bluuebunny/crossref_metadata_2025 huggingface dataset:
Acarbose lowers serum triglyceride and postprandial chylomicron levels in type 2 diabetes
Authors: Ogawa S. , Takeuchi K. , Ito S.
Published: August 2004

Aim:  This study was designed to examine the therapeutic effect of acarbose on serum triglyceride (TG), free fatty acid (FFA), very low‐density lipoprotein (VLDL) and chylomicron (CM) in the meal tolerance test (MTT) before and after acarbose treatment in type 2 diabetes mellitus (DM2).

Methods:  Effects of acarbose on postprandial lipid metabolism were examined in DM2 patients. The subjects with normotriglyceridaemia (TG ≥ 1.7 mmol/l, n = 60) were divided to three groups (A, B and C), and DM2 patients with hypertriglyceridaemia (TG > 1.7 mmol/l, n = 20) were designated group D. Group A was a control, and group B was designed to examine the one‐dose effect of acarbose (100 mg) on lipid levels in MTT using the balanced food of 400 kcal. In groups C and D, acarbose 300 mg/day was administered for 8 weeks, and MTT with the one‐dose acarbose administration was performed. We determined the levels of fasting and postprandial levels of glucose, insulin, FFA and TG‐rich lipoproteins such as CM and VLDL.

Results:  Acarbose treatment lowered plasma glucose levels and insulin secretion. In comparison among study groups A, B and C, acarbose significantly lowered serum TG levels in postprandial state. In group D, after the 8‐week acarbose administration, fasting or postprandial FFA, TG and VLDL levels were also lowered. Interestingly, postprandial increase in CM was suppressed by acarbose administration in group B, C or D.

Conclusions:  Acarbose lowers postprandial TG and CM levels in DM2 with either normotriglyceridaemia or hypertriglyceridaemia. Improvement of insulin resistance with acarbose may also reduce fasting TG levels in DM2 with hypertriglyceridaemia. Acarbose is a beneficial therapeutic agent to reduce TG levels in DM2 patients, thereby leading to suppression of cardiovascular events.
Laparoscopic nephroureterectomy for upper tract transitional cell carcinoma: a critical appraisal
Authors: McNeill Alan , Oakley Neil , Tolley David A. , Gill Inderbir S.
Published: August 2004

Two of the mini‐reviews in this issue evaluate the laparoscopic approach to urology; one critically appraising laparoscopic nephroureterectomy for upper tract TCC, and the other looking back on the first 10 years of laparoscopic pyeloplasty. They are also a testament to the relationship which has developed between the effects of British urologists in becoming experts in this area, and the outstanding help and supervision given by Inderbir Gill and his team at the Cleveland Clinic. The financial backing for this venture came from the British Urological Foundation, which enthusiastically supports the concept of this preceptorship at the Cleveland Clinic.
Anterior urethral valves and diverticula in children: a result of ruptured Cowper's duct cyst?
Authors: McLellan Dawn L. , Gaston Michael V. , Diamond David A. , Lebowitz Robert L. , Mandell James , Atala Anthony , Bauer Stuart B.
Published: August 2004

The experience from Boston in anterior urethral valves and diverticula over a 40‐year period is described. Other articles describe experience with both ignoring and treating VUR, and ballooning of the foreskin and physiological phimosis.

OBJECTIVE

To review a series of children with anterior urethral valves and diverticula, to elucidate the pathophysiology and optimal management of this entity.

PATIENTS AND METHODS

Nine cases (all boys; 1963 to 2003) were reviewed retrospectively.

RESULTS

Seven of nine boys had bulbar diverticula. Continuity between Cowper's duct and the diverticulum was noted endoscopically in two and confirmed radiographically in one. Initially, open surgery was curative but more recently endoscopic management has been the procedure of choice.

CONCLUSION

This series indicates that the distal lip of a ruptured syringocele may function as a flap‐valve, leading to anterior urethral obstruction. Advances in imaging and endoscopic instruments have altered the mode of presentation and management of this entity.
The association between patient age and prostate cancer stage and grade at diagnosis
Authors: Alibhai Shabbir M.H. , Krahn Murray D. , Fleshner Neil E. , Cohen Marsha M. , Tomlinson George A. , Naglie Gary
Published: August 2004

OBJECTIVES

To investigate the association of age with prostate cancer stage and grade, as the latter factors at the time of diagnosis influence management and prognosis, with some studies suggesting that they may change as a function of patient age.

PATIENTS AND METHODS

The charts were reviewed of an age‐stratified (<60, 60–69, 70–79 and ≥ 80 years) random sample of men with newly diagnosed, histologically confirmed prostate cancer in 1995/96 from three geographical areas in Ontario, Canada. Patients were identified using a comprehensive cancer registry, and the chi‐square analysis used to examine the relationship between age and stage, logistic regression for the effect of age on clinically localized disease, and linear regression to assess the age and grade relationships.

RESULTS

In all, 347 charts were reviewed; more men in the oldest group had T1 and metastatic disease than had younger men (P = 0.034). The proportion of patients with clinically localized disease (T1 and T2) did not change with age (P > 0.10). Tumour grade, as assessed by Gleason score, increased slightly with age (R2 = 0.017, P = 0.011). Excluding those patients diagnosed by transurethral prostatectomy did not influence either the age/stage or age/grade relationship. Adjusting for prostate‐specific antigen level attenuated the age/grade relationship.

CONCLUSION

The stage and grade of prostate cancer at diagnosis changes only slightly with age, probably because of a lower intensity of screening and later diagnosis in older men, rather than any change in prostate cancer biology with age.
Dendritic cell immunotherapy for urological cancers using cryopreserved allogeneic tumour lysate‐pulsed cells: a phase I/II study
Authors: Pandha Hardev S. , John Robert J. , Hutchinson James , James Nick , Whelan Mike , Corbishley Catherine , Dalgleish Angus G.
Published: August 2004

OBJECTIVE

To assess the feasibility, toxicity and immunogenicity of dendritic cell (DC)‐based immunotherapy in patients with advanced urological cancers.

PATIENTS AND METHODS

Patients with hormone‐refractory prostate cancer (11) and metastatic renal cell carcinoma (five) received 1–3 × 106intradermal allogeneic tumour lystate‐pulsed DCs fortnightly for six vaccinations then monthly until disease progression. Intradermal keyhole limpet haemocyanin was injected near the DCs as the adjuvant. DC vaccine was prepared from buffy coats, then lysate‐pulsed, cryopreserved in aliquots, and tested for phenotypic expression and activity in an allogeneic mixed lymphocyte reaction before clinical use.

RESULTS

There was no evidence of significant toxicity from vaccine or adjuvant. Delayed‐type hypersensitivity skin testing and biopsy revealed a cellular infiltrate to intradermal re‐challenge to tumour lysate and adjuvant in almost all patients. In addition, there was increased expression of T helper type 1 cytokines, interferon‐γ‐expressing T cell by ELISPOT analysis, but also interleukin‐10 in a few patients. Vaccination resulted in a reduction in the level of prostate‐specific antigen (PSA) in one patient, a reduction in PSA velocity in a further man and an increased PSA doubling time in six. Two of five patients with renal cell carcinoma had stabilization of disease.

CONCLUSION

The cryopreservation and repeated administration of DC vaccine was feasible and not toxic. There was evidence of induction of both humoral and cellular immunity to vaccine and adjuvant in most patients. The use of sequential aliquots of identical cryopreserved vaccine will ensure quality control and greatly facilitate future clinical studies in terms of consistency of vaccine administered and the provision of primed DCs forin vitroassessment of response.
Laparoscopic cytoreductive nephrectomy for metastatic renal cell carcinoma
Authors: Finelli Antonio , Kaouk Jihad H. , Fergany Amr F. , Abreu Sidney C. , Novick Andrew C. , Gill Inderbir S.
Published: August 2004

The theme of laparoscopy, which has been strongly stated in the mini‐review section, continues here with a paper from the Cleveland Clinic on a series of patients who had a laparoscopic nephrectomy as part of a cytoreductive strategy before immunotherapy for metatastic renal cancer. They found it safe and helpful in patients with tumours of <15 cm which do not have local invasion or caval thrombus.

Prostate cancer continues to occupy much time and interest. Papers this month from Canada, USA, Malaysia and Scotland assess the variation in PSA doubling time in untreated prostate cancer, the role of bone scintigraphy in patients with biochemical recurrence, the association between age and stage or grade, and the much‐vexed question of biopsy technique.

There are also three papers on superficial bladder cancer, evaluating the difference between tumours in young and elderly patients, intravesical epirubicin to prevent recurrence, and the use of the holmium laser to treat recurrent tumours.

OBJECTIVE

To critically analyse the results of laparoscopic cytoreductive surgery for renal cell carcinoma (RCC), as phase III evidence supports cytoreductive nephrectomy before immunotherapy, and there is an overall shift towards minimally invasive renal surgery for this disease.

PATIENTS AND METHODS

Since October 2000, 22 patients were treated by laparoscopic cytoreductive nephrectomy for metastatic RCC (group 1). All patients had radiological evidence of metastatic disease, with biopsy confirmation in 10. To put the results into perspective, 25 consecutive contemporary patients with large organ‐confined nonmetastatic RCC (>7 cm, clinical stage T2) undergoing laparoscopic radical nephrectomy (group 2) were compared retrospectively. The baseline demographics were comparable between the groups.

RESULTS

The mean tumour size was 8 cm in group 1 and 9.6 cm in group 2 (P = 0.07). Variables during and after surgery were comparable between the groups, with a mean operative duration of 3.1 vs 3.2 h (P = 0.82), blood loss of 285 vs 308 mL (P = 0.79), complications in two vs eight (P = 0.08), morphine sulphate equivalent requirements of 51.7 vs 44.1 mg (P = 0.1) and a median length of hospital stay of 1.7 vs 1.6 days (P = 0.68). In group 1 the median (range) time to immunotherapy was 35 (13–136) days.

CONCLUSIONS

Laparoscopic cytoreductive nephrectomy is safe and effective in selected patients. Currently the procedure is offered to candidates eligible for immunotherapy and with tumours of ≤ 15 cm, and no evidence of adjacent organ invasion or inferior vena caval thrombus. Significant perihilar adenopathy and numerous parasitic vessels can increase the complexity of the surgery. Adequate laparoscopic experience is necessary.
Radionuclide bone scintigraphy in patients with biochemical recurrence after radical prostatectomy: when is it indicated?
Authors: Gomez Pablo , Manoharan Marugesan , Kim Sandy S. , Soloway Mark S.
Published: August 2004

OBJECTIVE

To evaluate the use of radionuclide bone scintigraphy following biochemical recurrence after radical retropubic prostatectomy (RRP) for localized prostate cancer.

PATIENTS AND METHODS

Of 1197 patients undergoing RRP we identified those with biochemical recurrence and who had also had a bone scan. Biochemical recurrence was defined as a prostate specific antigen (PSA) level of ≥ 0.4 ng/mL. Patients with indeterminate bone scan findings and those in whom the interval between the PSA test and the bone scan was >3 months were excluded. Patient age, PSA level and other relevant pathological details were recorded. Clinical symptoms at the time of bone scan, androgen deprivation after RRP, bone scintigram details and time to recurrence were documented.

RESULTS

Of the 1197 patients, 153 (12.8%) had a biochemical recurrence and 35 (23%) of these had a total of 44 bone scans taken over a mean (sd) follow‐up of 70.4 (35.6) months; 34 (77%) bone scans were negative (group 1) and 10 (33%) positive (group 2). In group 1 the mean PSA at the bone scan was 5.2 ng/mL; 76% of the patients had a PSA of <7 ng/mL. In group 2 the mean PSA at the bone scan was 30.7 ng/mL and all patients had a PSA of >7 ng/mL. The only significant difference between the groups was the PSA at the time of the bone scan (P < 0.001).

CONCLUSION

Bone scintigraphy is a sensitive diagnostic tool for detecting prostate cancer metastases to bone. A bone scan in patients with a serum PSA of <7 ng/mL on biochemical recurrence after RRP is unlikely to be positive, whereas a PSA of ≥ 20 ng/mL is. The presence of skeletal symptoms or a PSA level of >7 ng/mL should prompt the clinician to obtain a bone scintigram.
Increasing prostate biopsy cores based on volume vs the sextant biopsy: a prospective randomized controlled clinical study on cancer detection rates and morbidity
Authors: Mariappan Paramananthan , Chong Wooi Loong , Sundram Murali , Mohamed Sahabudin R.
Published: August 2004

OBJECTIVE

To determine if a volume‐adjusted increase in the number of biopsy cores could detect more prostate cancers than the standard sextant biopsy alone, without increasing morbidity, and to determine its applicability in Malaysian patients, as a standard sextant biopsy misses 20–25% of prostate malignancies.

PATIENTS AND METHODS

In a prospective randomized study of patients undergoing transrectal ultrasonography (TRUS)‐guided biopsy for a prostate‐specific antigen (PSA) level of 4–20 ng/mL without abnormal digital rectal examination (DRE), the men were divided into five main groups (A–E) with prostate volumes of <20, 20–40,  40–60, 60–80 and >80 mL, respectively. Patients in groups B–E were randomized into sextant (B1 to E1) and increased biopsy‐core subgroups, i.e. B2 (eight cores), C2 (10 cores), D2 (12 cores) and E2 (14 cores). The morbidity profile was also evaluated during and after TRUS biopsy, assessing a pain score, rectal bleeding, haematuria, haemospermia and development of fever. In all, 132 patients were recruited (mean age 67.8 years; mean PSA 9.41 ng/mL).

RESULTS

The overall cancer detection rate was 24% (32 men). Taking more cores detected 65.5% of cancers, and the sextant biopsy 34.5% (P = 0.0025), but did not increase the overall morbidity.

CONCLUSIONS

The volume‐adjusted, increased‐core regimen significantly increased the positive biopsy rate of TRUS‐guided prostate biopsies with no added morbidity.
Superficial papillary urothelial carcinomas in young and elderly patients: a comparative study
Authors: Migaldi Mario , Rossi Giulio , Maiorana Antonio , Sartori Giuliana , Ferrari Paolo , De Gaetani Carmela , Cittadini Achille , Trentini Gian Paolo , Sgambato Alessandro
Published: August 2004

OBJECTIVE

To compare the clinicopathological and immunohistochemical findings of superficial papillary transitional cell carcinomas in ‘young’ and ‘elderly’ patients, as the natural history and prognosis of bladder tumours in young patients remains a matter of debate.

PATIENTS AND METHODS

Tumours from 50 patients with superficial urothelial tumours of the bladder diagnosed before 45 years old (‘young’ group, follow‐up 25–119 months) were compared with 90 similar tumours developed in patients aged >55 years (‘elderly’, follow‐up 24–102 months). All the patients had a transurethral resection with curative intent, and none had received any therapy before surgery. After surgery only patients diagnosed with pT1 tumours were treated by intravesical bacille Calmette‐Guérin (BCG) instillations; all received intravesical BCG if there was a recurrence. The clinicopathological variables, recurrence and disease‐free interval to recurrence were assessed. Proliferative activity (MIB‐1) and expression of cell‐cycle regulation proteins cyclin D1, p53 and p27kip1 were detected by immunohistochemistry in the tumours of both groups.

RESULTS

There were statistically significant differences in tumour grade, stage and occurrence between the ‘young’ and ‘elderly’ groups. The ‘young’ group had a longer disease‐free interval to recurrence. Among the immunohistochemical markers analysed, only MIB‐1 and cyclin D1 were associated with an increased risk of recurrence in the ‘young’ group (P < 0.04 and <0.01, respectively) in a univariate analysis.

CONCLUSIONS

Superficial papillary urothelial tumours of the bladder in ‘young’ patients had a better prognosis than those in the ‘elderly’ group, showing a lower grade and stage at diagnosis, and a lower recurrence rate. Proliferative activity and cyclin D1 expression levels were of prognostic significance for the risk of recurrence in these patients.
Natural history of lower urinary tract symptoms: preliminary report from a community‐based Indian study
Authors: Ganpule Arvind P. , Desai Mahesh R. , Desai Mihir M. , Wani Kishor D. , Bapat Sharad D.
Published: August 2004

OBJECTIVE

To describe the results of an analysis of baseline data from subjects included in the community‐screening programme for lower urinary tract symptoms (LUTS) in the Anand and Kheda district in the Gujarat state of India.

SUBJECTS AND METHODS

In all, 2406 men aged >40 years were screened in the community in 18 villages. All subjects were given an International Prostate Symptom Score (IPSS) to complete, had a detailed physical examination, uroflowmetry and urine analysis, and were assessed using transabdominal and transrectal ultrasonography. Spearman's correlation coefficient was used to assess the relationships between quality of life (QoL), age, IPSS, maximum flow rate (Qmax) and prostate volume (PV); stepwise multiple regression was also used.

RESULTS

The mean (sd) age of the men was 62.1 (9.5) years. The PV (mean 21.6 mL, sd 10.63) increased linearly with age, while Qmax (mean 14.6 mL/s, sd 8.4) decreased linearly. The mean (sd) IPSS was 12.2 (8.6) and did not correlate with age but correlated strongly with QoL (coefficient 0.72). Nocturia was the commonest symptom but correlated least with the IPSS and QoL (0.56 and 0.44). The correlations between Qmax, IPSS and PV were weak to moderate. The subjects had a 56% higher risk of developing moderate to severe symptoms if their PV was >25 mL.

CONCLUSION

These Indian men had smaller prostates with higher symptom scores than reported in the West. The IPSS was the strongest predictor of QoL. Overall, the correlation between Qmax, IPSS and PV was weak to moderate.
Modified S‐pouch neobladder vs ileal conduit and a matched control population: a quality‐of‐life survey
Authors: Protogerou Vassilis , Moschou Maria , Antoniou Nikos , Varkarakis John , Bamias Aris , Deliveliotis Charalambos
Published: August 2004

OBJECTIVES

To measure the quality‐of‐life (QoL) outcome and urinary and sexual function and bother after radical cystectomy and different types of urinary tract reconstruction (Bricker vs modified S‐pouch neobladder), also assessing differences between them and a normal population.

PATIENTS, SUBJECTS AND METHODS

Two groups of patients with bladder cancer were assessed; group 1 comprised 58 (mean age 65 years, mean follow‐up 28 months) with an ileal conduit diversion, and group 2, 50 (mean age 61 years, mean follow‐up 26 months) with a modified S‐pouch neobladder. All were disease‐free. Group 3 comprised 54 healthy subjects (a control population) of similar age, gender and comorbidities other than bladder cancer. A QoL questionnaire was used to study changes in QoL, and a specific questionnaire for urinary and sexual function and bother was also constructed.

RESULTS

There were no differences in the QoL scores among the three groups; group 3 (control) tended to have a better QoL for all domains except emotional functioning. Urinary function was seriously affected in group 1, with more daytime leakage than in groups 2 and 3 (37.8% vs 10%, P = 0.005, and 9.3%, P = 0.01), night loss of urine (39.5% vs 28%, P = 0.07, and 3.7%, P = 0.002) and urine odour (58.6% vs 4%, and 5.5%, both P = 0.001). Patients in group 2 differed from healthy individuals only in night loss of urine. Consequently urinary bother was more pronounced in group 1, as fewer were satisfied (68.9% vs 86% and 83.2%, both P = 0.03). Sexual function was seriously and similarly affected in groups 1 and 2; the erection rate was 28.9% for group 1, 35.5% for group 2 (P = 0.1) and 83.3% in group 3 (P = 0.003), while firm erections were present at 17.7%, 22.2% (P = 0.2) and 83.3% (P = 0.002). Women reported equivalent dysfunction in all three groups (15.4%, 20% and 16.6%, P = 0.3). Sexual desire was also equal in all groups (48.2%, 50% and 48.1). Patients in group 1 expressed more bother, while those in group 2 seemed more satisfied by their sexual life (84.4%, 68% and 68.5%, P = 0.04).

CONCLUSIONS

Radical cystectomy does not affect QoL whichever urinary reconstruction is used, and this implies a determination by the patients to live and adjust to their new conditions. On the contrary, urinary and sexual function are affected and related to the method used to reconstruct the urinary system.
Living‐donor kidney retransplantation: risk factors and outcome
Authors: El‐Agroudy Amgad E. , Wafa Ehab W. , Bakr Mohamed A. , Donia Ahmed F. , Ismail Amani M. , Shokeir Ahmed A. , Shehab El‐Dein Ahmed B. , Ghoneim Mohamed a.
Published: August 2004

Authors from Mansoura in Egypt present a study of risk factors and outcome from living‐donor renal re‐transplantation. This is sometimes avoided as being unlikely to have a good outcome, but it is shown here to be the treatment of choice in patients who have lost the primary graft.

OBJECTIVE

To review the results of kidney retransplantation at our centre.

PATIENTS AND METHODS

Between March 1976 and January 2002, 1406 kidneys were transplanted; among these, 54 patients received a second graft (39 men, mean age 32.1 years, sd 8.6). The donors were 48 relatives (mean age 35.4 years, sd 10.1).

RESULTS

The mean (sd, range) duration of the first graft was 49.1 (45.9, 1–192) months and the main cause of these grafts failing was immunological. The mean duration of graft failure was 17.3 (10.5, 5–62) months. The rate of histocompatibility leukocyte antigen (HLA)‐A, ‐B >3 was 16.7% and of haplotype DR matching was 11%. The immunosuppression regimen was mainly based on cyclosporin (75%). There were 33 episodes of acute rejection in 23 patients. The major complications were hypertension (70%), infections (30%) and hepatitis (11%). The overall graft and patient survival was good; 15 grafts (27%) were lost during the follow‐up of 1–17 years. Ten patients died, five with a functioning graft. Multivariate analysis showed that donor relationship, primary immunosuppression, duration of first graft and serum creatinine level at 1 year were predictors of graft survival.

CONCLUSION

Renal retransplantation is the treatment of choice in patients who have lost their graft. The use of related living‐donors and potent immunosuppression could help to improve the outcome.
Fibrin glue for the suture‐less correction of penile chordee: a pilot study in a rabbit model
Authors: Hafez Ashraf T. , El‐Assmy Ahmed , El‐Hamid Mohamed A.
Published: August 2004

OBJECTIVE

To evaluate the use of fibrin glue as a scaffold for patching defects in the tunica albuginea in a rabbit model for a future application in correcting chordee.

MATERIALS AND METHODS

Nine New Zealand white male rabbits were utilized. All had a 15 × 5‐mm defect created in the ventral tunica albuginea. Fibrin glue (1 mL) was applied to cover the defect in tunica albuginea and the penile skin closed with a continuous 5/0 chromic catgut suture. Animals were killed in groups of three at 2, 6 and 12 weeks afterward. The evaluation included an artificial erection test with intracavernosal injection of prostaglandin E1 (5 µg), cavernosography and histopathological examination of sections of the penis stained with haematoxylin and eosin or Masson trichrome.

RESULTS

None of the rabbits died during the procedure or developed bleeding or haematoma afterward. All animals had straight erections on testing with prostaglandin (5 µg). There was no evidence of corporal narrowing or venous leakage on cavernosography. Histopathological evaluation showed evidence of the fibrin sealant layer, with angiogenesis and a cell infiltrate at 2 weeks. At 6 and 12 weeks there was completely normal regeneration of the tunica albuginea.

CONCLUSIONS

In this pilot study in a rabbit model the haemostatic effect of fibrin glue was confirmed on covering a defect in the tunica albuginea. Moreover, there was regeneration of normal tunica albuginea with no scarring at 6 weeks and maintained at 12 weeks. Further well‐controlled studies are required before using fibrin glue for corporal body grafting to treat chordee.
Quo vadis? Ureteric reimplantation or ignoring reflux during augmentation cystoplasty
Authors: Soylet Yunus , Emir Haluk , Ilce Zekeriya , Yesildag Ebru , Buyukunal S.N. Cenk , Danismend Nur
Published: August 2004

OBJECTIVE

To decide whether antireflux surgery should be used in the presence of vesico‐ureteric reflux (VUR) in children, in whom an augmentation procedure is needed, because secondary VUR in children with a neurogenic bladder, infravesical obstruction and primary VUR in the exstrophy‐epispadias complex is expected to resolve after augmentation, which decreases the intravesical pressure and increases capacity.

PATIENTS AND METHODS

Between 1987 and 2001, the bladder was augmented in 38 children, using no antireflux surgery in group 1 (15 patients) and antireflux surgery in group 2 (23 patients).

RESULTS

VUR was detected in all patients on cysto‐urethrography before surgery; reflux resolved after augmentation cystoplasty in 97% and 93% of refluxing units in groups 1 and 2, respectively. The increase in the expected bladder capacity was from 35% to 86% in group 1 and from 38% to 90% in group 2. No patient had any deterioration in renal function.

CONCLUSIONS

We recommend using only augmentation in patients with low‐ or high‐grade VUR and a neurogenic bladder, infravesical obstruction and exstrophy‐epispadias. Combining antireflux surgery with cystoplasty has no significant effect on either the resolution of VUR or renal function.
Long‐term outcome of the endoscopic correction of vesico‐ureteric reflux: a comparison of injected substances
Authors: Sugiyama Takahide , Hanai Tadashi , Hashimoto Kiyushi , Umekawa Tohru , Kurita Takashi
Published: August 2004

OBJECTIVE

To summarize the long‐term outcome of endoscopic surgery to correct vesico‐ureteric reflux (VUR) using different injected substances, i.e. autologous blood, hyaluronan/dextranomer copolymer (HDC), PTFE and glutaraldehyde cross‐linked bovine dermal (GAX) collagen.

PATIENTS AND METHODS

Treatment results on 270 ureters of 185 patients followed for >5 years (mean 8.5) were summarized according to the injected substances. The substances were injected into the 6 o’clock position of the ureteric orifice endoscopically. ‘Success’ was defined as the absence of VUR for >5 years after a single injection.

RESULTS

The treatment was successful in two of 24 patients (8%) with autologous blood, 17 of 32 (53%) with HDC, 108 of 171 (63%) with PTFE and 24 of 43 (56%) with GAX collagen. The success rate was lower in patients with higher grades of VUR.

CONCLUSIONS

Autologous blood is unsuitable for clinical application because of its poor durability. We will no longer use PTFE because its safety is not well established. The overall success rates of endoscopic surgery with GAX collagen and HDC were insufficient compared with surgical reimplantation, but it is advantageous that this procedure is less invasive and can be repeated. The cure rate could be improved by excluding high‐grade VUR from the indications for endoscopic surgery.
Gender assignment in female congenital adrenal hyperplasia: a difficult experience
Authors: Özbey Hüsoyin , Darendeliler Fayza , Kayserili Hüyla , Korkmazlar Ümran , Salman Tansu
Published: August 2004

OBJECTIVE

To report experience of gender (re)assignment in genotypic female (46XX) patients with congenital adrenal hyperplasia (f‐CAH), a difficult and stressful experience if complicated with delayed presentation and inadvertent assignment.

PATIENTS AND METHODS

Between 1983 and 2002, 70 patients with f‐CAH were counselled for gender assignment. The age at diagnosis and operation, the degree of virilization, parental consanguinity, the gender preference of the families, and the factors governing the decision‐making process were determined.

RESULTS

Forty‐one (59%) patients presented after the neonatal period. All parents had already assumed or were advised of a gender for their children, based on the suggestive appearance of the external genitalia. Consequently, 49 patients were reared as female and 21 as ‘male’. Only nine of these ‘males’ could be reassigned as females (mean age at presentation 7.87 months, sd 10.42). Twelve children had to be reared as ‘male’ (mean age at presentation 55.8 months, sd 32.42) in compliance with the parents’ and the study group's decision, and appropriate masculinizing reconstructive surgery was undertaken. The difference in the mean age of those reassigned as female and those who remained ‘male’ was significant (P < 0.001). The parental consanguinity rate among the families was especially high in the ‘male’ patients.

CONCLUSIONS

It is extremely difficult to correct the gender of patients with f‐CAH when they present at >2.5 years old. Furthermore, the delay in diagnosis and the male bias in choice of gender in our population might be a result of strong social pressures on families, influenced by cultural, traditional and economic factors.
Diagnosis and management of ureteric injury: an evidence‐based analysis
Authors: Brandes Steven , Coburn Michael , Armenakas Noel , McAninch Jack
Published: August 2004

The Consensus on Genitourinary Trauma continues this month with an evidence‐based analysis, by a team of experts under the chairmanship of Dr Jack McAninch, of current reports on the diagnosis and management of ureteric trauma. This is quite a unique document, and of interest to all urologists; not only as a consensus on how this condition should be managed, but also as a model of how to review current publications.
Long‐term results of sacral neuromodulation for women with urinary retention
Authors: Dasgupta Ranan , Wiseman Oliver J. , Kitchen Neil , Fowler Clare J.
Published: August 2004

OBJECTIVE

To review the long‐term results of sacral nerve stimulation in the treatment of women with Fowler's syndrome, over a 6‐year period at one tertiary referral centre.

PATIENTS AND METHODS

Between 1996 and 2002, 26 women with urinary retention were treated by implanting a sacral nerve stimulator. Their case records were reviewed for follow‐up, complications and revision procedures, and the most recent uroflowmetry results.

RESULTS

There were 20 patients (77%) still voiding spontaneously at the time of review (with two having deactivated their stimulator because of pregnancy). Fourteen patients (54%) required revision surgery, and the most common complications included loss of efficacy, implant‐related discomfort and leg pain. The mean postvoid residual volume was 75 mL and mean maximum flow rate 20.8 mL/s.

CONCLUSION

In young women with retention, for whom there is still no alternative to lifelong self‐catheterization, sacral neuromodulation is effective for up to 5 years after implantation. However, there was a significant complication rate, in line with other reports, which may be improved by new technical developments.
Trends in aquatic macrophyte species turnover in Northern Ireland — which factors determine the spatial distribution of local species turnover?
Authors: Heegaard Einar
Published: August 2004

Aim The study examined qualitative predictions of ecological theories in relation to the spatial distribution of species turnover of aquatic macrophytes, through the following parameters: (1) distance between lakes (2) chemical conditions of the lakes (3) chemical differences between the lakes, and (4) the lake size.

Location 562 lakes dispersed throughout Northern Ireland were analysed.

Methods To obtain species turnover estimates independent of richness, the average distance between focal lakes and their five nearest neighbours in ordination space (DCA) was standardized by the species richness in a Generalized Additive Model (GAM). The relationships between species turnover and ecological (chemical condition, chemical difference, distance between lakes, and lake‐size) and geographical parameters (latitude, longitude, and altitude) were analysed using GAM.

Results The results indicate that the pattern in species turnover is a combination of the chemical conditions and the distance between the lakes, including the interaction term. The effects of chemical heterogeneity and lake size parameters were both positive but weak. In general, increased distance and decreased ionic concentration contribute to increased turnover. The influence of distance on species turnover is strongest at low and high altitude, and at mid‐elevation the species turnover is mainly driven by the chemical conditions. Towards the north there is an increasing influence of distance, whereas in the south the chemical conditions have their strongest influence.

Conclusions There is a need for components from several established ecological theories to explain the spatial trends in species turnover within Northern Ireland. Central theories in this particular study are the population/metapopulation dynamics, the continuum concept, and the species‐pool concept.
Hybrid Meta‐Heuristic Algorithm for the Simultaneous Optimization of the O–D Trip Matrix Estimation
Authors: Stathopoulos Antony , Tsekeris Theodore
Published: August 2004

Abstract:  In the present article, the origin–destination (O–D) trip matrix estimation is formulated as a simultaneous optimization problem and is resolved by employing three different meta‐heuristic optimization algorithms. These include a genetic algorithm (GA), a simulated annealing (SA) algorithm, and a hybrid algorithm (GASA) based on the combination of GA and SA. The computational performance of the three algorithms is evaluated and compared by implementing them on a realistic urban road network. The results of the simulation tests demonstrate that SA and GASA produce a more accurate final solution than GA, whereas GASA shows a superior convergence rate, that is, faster improvement from the initial solution, in comparison to SA and GA. In addition, GASA produces a final solution that is more robust and less dependent on the initial demand pattern, in comparison to that obtained from a greedy search algorithm.
Analysis of a Climbing Parallel Robot for Construction Applications
Authors: Saltaren R. , Aracil R. , Reinoso O.
Published: August 2004

Abstract: In this article, a parallel structure capable of climbing metal structures is presented. Critical configurations of the designed robot to overcome structural nodes are analyzed. Considering its high load capacity and geometrical dexterity, the system is appropriate for maintenance, building construction, and cleaning of large and dangerous structures. The designed climbing parallel robot (CPR) has a new kinematics structure for this kind of application based on a Stewart 6–6 platform. The aim of this article is to show the kinematics and dynamics behavioral study of the CPR when used in different structures in construction sites. A series of configurations have been evaluated to simplify robot movement and displacement around corner positions of rectangular structures and beams as required in the construction framework.
Estimating multiple equation hybrid models with endogenous dummy regressors*
Authors: Wilde Joachim
Published: August 2004

Estimating multiple equation hybrid models with endogenous dummy regressors is burdensome if the number of dummies and equations is large. Therefore, after clarifying model structure and identification issues the paper presents a generalization of the Amemiya principle. The new estimator reduces the computational costs and is flexible with regard to different types of variables. Furthermore, it is consistent and asymptotically normal distributed.
Estimating the causal effect of a time‐varying treatment on time‐to‐event using structural nested failure time models
Authors: Lok Judith , Gill Richard , Van Der Vaart Aad , Robins James
Published: August 2004

In this paper we review an approach to estimating the causal effect of a time‐varying treatment on time to some event of interest. This approach is designed for a situation where the treatment may have been repeatedly adapted to patient characteristics, which themselves may also be time‐dependent. In this situation the effect of the treatment cannot simply be estimated by conditioning on the patient characteristics, as these may themselves be indicators of the treatment effect. This so‐called time‐dependent confounding is typical in observational studies. We discuss a new class of failure time models, structural nested failure time models, which can be used to estimate the causal effect of a time‐varying treatment, and present methods for estimating and testing the parameters of these models.
A multivariate Poisson mixture model for marketing applications
Authors: Brijs Tom , Karlis Dimitris , Swinnen Gilbert , Vanhoof Koen , Wets Geert , Manchanda Puneet
Published: August 2004

This paper describes a multivariate Poisson mixture model for clustering supermarket shoppers based on their purchase frequency in a set of product categories. The multivariate nature of the model accounts for cross‐selling effects between the purchases made in different product categories. However, for computational reasons, most multivariate approaches limit the covariance structure by including just one common interaction term, or by not including any covariance at all. Although this reduces the number of parameters significantly, it is often too simplistic as typically multiple interactions exist on different levels. This paper proposes a theoretically more complete variance/covariance structure of the multivariate Poisson model, based on domain knowledge or preliminary statistical analysis of significant purchase interaction effects in the data. Consequently, the model does not contain more parameters than necessary, whilst still accounting for the existing covariance in the data. Practically, retail category managers can use the model to devise customized merchandising strategies.
A bivariate Poisson count data model using conditional probabilities
Authors: Berkhout Peter , Plug Erik
Published: August 2004

The applied econometrics of bivariate count data predominantly focus on a bivariate Poisson density with a correlation structure that is very restrictive. The main limitation is that this bivariate distribution excludes zero and negative correlation. This paper introduces a new model which allows for a more flexible correlation structure. To this end the joint density is decomposed by means of the multiplication rule in marginal and conditional densities. Simulation experiments and an application of the model to recreational data are presented.
UK Business Investment and the User Cost of Capital
Authors: Ellis Colin , Price Simon
Published: August 2004

Theory tells us that output, the capital stock and the user cost of capital are related. From the capital accumulation identity, it also follows that the capital stock and investment have a long‐run proportional relationship. The dynamic structure thus implies a multicointegrating framework, in which separate cointegrating relationships are identifiable. This has been used to justify the estimation of investment equations embodying a reduced‐form long‐run relationship between investment and output (rather than between the capital stock and output). In this paper, a new investment equation is estimated in the full structural framework, exploiting a measure of the capital stock constructed by the Bank, and a long series for the cost of capital. A constant elasticity of substitution production function is assumed, and a well‐determined estimate of the elasticity of substitution is obtained by a variety of measures. The robust result is that the elasticity of substitution is significantly different from unity (the Cobb–Douglas case), at about 0.45. Overidentifying restrictions on the long‐run relationship are all accepted. Thus there is strong evidence for a significant effect from the user cost of capital.
House Price Shocks, Windfall Gains and Hours of Work: British Evidence*
Authors: Henley Andrew
Published: August 2004

Do workers adjust hours of work in response to capital gains and losses? This paper investigates this question using British panel data on individual employees from 1992 to 2001. It investigates hours of work adjustments to two sources of capital gain: financial windfalls and real housing wealth gains. Significant reductions in hours are found for both men and women in response, in particular, to housing gains. Men appear to increase hours in response to real housing losses, whereas women reduce hours in response to real housing gains. Evidence on hours of work preferences suggests that observed adjustments are only partial responses.
The Rise in Danish Unemployment: Reallocation or Mismatch?*
Authors: Albæk Karsten , Hansen Henrik
Published: August 2004

The two main competing theories for the outward shift in the uv‐curve are investigated: increased separations from employment at a given employment level (reallocation) and decreased levels of hires, given unemployment and vacancies (mismatch). Shifts in the unemployment–vacancy (uv)‐curve and the hiring function are modelled by smooth transition functions, and the hypothesis of analogous shifts in the two curves is tested and accepted. This is interpreted as evidence in favour of the mismatch hypotheses.
Dating Business Cycles: A Methodological Contribution with an Application to the Euro Area
Authors: Artis Michael , Marcellino Massimiliano , Proietti Tommaso
Published: August 2004

This paper proposes a dating algorithm based on an appropriately defined Markov chain that enforces alternation of peaks and troughs, and duration constraints concerning the phases and the full cycle. The algorithm, which implements Harding and Pagan's non‐parametric dating methodology, allows an assessment of the uncertainty of the estimated turning points caused by filtering and can be used to construct indices of business cycle diffusion, aiming at assessing how widespread are cyclical movements throughout the economy. Its adaptation to the notion of a deviation cycle and the imposition of depth constraints are also discussed. We illustrate the algorithm with reference to the issue of dating the euro‐area business cycle and analysing its characteristics, both from the classical and the growth cycle perspectives.
The 3‐day Week of 1974 and Earnings Data Reliability in the Family Expenditure Survey and the National Child Development Study*
Authors: Grawe Nathan D.
Published: August 2004

In early 1974, an energy conservation policy limited the British workweek to 3 days. Researchers fear that earnings reports given by survey respondents during this period may not be comparable with those given in more typical circumstances. This study uses responses during and after the 3‐day week policy to estimate the degree of misreporting in the National Child Development Study (NCDS) and the Family Expenditure Survey (FES). The estimates show that very few respondents gave ‘incorrect’ 3‐day figures. In the FES, the estimated fraction of misreports is no larger than 3.2%; in the NCDS, the best estimate is 0.
Plant and mycorrhizal regulation of rhizodeposition
Authors: Jones David L. , Hodge Angela , Kuzyakov Yakov
Published: August 2004

The loss of carbon from roots (rhizodeposition) and the consequent proliferation of microorganisms in the surrounding soil, coupled with the physical presence of a root and processes associated with nutrient uptake, gives rise to a unique zone of soil called the rhizosphere. In this review, we bring together evidence to show that roots can directly regulate most aspects of rhizosphere C flow either by regulating the exudation process itself or by directly regulating the recapture of exudates from soil. Root exudates have been hypothesized to be involved in the enhanced mobilization and acquisition of many nutrients from soil or the external detoxification of metals. With few exceptions, there is little mechanistic evidence from soil‐based systems to support these propositions. We conclude that much more integrated work in realistic systems is required to quantify the functional significance of these processes in the field. We need to further unravel the complexities of the rhizosphere in order to fully engage with key scientific ideas such as the development of sustainable agricultural systems and the response of ecosystems to climate change.

Contents

I.
Introduction
460

II.
What is rhizodeposition?
460

III.
Regulation of rhizodeposition
460

IV.
How large is the root exudation C flux?
463

V.
How responsive is the root exudation C flux?
463

VI.
How responsive is the microbial community to root exudation?
464

VII.
The role of root exudates in nutrient acquisition
464

VIII.
Mycorrhizal fungi and rhizodeposition
471

IX.
Future thoughts
474

Acknowledgements
474

References
474
Relationships beliefs and relationship quality across cultures: Country as a moderator of dysfunctional beliefs and relationship quality in three former Communist societies
Authors: Goodwin Robin , Gaines Stanley O.
Published: August 2004

Research on the correlation between relationship beliefs and quality has rarely considered the impact of culture. In this study, 206 manual workers, students, and entrepreneurs from Georgia, Hungary, and Russia completed a modified Relationship Beliefs Inventory (Eidelson & Epstein, 1982, Journal of Consulting and Clinical Psychology, 50, 715) and the Abbreviated Dyadic Adjustment Scale (Sharpley & Rogers, 1984, Educational and Psychological Measurement, 44, 1045). Results indicated a significant pan‐cultural correlation between dysfunctional beliefs and relationship quality but a moderating effect for country, with dysfunctional beliefs in Hungary explaining more than four times of the variance in relationship quality than in the other countries. Findings are interpreted in light of major value and ecological differences between the three countries.
Attachment models of the self and others: Relations with self‐esteem, humanity‐esteem, and parental treatment
Authors: Luke Michelle A. , Maio Gregory R. , Carnelley Katherine B.
Published: August 2004

The present research tested the extent to which perceptions of early childhood experiences with parents predicted general views of the self (i.e., self‐esteem) and others (i.e., humanity‐esteem), and whether attachment self‐ and other‐models mediated these links. Two studies used a new measure of humanity‐esteem (Luke & Maio, 2004) to achieve these ends. As expected, indices that tapped a positive model of the self in relationships were associated with high self‐esteem and indices that tapped a positive model of others in relationships were associated with high humanity‐esteem. Also, early attachment experiences with fathers and mothers predicted self‐esteem and humanity‐esteem, respectively, and these direct relations were mediated by the attachment models. The studies, therefore, provide direct evidence that attachment measures predict general favorability toward the self and others, while revealing novel differences in the roles of childhood experiences with fathers and mothers.

No variables, it is held, have more far‐reaching effects on personality development than a child's experiences within the family: for, starting during his first months in his relation with his mother figure, and extending through the years of childhood and adolescence in his relation to both parents, he builds up working models of how attachment figures are likely to behave towards him in any of a variety of situations; and on those models are based all his expectations, and therefore all his plans, for the rest of his life.

Bowlby (1973; p. 369)