side in 26 (79%) women, and thought to be clinically bilaterally absent in 7 (21%). Electrophysiologic testing revealed CARs to be at least unilaterally present in 30 (91%) patients. When the BCR was clinically present, a CAR was recorded in 92% of patients. Of the seven women with clinically absent BCR, just one had absent CARs.

Conclusions

In this sample of women with detrusor overactivity, the clinical BCR did not have strong correlation with the electrically obtained reflex. Neurourol. Urodynam. 22:589–592, 2003. © 2003 Wiley‐Liss, Inc.
Relationship of abdominal pressure and body mass index in men with LUTS
Authors: McIntosh Stuart , Drinnan Michael , Griffiths Clive , Robson Wendy , Ramsden Peter , Pickard Robert
Published: September 2003

Aims

In the development of a non‐invasive method for estimating isovolumetric intravesical pressure (pves,isv) we looked for a relationship between intra‐abdominal pressure (pabd) and general build, expressed as body mass index (BMI) in men with lower urinary tract symptoms (LUTS).

Materials and Methods

In 100 consecutive male patients undergoing an invasive pressure flow study (PFS) the pabd was recorded continuously during filling and voiding. The magnitude at four set points was measured: before filling, after filling, during voiding and at the end of voiding. Patients' weight (kg) and height (m) were also recorded and their BMI (weight/height2) was calculated.

Results

During the fill/void cycle pabd increased during bladder filling from 37 ± 7 cm H2O (mean ± SD) to 38 ± 8 cm H2O, fell during voiding to 35 ± 9 cm H2O before increasing to 36 ± 8 cm H2O at the end of voiding. There was a clear relationship between the individual values of pabd and BMI (correlation co‐efficient = 0.52) and to a lesser extent weight (correlation co‐efficient = 0.42). The relationship with BMI was clarified by separating the subjects into groups of normal, overweight and obese.

Conclusions

A clear relationship between BMI and pabd was demonstrated, but because of the difficulties in quantifying it for an individual, it is impractical to apply an adjustment to non‐invasive estimates of pves,isv. Neurourol. Urodynam. 22:602–605, 2003. © 2003 Wiley‐Liss, Inc.
Locating information with uncertainty in fully interconnected networks: The case of nondistributed memory
Authors: Kirousis Lefteris M. , Kranakis Evangelos , Krizanc Danny , Stamatiou Yannis C.
Published: September 2003

We consider the problem of searching for a piece of information in a fully interconnected computer network (also called a complete network orclique) by exploiting advice about its location from the network nodes. Each node contains a database that “knows” what kind of documents or information are stored in other nodes (e.g., a node could be a Web server that answers queries about documents stored on the Web). The databases in each node, when queried, provide a pointer that leads to the node that contains the information. However, this information is up‐to‐date (or correct) with some bounded probability. While, in principle, one may always locate the information by simply visiting the network nodes in some prescribed ordering, this requires a time complexity in the order of the number of nodes of the network. In this paper, we provide algorithms for locating an information node in the complete communication network, which take advantage ofadvicegiven from network nodes. The nodes may either give correct advice, by pointing directly to the information node, or give wrong advice, by pointing elsewhere. On the lower‐bounds' side, we show that no fixed‐memory (i.e., with memory independent of the network size) deterministic algorithm may locate the information node in a constant (independent of the network size) expected number of steps. Moreover, ifp= ω(1/n) is the probability that a node of ann‐node clique gives correct advice, we show that no algorithm may locate the information node in an expected number of steps less than 1/p−o(1). To study how the expected number of steps is affected by the amount of memory allowed to the algorithms, we give a memoryless randomized algorithm with expected number of steps 4/p+o(1/p) +o(1) and a 1‐bit randomized algorithm requiring on the average at most 2/p+o(1) steps. In addition, in the memoryless case, we also prove a 4/plower bound for the expected number of steps in the case where the nodes giving faulty advice may decide on the content of this advice in any possible way and not merely at random (adversarialfault model). Finally, for the case where faulty nodes behave randomly, we give an optimal, unlimited memory deterministic algorithm with expected number of steps bounded from above by 1/p+o(1/p) + 1. © 2003 Wiley Periodicals, Inc.
Time continuity in cohesive finite element modeling
Authors: Papoulia Katerina D. , Sam Chin‐Hang , Vavasis Stephen A.
Published: September 2003

We introduce the notion of time continuity for the analysis of cohesive zone interface finite element models. We focus on ‘initially rigid’ models in which an interface is inactive until the traction across it reaches a critical level. We argue that methods in this class are time discontinuous, unless special provision is made for the opposite. Time discontinuity leads to pitfalls in numerical implementations: oscillatory behavior, non‐convergence in time and dependence on nonphysical regularization parameters. These problems arise at least partly from the attempt to extend uniaxial traction–displacement relationships to multiaxial loading. We also argue that any formulation of a time‐continuous functional traction–displacement cohesive model entails encoding the value of the traction components at incipient softening into the model. We exhibit an example of such a model. Most of our numerical experiments concern explicit dynamics. Copyright © 2003 John Wiley & Sons, Ltd.
A novel approach to the analysis of distributed shear banding in polymer blends
Authors: Pijnenburg K. G. W. , Van der Giessen E.
Published: September 2003

The toughness of glassy polymers can be enhanced by blending with rubber particles. The consensus is that this toughening is due to massive plastic deformation of the matrix that takes place once the particles have cavitated. Micromechanical studies of regular stackings of particles in a polymer matrix have provided much insight into the localized plastic flow in blends at the microscale of individual particles (or voids, once cavitated). Even some steps towards macroscopic constitutive models have been made. However, at intermediate length scales (i.e. larger than several particles, but smaller than the scale at which the material may be regarded as homogeneous) the situation is unclear. It is this length scale that becomes important around crack tips, for example, where a thorough understanding of the toughening effect has to be derived from. In this paper, we therefore present a novel approach to the analysis of distributed shear banding in polymer–rubber blends. A coarse‐grain description, in which much of the morphology is retained but the local shear banding is idealized into ‘shear surfaces’, will enable us to analyse ensembles with large numbers of particles. The parameters of this model will be validated with results from detailed cell analyses. Copyright © 2003 John Wiley Sons, Ltd.
3D computer simulation of melt flow and heat transfer in the lost foam casting process
Authors: Mirbagheri S. M. H. , Varahram N. , Davami P.
Published: September 2003

A new mathematical model has been developed to simulate mould filling in the lost foam casting process, using the finite difference method. The simulation of molten flow and track of free surfaces is based on the SOLA‐VOF numerical technique. An algorithm was developed to calculate the gas pressure of the evaporated foam during the mould filling. The effect of backpressure on the filling behaviour was modelled with an experimental function by adding three‐dimensions 3DVOF functions. In order to verify the computational results, a thin grey iron plate was poured into a transparent mould. Cavity filling, foam depolymerization and gap formation were recorded with a 16mm high‐speed camera. A good agreement was achieved for simulation results of filling sequences with those from experiments. Copyright © 2003 John Wiley & Sons, Ltd.
Effective volume‐fraction optimization for thermal stress reduction in FGMs using irregular h‐refinement
Authors: Cho J. R. , Park H. J.
Published: September 2003

The volume fraction of constituent particles in functionally graded materials (FGM) varies continuously and functionally, and its optimal tailoring could be made by the numerical optimization incorporated with the finite element method. In such a case, the mesh density in finite element discretization of the volume fraction field influences the final design quality such that the further objective function reduction requires the refinement of volume fraction meshes. However, the uniform refinement of the volume fraction mesh is not effective, from the numerical point of view, particularly when the finite difference scheme is employed. This numerical inefficiency could be resolved by locally increasing the mesh density only where more volume‐fraction flexibility (i.e. more mesh density) is required. In this paper, we propose an effective volume‐fraction optimization procedure by applying the irregular h‐refinement to the volume fraction discretization. Copyright © 2003 John Wiley & Sons, Ltd.
Topology optimization of trusses using genetic algorithm, force method and graph theory
Authors: Kaveh A. , Kalatjari V.
Published: September 2003

In this article size/topology optimization of trusses is performed using a genetic algorithm (GA), the force method and some concepts of graph theory. One of the main difficulties with optimization with a GA is that the parameters involved are not completely known and the number of operations needed is often quite high. Application of some concepts of the force method, together with theory of graphs, make the generation of a suitable initial population well‐matched with critical paths for the transformation of internal forces feasible. In the process of optimization generated topologically unstable trusses are identified without any matrix manipulation and highly penalized. Identifying a suitable range for the cross‐section of each member for the ground structure in the list of profiles, the length of the substrings representing the cross‐sectional design variables are reduced. Using a contraction algorithm, the length of the strings is further reduced and a GA is performed in a smaller domain of design space. The above process is accompanied by efficient methods for selection, and by using a suitable penalty function in order to reduce the number of numerical operations and to increase the speed of the optimization toward a global optimum. The efficiency of the present method is illustrated using some examples, and compared to those of previous studies. Copyright © 2003 John Wiley & Sons, Ltd.
Shape optimization of bonded patch to cylindrical shell structures
Authors: Tong Liyong , Sun Xiannian
Published: September 2003

Adhesive bonding has been widely used to join or repair metallic and composite structural components to achieve or restore their designated structural stiffness and strengths. However, current analysis methods and empirical databases for composite bonded patch repairs or joints are limited to flat structures, and there exists a very limited knowledge on the effect of curvature on the performance and durability of composite bonded joints and repairs. Recently, a novel finite element formulation was presented for developing adhesive elements for conducting 2.5‐D simplified stress analysis of bonded repairs to curved structures. This paper presents the work on optimal shape design of a bonded curved composite patch using the newly developed adhesive element. The Sequential Linear Programming (SLP) method is employed as the optimization algorithm in conjunction with a fully implemented mesh generation algorithm into which new features have been incorporated. The objective of shape optimization is to minimize the maximum stress in the entire adhesive layer to ensure that the bonded patch effectively works together with the parent structure in service. Several different objective functions, related to possible failure mechanisms of the adhesive layer, are proposed to optimize the shape of a bonded patch. Copyright © 2003 John Wiley & Sons, Ltd.
22q11 deletions in fetuses with malformations of the outflow tracts or interruption of the aortic arch: impact of additional ultrasound signs
Authors: Volpe Paolo , Marasini Maurizio , Caruso Gilda , Marzullo Andrea , Buonadonna Antonia Lucia , Arciprete Paolo , Paolo Salvatore Di , Volpe Gennaro , Gentile Mattia
Published: September 2003

Objectives

One hundred and forty‐one consecutive cases of malformations of the outflow tracts or interrupted aortic arch (IAA), detected by fetal echocardiography, underwent detailed anatomy scan, karyotyping and fluorescence in situ hybridization analysis (FISH) to detect the prevalence of 22q11 microdeletion and to evaluate neonatal clinical findings and outcome according to the presence of the genetic defect. Then, we sought to investigate whether some prenatal ultrasound findings could help identify fetuses at higher risk of carrying the 22q11 microdeletion.

Methods

Echocardiography and FISH for the DiGeorge critical region (22q11) were performed in all cases.

Results

22q11 microdeletion was detected in 28 of 141 fetuses (19.8%). Intrauterine growth restriction (IUGR) appeared to be associated with the worst prognosis, being present in 2/2 intrauterine fetal deaths and 5/6 post‐natal deaths. IUGR, additional aortic arch anomalies and thymic hypo/aplasia were significantly more frequent in fetuses with 22q11 microdeletion (p = 0.011, 0.011 and <0.0001, respectively). Prenatal ultrasound thymus examination, performed on the last 84 fetuses, showed 75% sensitivity and 94% specificity. The combination of 2 predictors, namely, thymus defects and IUGR associated with additional aortic arch anomalies reached more than 90% sensitivity and 100% specificity.

Conclusions

Our study demonstrates that 22q11 microdeletion occurs in 20% of malformations of the outflow tracts and IAA type B, as detected in utero, and that this association is significantly predicted by the presence of associated ultrasound findings: thymic hypo/aplasia, IUGR and additional aortic arch anomalies. The feasibility of a correct prenatal diagnosis should enable clinicians to provide the couple with further informative counselling and to plan adequate post‐natal medical interventions. Copyright © 2003 John Wiley & Sons, Ltd.
Pericardial teratoma complicated by hydrops: successful fetal therapy by thoracoamniotic shunting
Authors: Grebille A. G. , Mitanchez D. , Benachi A. , Aubry M. C. , Houfflin‐Debarge V. , Vouhé P. , Dumez Y. , Dommergues M.
Published: September 2003

Pericardial teratoma is a potentially curable lesion that may become life threatening when it induces mediastinal compression and fetal hydrops. So far, cases with fetal hydrops have been managed by elective delivery or pericardial needle decompression.

We report a case in which pericardial teratoma resulted in fetal hydrops. Following transpleural needling of the fetal pericardium at 29 weeks and 6 days, pericardial effusion decreased but hydrops persisted, while major unilateral pleural effusion appeared. A thoracoamniotic shunt was placed at 30 weeks and 5 days. Hydrops resolved, although incompletely. The baby was delivered at 32 weeks and was operated upon on day 3.

This observation suggests that fetal hydrops associated with pericardial teratoma may improve following thoracoamniotic shunting. Fetal therapy may limit the risks of respiratory distress arising from the combined effect of airways compression and lung immaturity. Copyright © 2003 John Wiley & Sons, Ltd.
Using disease registries for pharmacoepidemiological research: a case study of data from a cystic fibrosis registry
Authors: Strobl Judith , Enzer Ian , Bagust Adrian , Haycox Alan , Smyth Rosalind , Ashby Deborah , Walley Tom
Published: September 2003

Background

The Epidemiologic Registry of Cystic Fibrosis (ERCF) was a multicentre, longitudinal follow‐up project of cystic fibrosis patients enrolled at some 200 centres in nine European countries between 1994 and 1999.

Purpose

We aimed to assess and improve the quality of a subset of data from the ERCF relating to seven English centres (1184 patients), prior to using the data for a long‐term cost‐effectiveness analysis of dornase alfa (Pulmozyme®). Specifically we wanted to assess the completeness and accuracy of the data and the comparability of cases across centres.

Methods

We used a subset of ERCF data relating to seven UK cystic fibrosis (CF) centres. Following initial data editing, key variable data from a sample of patients from five centres were subjected to a detailed verification of ERCF data against original data sources available in the centres. Disagreements between ERCF reports and original data sources were identified and corrected in the study dataset. In addition, centre staff were questioned about relevant clinical and recording practices.

Results

Thanks to detailed routine data checking procedures on key variables operated by the ERCF, the rates of disagreement between ERCF data and original data as identified in our verification process on the assessed variables are generally low (0.4–3.7%). Some outcome variables (deaths, hospitalisations) seem to be under‐reported by some centres. Episodes of pulmonary exacerbation are difficult to identify and also to verify. Twenty‐four patients were registered twice (consecutively in two different centres). There were some differences between centres in their interpretation of recording rules.

Conclusions

Researchers seeking to use disease registry data should consider detailed data quality review processes. Apart from data accuracy, reliable definitions of both critical events as well as their timing are important. The degree of under‐reporting, particularly of outcome variables, should be estimated. Information on local clinical and reporting practices is necessary to interpret multi‐centre data. Data protection issues may limit the possibilities for detailed data quality assessments of secondary data, as does the accessibility of original data for verification purposes. Our experiences and recommendations may be valuable for those intending to use disease registry data as well as those devising and operating such registries. Copyright © 2003 John Wiley & Sons, Ltd.
Intensive monitoring of new drugs based on first prescription signals from pharmacists: a pilot study
Authors: van Grootheest A. C. , Groote J. K. , de Jong‐van den Berg L. T. W.
Published: September 2003

Background

Intensive monitoring can be a valuable tool in the early detection of adverse drug reactions, especially of new drugs. Aim of this pilot study was to investigate the practical possibilities of a system of intensive monitoring, using the pharmacy computer system to detect the first dispensing of a new drug.

Method

Eight pharmacists were asked to monitor, using their computer system, when a general practitioner prescribed the target drug (rofecoxib). The pharmacists were also requested to provide the researchers at Lareb with an overview of the patient's medication history. Subsequently, the pharmacist sent the prescribing physician an envelope containing information about the project and a reporting form (all provided by Lareb), which the GP was requested to return to Lareb after the next visit of the patient. The items on the questionnaire concerned characteristics of the patient (anonymous), indication, dose and information about possible adverse drug reactions.

Results

During a 4‐week period, the participating pharmacists signalled 44 first prescriptions of rofecoxib. For each of these signals, the pharmacist provided Lareb with the medication history of the patient involved. Of the prescribing GPs who had been sent the report form, 70.5% (n=31) returned the form. Twenty‐one of the 31 forms were returned within 4 weeks. The medication histories showed that in 43 of the 44 cases, the dispensing of the target drug was indeed the first delivery. The participating pharmacists and GPs were also sent an evaluation form. All pharmacists returned their evaluations, indicating an overall motivation to participate in the proposed system. In total, seven GPs returned their evaluation forms, three of whom had not reported adverse drug events to the national spontaneous reporting centre before.

Conclusion

Although the number of participants in this trial was small, we conclude that pharmacists and prescribing physicians are able and willing to contribute to an intensive monitoring system for new drugs. Copyright © 2003 John Wiley & Sons, Ltd.
The General Practice Research Network: the capabilities of an electronic patient management system for longitudinal patient data
Authors: Sayer Geoffrey P. , McGeechan Kevin , Kemp Andrew , Bhasale Alice , Horn Fiona , Hendrie Leigh , Swan Lisa , Scahill Sharon
Published: September 2003

Purpose

To evaluate the potential of a general practice research database derived directly from de‐identified electronic medical records to provide national prescribing data in Australia. To observe the utilisation of a computer‐based patient management system over time. To evaluate the impact of the research network participation on data quality in participants' electronic records.

Method

A random sample of 297 general practitioners (GPs) from 128 practices provided longitudinal patient data from electronic medical records (using Medical Director® software) retrospectively from 1 January 1999 to April 2002. The General Practice Research Network (GPRN) database contains approximately 600 000 patients, representing over 4 million prescriptions from 4 million encounters. The quality and representativeness of data for prescribing, morbidity and software usage were evaluated by comparison with National data.

Results

Older GPs (>55) were under‐represented, perhaps due to lower computer usage rates, but patient visits were similar to the national distribution. Over time, there were increases in: the quality of prescribing data (with reason for visit/prescription being compulsorily recorded); recording of non‐prescribing visits; and the use of other features of the electronic patient management software.

Conclusions

Data derived from electronic general practice records is of sufficient quality to be used to provide national prescribing estimates and has potential value for pharmacoepidemiology and population health monitoring. Such longitudinal data has previously been unavailable in Australia. Monitoring of software usage demonstrates the evolution of the Australian GP user and will be increasingly useful in assessing and improving the quality of electronic medical records. Copyright © 2003 John Wiley & Sons, Ltd.
Medication history on internal medicine wards: assessment of extra information collected from second drug interviews and GP lists
Authors: Andersen S. E. , Pedersen A. B. , Bach K. F.
Published: September 2003

Purpose

To assess the extra information about patients' pre‐admission medication that second drug interviews and general practitioners' (GP) drug lists add to routine medication histories.

Methods

The medication histories of 81 patients from two medicine wards were compared with information collected from second interviews and GP drug lists. A panel of clinicians assessed the potential clinical impact of any discrepancies.

Results

In nine cases (11%CI: 6–20%) the medication history, the second interview and the GP lists were identical. The interviews revealed extra information about 54 prescription drugs and 72 over‐the‐counter drugs (OTCs) in 56 (69%CI: 58–78%) cases. The GP lists added 74 prescription drugs and 26 OTCs to the medication histories in 57 (70%CI: 60–79%) cases. Discrepancies were not associated with age, gender or number of drugs in medication history. In 18% (CI: 10–30%) of the cases, the specialist panel ascribed potential clinical problems to missing drug information.

Conclusions

Second interviews and GP lists reveal extra information about pre‐admission medication in two‐thirds of cases. Both procedures should be routinely performed to compile a more comprehensive basis for drug prescribing. This approach may mend the course of roughly one in five patients. Copyright © 2003 John Wiley & Sons, Ltd.
Drug utilisation 90% profiles—a useful tool for quality assessment of prescribing in primary health care in Stockholm
Authors: Wettermark Björn , Pehrsson Åke , Jinnerot Dane , Bergman Ulf
Published: September 2003

Purpose

To analyse strengths and weaknesses of a simple method for assessing the general quality of drug prescribing and to study the acceptance of the method among general practitioners (GPs).

Methods

Prescriptions dispensed during October–December 1999 and 2000, respectively, were analysed for 38 Primary Health Care centres (PHC) in Stockholm participating in an intervention project with the aim of increasing cost‐consciousness among GPs. Focus was on quality of prescribing rather than on costs. Prescribing profiles focusing on the number of drugs constituting 90% of the volume (= DU90%) and the adherence to local drug committee guideline within this segment were presented for the prescribers. The credibility and usefulness of the method was evaluated by a questionnaire.

Result

Among the PHCs, the total number of drugs prescribed varied between 358 and 674. The number of drugs in the DU90%‐segment varied between 117 and 194. The adherence to guideline within this segment varied between 56% and 74% and increased over time. The prescribers found the DU90%‐profiles clear and relevant and considered the method to be a useful tool for improving the quality of drug prescribing.

Conclusion

Providing DU90%‐profiles with guideline adherence as feedback was shown to be a valuable tool in general practice for assessing the overall quality in prescribing and to form the basis for more disease‐ or patient‐specific analyses. Copyright © 2003 John Wiley & Sons, Ltd.
Benzodiazepine utilization patterns in Alzheimer's disease patients
Authors: Lagnaoui Rajaa , Moore Nicholas , Moride Yola , Miremont‐Salamé Ghada , Bégaud Bernard
Published: September 2003

Background

Benzodiazepines (BZD) are commonly prescribed in the elderly. Persons with dementia may be at a greater risk of adverse reactions of BZD such as cognitive impairment.

Objective

To assess the prevalence of BZD use in Alzheimer's disease patients and to examine patient and drug‐characteristics associated with this use.

Design

Cross‐sectional study.

Participants

Five thousand community‐dwelling and institutionalized patients initiating a treatment with tacrine for a mild to moderate Alzheimer's disease and included in the tacrine‐study (Paco cohort).

Measurements

Patient characteristics and BZD use recorded at the inclusion.

Main outcome

Use of BZD during the 3 months prior to inclusion.

Results

The 3‐month prevalence of ever use of BZD was 20%. After controlling for age and gender, there was a non‐significant inverse association between BZD use and a score of Mini‐Mental Status Evaluation (MMSE) below 24 (OR: 0.88, 95%CI: 0.71–1.09), and significant inverse association with an increased number of chronic conditions (OR: 0.73, 95%CI: 0.58–0.91). Higher use of BZD was associated with higher level of overall drug consumption (OR: 2.3, 95%CI: 1.97–2.80).

Conclusion

Alzheimer's disease patients are frequently prescribed BZD. A low score of MMSE (< 24) is associated with a decreased use of BZD. These results suggest important differences in BZD use patterns among persons with Alzheimer's disease.. Copyright © 2003 John Wiley & Sons, Ltd.
A case‐control study of acetaminophen use in relation to the risk of first myocardial infarction in men
Authors: Rosenberg Lynn , Rao R. Sowmya , Palmer Julie R.
Published: September 2003

Purpose

Experimental evidence raises the possibility that acetaminophen use could reduce the risk of myocardial infarction (MI). We assessed the relation of acetaminophen use, and also of aspirin use, to first MI in a case‐control study.

Methods

Data on analgesic use and other factors were collected in a hospital‐based case‐control study of first MI in men under 55 years of age conducted from 1980 to 1983. We compared 2035 men with first MIs to 2656 control men admitted for conditions unrelated to analgesic use. Odds ratios (ORs) for acetaminophen use relative to nonuse were estimated with logistic regression analysis, controlling for major MI risk factors.

Results

The OR was 0.9 (95% confidence interval (CI): 0.6–1.3) for acetaminophen use at least once a week for at least 3 months, 0.7 (95%CI: 0.4–1.1) for daily use for at least 3 months, and 0.5 (95%CI: 0.2–1.6) for daily use for at least 5 years. In analyses of aspirin use, the OR was 0.9 (95%CI: 0.7–1.2) for use at least once a week for at least 3 moths, 0.9 (95%CI: 0.6–1.2) for daily use lasting at least 3 months, 0.6 (95%CI: 0.4–1.1) for daily use for at least 5 years, and 0.4 (95%CI: 0.2–1.0) for daily use for at least 10 years.

Conclusions

While our results raise the possibility of a protective effect of long‐term regular acetaminophen use against first MI, they are compatible with no effect. The data suggest a potential protective effect of long‐term regular aspirin use. Copyright © 2003 John Wiley & Sons, Ltd.