bluuebunny/crossref_metadata_2025 huggingface dataset:
Clustering of cardiovascular risk factors with diabetes in Chinese patients: the effects of sex and hyperinsulinaemia
Authors: Xu Z. ‐R. , Molyneaux L. , Wang Y. ‐Z. , Jing H. , Liu Y. , McGill M. , Huang L. , Yue D.
Published: March 2003

SUMMARY

Objective  This study was designed to investigate factors which affect the clustering of cardiovascular risk factors with diabetes in Chinese patients.

Research Design and Methods: Six hundred and fifty‐four patients with diabetes were assessed comprehensively for diabetes complications and cardiovascular risk factors in a metropolitan hospital in Beijing, China. Insulin resistance and secretion were also evaluated by measurement of glucose and insulin levels before and after a meal tolerance test. Results were analysed according to patient groups stratified by the number of cardiovascular risk factors coexisting with diabetes.

Results  Cardiovascular risk factors were common in Chinese diabetic patients. The clustering of three or more of these factors with diabetes occurred more often than by chance alone and was associated with postprandial hyperinsulinaemia. Patients with a high number of risk factors were more prone to macrovascular events but did not have higher albuminuria. Using the commonly adopted lower threshold for diagnosing obesity and central obesity in women, there were more women with multiple risk factors. However, this disappeared if the same criteria were used for men and women. Even in the presence of diabetes, cardiovascular risk factors were inadequately controlled in most patients.

Conclusions  The concurrence of diabetes and other cardiovascular risk factors which constitute the metabolic syndrome is a common phenomenon in urban Chinese diabetic patients. It is associated with hyperinsulinaemia and possibly the female sex. This study emphasises the importance of public health measures to control cardiovascular risk factors in patients with diabetes.
Effects of nerve growth factor on expression of GAP‐43 in right atria after sympathectomy in diabetic rats
Authors: Vo P. A. , Tomlinson D. R.
Published: March 2003

SUMMARY

Aim  The present study investigated the role of nerve growth factor (NGF) in the regeneration of noradrenergic nerves of right atria (following 6‐hydroxydopamine; 6‐OHDA, 100 mg/kg, i.p.) from non‐diabetic and 8‐week diabetic rats.

Results  In cryostat sections of the right atria, GAP‐43 immunoreactivity was concentrated in nerve terminals, preterminal axons of the endocardium, epicardium and myocardium, as well as in nerve fibres innervating the blood vessels and ganglionic cells. In serial sections, all positive staining for GAP‐43 showed immunoreactivity for the neuronal marker PGP‐9.5. In untreated non‐diabetic rats, the total GAP‐43 immunoreactivity was reduced to 60% relative to pretreatment levels, at day 14 after 6‐OHDA, as quantified by Western blotting. In diabetic rats, 6‐OHDA treatment produced a marked increase in the levels of total GAP‐43 at days 28 and 49. NGF treatment (1 mg/kg, s.c., 3 times/week, for 2 weeks) had no effect on the level of total GAP‐43 in right atria from non‐diabetic and diabetic rats before treatment with 6‐OHDA. However, it normalized the reduced GAP‐43 immunoreactivity observed in 6‐OHDA‐treated non‐diabetic rats. Interestingly, NGF treatment alone produced an increase in GAP‐43 phosphorylation relative to total GAP‐43 in right atria from both non‐diabetic (44%) and diabetic groups (42%).

Conclusions  These findings suggest that nerve terminals of the right atria retain, in the mature adult, the capacity for structural and functional plasticity. The expression of GAP‐43 in right atria of control and diabetic rats was differentially affected by 6‐OHDA treatment. In injured noradrenergic neurones of the right atria, NGF modified the expression of GAP‐43 only in non‐diabetic rats and not in diabetic rats.
Substitution of Dmo1 with normal alleles results in decreased manifestation of diabetes in OLETF rats
Authors: Okuno S. , Kondo M. , Yamasaki Y. , Miyao H. , Ono T. , Iwanaga T. , Omori K. , Okano M. , Suzuki M. , Momota H. , Hishigaki H. , Hayashi I. , Goto Y. , Shinomiya H. , Harada Y. , Hirashima T. , Kanemoto N. , Asai T. , Wakitani S. , Takagi T. , Nakamura Y. , Tanigami A. , Watanabe T. K.
Published: March 2003

Aim: Dmo1 (Diabetes Mellitus OLETF type I) is a major quantitative trait locus for dyslipidaemia, obesity and diabetes phenotypes in the Otsuka Long Evans Tokushima Fatty (OLETF) rat strain. To evaluate possible metabolic and pathological improvements generated by correction of the Dmo1 genetic pathway, we produced congenic lines, in which both OLETF Dmo1 alleles are replaced by the F344‐derived genome.

Methods: Congenic animals were produced by introgressing F344‐derived Dmo1 alleles into the OLETF rat. Congenic animals of the fourth generation (BC4) were intercrossed to obtain F1 animals (BC4:F1). Animals of the next generation, BC4:F2, were used for this study. We used 23 BC4:F2 males harbouring homozygous replacement of the OLETF Dmo1 region with the F344‐derived genome. Seven animals with OLETF‐derived Dmo1 alleles were used as controls.

Results: Dmo1‐F344/F344 congenic rats showed significant decreases in body weight, abdominal fat weight, serum triacylglycerols, total cholesterol, food consumption and blood glucose after glucose loading (13%, 39%, 45%, 27%, 18% and 27% respectively; p < 0.05) compared with Dmo1‐OLETF/OLETF animals. Furthermore, histopathological analysis of the kidney showed that mesangial sclerosis, hyalin deposits and deposition of PAS‐positive substance were significantly lower in Dmo1‐F344/F344 animals (p < 0.05).

Conclusion: Improvements in metabolic parameters and histopathological scores show that correction of the Dmo1 genetic pathway in the diabetic and mildly obese OLETF rat strain produces wide‐ranging therapeutic effects. Thus, this pathway might represent a new drug target also applicable to humans.
Effects of metformin on bile salt transport by monolayers of human intestinal Caco‐2 cells
Authors: Carter D. , Howlett H. C. S. , Wiernsperger N. F. , Bailey C.
Published: March 2003

The antidiabetic biguanide metformin has been shown to increase faecal excretion of bile salts in type 2 diabetes. Cultured human intestinal Caco‐2 cell monolayers provide a model of human enterocytes. These monolayers are used here to determine the effect of metformin on the secondary‐active, sodium‐linked transfer of 14C‐glycocholate from the apical (brush border) to the basolateral (serosal) surface. During 24‐h incubations, 10−2 mol/l metformin significantly reduced 14C‐glycocholate transfer. This could not be attributed to alterations of monolayer integrity or Na+‐K+ ATPase pump activity. For example, the secondary‐active transport of glucose and proline was not interrupted, and the inhibitory effect of metformin on bile salt transport was additive to the inhibitory effect of ouabain. The results suggest that metformin can act directly on intestinal enterocytes to reduce the active transfer of bile salts by a mechanism that is independent of Na+‐K+ ATPase activity.
TRP64ARG polymorphism of the β3‐adrenergic receptor gene and obesity risk: effect modification by a sedentary lifestyle
Authors: Marti A. , Corbalán M. S. , Martínez‐Gonzalez M. A. , Martinez J. A.
Published: March 2003

Aim: We performed a case–control study to assess the association between obesity risk and the Trp64Arg polymorphism of the β3‐adrenergic receptor gene.

Methods: Obese subjects [n = 159; body mass index (BMI) > 30 kg/m2] and controls (n = 154; BMI < 25 kg/m2) were compared using multivariable logistic regression to control for potential confounders.

Results: A higher obesity risk (adjusted OR: 2.98; 95% CI: 1.00–8.56; p = 0.05) was associated with the Trp64Arg polymorphism among sedentary, but not among more active people.

Conclusions: Our results suggest that the TRP64ARG polymorphism of the ADRB3 seems to be a risk factor for obesity that is dependent on a sedentary lifestyle.
Effect of cogent db, a herbal drug, on plasma insulin and hepatic enzymes of glucose metabolism in experimental diabetes
Authors: Saravanan G. , Pari L. , Venkateswaran S.
Published: March 2003

Aims: The present study was designed to investigate the effect of cogent db, a polyherbal drug on blood glucose, plasma insulin and the activities of hepatic glucose metabolic enzymes in alloxan‐induced diabetic rats.

Methods: Male Wistar rats body weight of 180–200 g (six normal and 18 diabetic rats) were used in this study. The rats were divided into four groups after the induction of alloxan diabetes. In the experiment, six rats were used in each group: Group 1, normal rats given 2 ml of saline; Group 2, diabetic control rats given 2 ml of saline; Group 3, diabetic rats given aqueous solution of cogent db (0.45 g/body kg weight); and Group 4, diabetic rats given aqueous solution of glibenclamide (600 µg/kg body weight). The treatment was given for 40 days. After the treatment, fasting blood glucose, plasma insulin, urine sugar and the activities of hepatic glucose metabolic enzymes were determined in normal and experimental animals.

Results: Treatment with cogent db resulted in a significant reduction in blood glucose and the activities of glucose‐6‐phosphatase and fructose‐1,6‐bisphosphatase in the liver, whereas the level of plasma insulin and hepatic hexokinase activity were significantly increased in alloxan‐diabetic rats.

Conclusions: The present investigation suggests that cogent db controls the blood glucose level by increasing glycolysis and decreasing gluconeogenesis with a lower demand of pancreatic insulin than in untreated rats. This is possible because it regulates the activities of hepatic glucose metabolic enzymes.
Impact of weight loss on the metabolic syndrome
Authors: Case C. C. , Jones P. H. , Nelson K. , O'Brian Smith E. , Ballantyne C. M.
Published: March 2003

Aim: Individuals with the metabolic syndrome (MS), a clustering of risk factors [triglycerides, glucose, high‐density lipoprotein cholesterol, blood pressure (BP), abdominal obesity] defined by the National Cholesterol Education Program (NCEP), are at high risk for coronary heart disease and type 2 diabetes mellitus, and may benefit from aggressive lifestyle modification.

Methods: We reviewed 1 year of consecutive patients' charts to determine the prevalence of the MS in obese individuals enrolled in a medically supervised rapid weight loss programme, the correlation of weight change with the components of the MS, and response to diet‐induced weight loss.

Results: Out of 185 individuals, 125 (68%) met the NCEP definition of the MS. A moderate decrease in weight (6.5%) induced by a very low calorie diet (VLCD) resulted in substantial reductions of systolic (11.1 mmHg) and diastolic (5.8 mmHg) blood pressure (BP), glucose (17 mg/dl), triglycerides (94 mg/dl) and total cholesterol (37 mg/dl) at 4 weeks (all p < 0.001). These improvements were sustained at the end of active weight loss (average 16.7 weeks; total weight loss 15.1%), with further significant reductions in BP and triglycerides. Weight loss was related to the changes in each criterion of the metabolic syndrome.

Conclusions: The MS is prevalent in two‐thirds of obese individuals enrolling in a structured weight loss programme. Moderate weight loss with a VLCD markedly improved all aspects of the MS.
Evidence‐based symptom relief of intermittent claudication: efficacy and safety of cilostazol
Authors: Donnelly Richard
Published: March 2003

Intermittent claudication (IC) is a common, debilitating symptom of atherosclerotic peripheral arterial disease. There are two therapeutic objectives in patients with IC: relief of symptoms and secondary prevention of acute thrombotic complications. Among patients with Fontaine stage II disease, surgical revascularization for symptom relief is reserved for those in whom exercise/lifestyle modification and medical therapy has failed. To improve exercise tolerance in IC requires favourable alteration in the oxygen supply/demand relationship in the lower limb. Following the largest ever clinical trials programme in patients with IC, cilostazol, a phosophodiesterase III inhibitor, has been licensed for symptom relief in the UK. In double‐blind, randomized, placebo‐controlled trials involving over 2000 patients, cilostazol 100 mg b.d. produced significant and sustained improvements in pain‐free and maximal walking distances as well as improved subjective assessments of quality of life. In particular, comparative studies with pentoxifylline (oxpentifylline) showed that cilostazol had significantly greater effects on functional outcome and exhibited good patient tolerance.
Fasting serum adiponectin concentration is reduced in Indo‐Asian subjects and is related to HDL cholesterol
Authors: Valsamakis G. , Chetty R. , McTernan P. G. , Al‐Daghri N. M. , Barnett A. H. , Kumar S.
Published: March 2003

Aims: Adiponectin is a 30‐kDa protein secreted by adipose tissue. The aim of the present study was to compare serum adiponectin in male Indo‐Asian and Caucasian subjects and examine its association with fat topography and metabolic parameters.

Methods: Diabetic and non‐diabetic male subjects (n = 48) were studied. A single observer carried out blood pressure and anthropometric measurements. Serum glucose, insulin, lipid profile and adiponectin (measured by RIA) were measured on a fasting sample.

Results: There was no statistically significant difference in serum adiponectin between diabetic and BMI‐matched non‐diabetic subjects. However, serum adiponectin was lower in Indo‐Asians compared with BMI‐matched Caucasians, [median adiponectin (interquartile range) 3.3 (2.1–3.9) vs. 4.9 (3.5–6.6) μg/ml respectively (p = 0.016)]. Univariate analysis showed serum adiponectin to be positively associated with HDL in diabetic (p = 0.039) and non‐diabetic subjects (p = 0.0098). Waist circumference (p = 0.02), saggital diameter (p = 0.04) were negatively correlated with serum adiponectin in diabetic subjects. Multiple regression analysis including waist, HDL, fasting insulin, age, diabetes and ethnicity in all subjects showed HDL to be the best predictor of serum adiponectin.

Conclusions: Serum adiponectin is associated with HDL cholesterol and central obesity. Caucasians have higher serum adiponectin levels compared with Indo‐Asians. Further studies are needed to explore basis for the association of adiponectin with HDL cholesterol and the reason for lower levels in Indo‐Asians.
Histology and biochemical composition of the autotomy mantle of Ficus ficus (Mesogastropoda: Ficidae)
Authors: Liu L. L. , Wang S. P.
Published: March 2003

When the foot of the figsnail Ficus ficus is mechanically stimulated, a portion of the mantle on the side of the inner lip, recognized as the autotomy tissue, swells then autotomizes. Studies of the behaviour and population dynamics of mantle autotomy in F. ficus have previously been reported, but here, a detailed description of the structure of the autotomy tissue is presented for the first time. Whether or not this autotomy tissue has the secondary function of a storage compartment was also investigated through analysis of its biochemical composition. Figsnails were collected from the coast of Kaohsiung, Taiwan. Histological observations indicated that the most obvious feature of the autotomy tissue is the extensive network of muscle fibres and connective tissues. In the swollen autotomy tissue, not only do the epithelia rupture, but the connective tissue expands threefold on the dorsal side and 15‐fold on the ventral side. Chemical analysis of body composition indicated that the average contents of protein, lipid, carbohydrate and ash in the foot, mantle and autotomy tissue are in the range of 55.6–76.5%, 0.6–14.1%, 2.0–27.9% and 6.5–13.5%, respectively, with the caloric value ranging from 4.7 to 5.5 kcal g−1 dry wt. The content of carbohydrate in the autotomy tissue is much less than that in the foot and mantle, i.e. 2.0–6.8% vs. 13.0–27.9%. There is no indication that the autotomy tissue serves as an energy reserve. Hence, it is suggested that the autotomy tissue functions only as a defensive weapon.
The dorsal strand of Polyandrocarpa misakiensis (Protochordata: Ascidiacea): a light and electron microscopic study
Authors: Koyama H.
Published: March 2003

The dorsal strand of a budding ascidian, Polyandrocarpa misakiensis, was studied by light and electron microscopy. The length and morphology of this organ vary even among zooids in the same colony. After curving between the paired posterior nerve trunks, the strand turns left and terminates in a dead end. The dorsal strand of this species is one of the simplest types among ascidians, since there is no branching, no extensive nerve plexus, and no neuronal or non‐neuronal endocrine cells surrounding it. The strand mainly consists of a simple cuboidal epithelium, but has several variations, such as multilayered regions, and protrusions of a cellular chain. The strand cells usually have mitochondria, free ribosomes and a Golgi complex of dictyosomal type. There are many mitotic cells in the strand epithelium. The presence, between the cerebral ganglion and dorsal strand epithelium, of cells with morphology intermediate between the strand and neuronal cells suggests that the dorsal strand might supply cellular components, such as neurones, to the cerebral ganglion in adult zooids. At the caudal end, the strand cells show ultrastructural features suggesting active protein synthesis and secretion. These cells appear to be liberated from the epithelium to release the content of their granules.
Fuseudoxid: the elusive sexual stage of the calycophoran siphonophore Crystallophyes amygdalina (Clausophyidae: Crystallophyinae)
Authors: Pagès F. , Pugh P. R.
Published: March 2003

We have identified the sexual stage of the calycophoran siphonophore Crystallophyes amygdalinaMoser, 1925 and it appears to be closely related to the undescribed Eudoxia X. In both of these sexual stages, the bract and gonophore have become fused together as a single entity. This new type of siphonophoran sexual stage warrants the creation of a particular terminology and here we name it a fuseudoxid (fused eudoxid). To demonstrate these findings, both fuseudoxids are described, and their phylogenetic relationships as well as the systematic position of the genus Crystallophyes are discussed. The subfamily Crystallophyinae Moser (1925) is re‐established.
Distribution of glial cells in the central nervous system of the pulmonate snail Megalobulimus oblongus identified by means of a glial fibrillary acidic protein marker
Authors: Santos Paula dos , Gehlen Günther , Faccioni‐Heuser M. Cristina , Zancan Denise M. , Achaval Matilde
Published: March 2003

The distribution of the glial cells in the pulmonate gastropod Megalobulimus oblongus was studied by means of an immunohistochemical procedure. These cells expressed glial fibrillary acidic protein in their cell bodies as well as in their processes. In all ganglia of the central nervous system, four types of glial cells were identified. The glial lacunar network and the perineuronal glial cells were found in the cortical region of the ganglia, and the perisynaptic and the fibrous glial cells in the neuropilar region. However, in the procerebrum of the cerebral ganglion the glial cells only had a reticular distribution throughout the cellular area. These observations provide morphological evidence of glial cell functions. These cells are probably involved in the support of neurones, the uptake and/or degradation of neurotransmitters, the transfer of metabolic substrates to neurones, as well as the regulation of ionic constituents of extracellular space. As occurs in vertebrates, there is a strong relationship between the different cellular components of the central nervous system of this invertebrate.
A scanning electron microscopic study of germ cell maturation in the reproductive tract of the male soupfin shark (Galeorhinus galeus)
Authors: McClusky Leon M.
Published: March 2003

Germ cell maturation in the reproductive tract of the soupfin shark (Galeorhinus galeus) was studied using scanning electron microscopy (SEM). The SEM showed changes in Sertoli cytoplasm volume during spermatogenic development. In immature spermatocysts in the germinal zone, spermatogonia were embedded in Sertoli cytoplasm. In spermatogonial spermatocysts, Sertoli cells were adluminally located in the spermatocyst, with spermatogonia enveloped in the basal portions of the cytoplasm. During the round spermatid stage, Sertoli cytoplasm was very scanty. Spermatid elongation was accompanied by a progressive increase in the volume of Sertoli cytoplasm, notably around the spermatid heads. In the mature spermatocyst, bundles of spermatozoa are totally enveloped by Sertoli cytoplasm. Spermatozoa occurred randomly in the epididymis. However, in the ampulla ductus deferentis, spermatozoa reaggregated and were embedded in a mucoid substance to form highly ordered spherical bundles. In the sperm bundle, the spermatozoa heads were arranged such that the helical turns of adjacent spermatozoa were precisely aligned, and all the heads in the bundle formed a distinct apex. This study demonstrates the utility of exploring the relationship between germ cells and Sertoli cells in an evolutionarily ancient vertebrate, such as the shark.
Retrospective review and long‐term follow‐up of radical cystectomy in a developing country
Authors: Gaitonde K. , Goyal A. , Nagaonkar S. , Patil N. , Singh D.R. , Srinivas V.
Published: March 2003

Objective To retrospectively review the clinical data from patients undergoing radical cystectomy for bladder cancer, and to analyse the complications and survival rates associated with this operation in a developing country.

Patients and methods The study comprised 105 patients who underwent radical cystectomy from 1986 to 1993. Data were collected from retrospective reviews of hospital and physician's office records, and by contact with the patients. Metastatic status was evaluated before surgery and tumours staged using the Tumour‐Nodes‐Metastasis classification. The indication for surgery was histologically confirmed muscle invasion after transurethral resection biopsy, or endoscopically uncontrollable superficial disease. The data were analysed to assess the perioperative complications and long‐term survival, with 5‐year survival rates determined using Kaplan–Meier survival curves.

Results The complication rate was 27.6%; most of the complications were managed conservatively with good results and re‐operation was required in only two patients. There were two deaths (1.9%) at 15–45 days after surgery, but none during surgery. Patients were divided into node‐negative and node‐positive groups for analysis and 5‐year survival rates determined; for node‐negative organ‐confined disease ( pT3A) the survival was 68% and for nonorgan‐confined disease ( pT3B) 25%. The 5‐year survival rate in the presence of nodal metastases was 13% for N1 and none for N2 disease. Six patients developed urethral recurrence, detected on follow‐up urethral‐wash cytology. Five of these patients underwent urethrectomy, and four of the six survived for 5 years. Pelvic recurrence occurred in five patients (4.7%), none of whom survived for 5 years.

Conclusion Radical cystectomy and pelvic lymph node dissection remains the mainstay of treatment in muscle‐invasive bladder cancer. This is a relatively safe procedure with minimal morbidity and mortality; 68% of the present patients with organ‐confined disease survived 5 years and 12 patients were alive at 10 years, indicating the effectiveness of this operation in selected cases. However, < 29% of patients with nonorgan‐confined and nodal metastatic disease survived 5 years, thereby implying the need for more effective adjuvant therapy in these patients. Radical cystectomy is a viable option in developing countries, with 5‐year survival rates comparable with most large published series.
The cost‐effectiveness of preoperative testing (basic office assessment vs urodynamics) for stress urinary incontinence in women
Authors: Weber A.M. , Taylor R.J. , Wei J.T. , Lemack G. , Piedmonte M.R. , Walters M.D.
Published: March 2003

ObjectiveTo compare the cost‐effectiveness of preoperative testing strategies in women with stress incontinence symptoms, as although urodynamic testing is used to improve the diagnostic accuracy in women with incontinence, the clinical and economic consequences of different levels of testing have not been evaluated.

Materials and methodsDecision analysis was used to evaluate basic office assessment (BOA) and urodynamic testing for women with stress incontinence symptoms who were candidates for primary surgical treatment. Costs were calculated using the Federal Register. Parameter estimates for the effectiveness of treatment for different diagnoses of incontinence were based on published reports. Incremental cost‐effectiveness was defined as the cost in dollars per additional patient cured of incontinence.

ResultsUrodynamics did not improve the effectiveness of treatment; both strategies of a BOA and urodynamic testing resulted in a cure rate of 96% after initial and secondary treatments. The mean cost of care (including initial and secondary treatments and outcomes) was similar for the two strategies ($5042 for BOA, $5046 for urodynamic testing). With BOA reduced testing costs were balanced by increased costs for patients who failed the initial treatment. Under baseline assumptions, one additional cure of incontinence (incremental cost‐effectiveness) using the urodynamic strategy cost $3847, compared with BOA. By sensitivity analyses, BOA was less costly than urodynamics when the prevalence of genuine stress incontinence was  80%.

ConclusionThese findings do not support the routine use of urodynamics before surgery in women likely to have genuine stress incontinence, and provide the justification for randomized trials of preoperative testing strategies.
Religious circumcision under local anaesthesia with a new disposable clamp
Authors: Schmitz R.F. , Schulpen T.W.J. , Redjopawiro M.S. , Liem M.S.L. , Madern G.C. , Van Der Werken C.
Published: March 2003

Objective To compare the results using a new disposable clamp (the Taraklamp Circumcision Device®, TCD, Taramedic Europe BV, Bilthoven, The Netherlands), used since 1998 in one clinic, and the conventional dissection technique (CDT) in another clinic, for religious circumcision in infants.

Subjects and methods The TCD and CDT were compared prospectively; the duration of the procedure, complications and postoperative pain were recorded. The cosmetic result and the degree to which the parents were satisfied were evaluated after 6 weeks. After obtaining informed consent, 275 boys were included in the study (median age 3 years).

Results The median operative duration was 8 min less for the TCD (15 vs 7 min; P < 0.001). There was no difference in complication rate (bleeding in one vs two; infection in two vs three) and postoperative pain was comparable in both groups. The cosmetic results were better for the TCD group (P < 0.001). The parents' satisfaction score for the procedure was equal in the groups, at 8, on a scale of 1 (very bad) to 10 (extremely good).

Conclusion A religious circumcision outside the hospital with the TCD is quicker and leads to a better cosmetic result than with the CDT, without increasing morbidity.
Endoscopic treatment of urinary incontinence in children with primary epispadias
Authors: Duffy  , Ransley
Published: March 2003

Objective

 To evaluate the efficacy of the endoscopic insertion of polydimethylsiloxane particles (MacroplastiqueTM , Uroplasty Inc) (MPQ) into the posterior urethral region of boys with urinary incontinence and primary epispadias.

Patients and methods

 Between 1991 and 1995, 12 boys aged 3–7 years (mean 4.8) received an endoscopic submucosal injection with MPQ into the posterior urethra to correct urinary incontinence; the 12 boys were wet day and night. All patients had undergone a modified Cantwell epispadias repair before injection. The procedure was performed 24 times with a total volume of 83 mL of material injected into 59 sites in the posterior urethra (mean volume per injection 1.4 mL). The mean follow‐up after injection was 10.8 months (range 3–22).

Results

 Three patients became completely dry, the degree of incontinence was improved in six and there was no change in three.

Conclusion

 The preliminary results of this relatively non‐invasive treatment are encouraging.
Predicting regional lymph node metastasis in carcinoma of the penis: a comparison between fine‐needle aspiration cytology, sentinel lymph node biopsy and medial inguinal lymph node biopsy
Authors: Senthil Kumar  , Ananthakrishnan  , Prema
Published: March 2003

Objective

 To evaluate the accuracy of clinical examination and fine‐needle aspiration cytology (FNAC) in detecting groin metastases in patients with carcinoma of the penis, and to assess the positive and negative predictive value (PPV, NPV) of a preliminary sentinel lymph‐node biopsy (SNB) and biopsy of the most medial of the horizontal group of inguinal lymph nodes (MIN) in selecting patients for an ilio‐inguinal block dissection.

Patients and methods

 The study comprised 28 patients (56 groins) with Stage I (one), Stage II (11) and Stage III (16) carcinoma of the penis. All patients underwent a detailed clinical examination followed by FNAC of the palpable inguinal nodes, and were subsequently submitted for block dissection. The MIN, the SN and the rest of the inguinal and iliac nodes were histologically examined separately for metastases.

Results

 The clinical evaluation had a sensitivity of 74%, a specificity of 61%, a PPV of 57% and a NPV of 77%. The corresponding values for FNAC were all 100%, and the specificity and PPV for both MIN and SN were 100%. The sensitivity and NPV of MIN were higher than for SN, although not significantly so.

Conclusion

 Clinical examination alone is inaccurate in selecting patients with carcinoma of the penis for block dissection. FNAC is accurate and specific when nodes are palpable; in those with impalpable nodes a preliminary MIN biopsy followed by SNB if the MIN biopsy is negative will accurately select all patients with metastases in the groin nodes. This can be performed by examining frozen sections of the lymph nodes; if positive, block dissection can be carried out at the same time.
Prostate specific antigen (PSA) value adjusted for transition zone volume and free PSA (γ‐seminoprotein)/PSA ratio in the diagnosis of prostate cancer in patients with intermediate PSA levels
Authors: Kurita  , Terada  , Masuda  , Suzuki  , Fujita
Published: March 2003

Objectives

 To determine: (i) whether the accuracy of prostate‐specific antigen (PSA) density is improved by using the transition zone (TZ) volume instead of total prostate volume, with the γ‐seminoprotein (γSP, a measure of free PSA) to total PSA ratio, for detecting prostate cancer; and (ii) to assess the influence of prostate volume on PSA density and γSP/PSA ratio.

Patients and methods

  From April 1995 to July 1997, 297 consecutive patients (46–88 years old) were examined; all had intermediate serum PSA levels (4–10 ng/mL) and/or abnormal findings on digital rectal examination. All patients underwent transrectal ultrasonography (TRUS)‐guided biopsy, and the prostate and TZ volumes determined from TRUS. The PSA density relative to the total prostate volume (PSAD) and to the TZ volume (PSAT) were then calculated. The total PSA and γSP levels were measured before the diagnostic procedures.

Results

 Of the 297 patients, 62 (21%) were histologically confirmed to have prostate cancer by biopsy. The area under the receiver operating characteristic curve was 0.680 for PSA, 0.684 for PSAD, 0.764 for PSAT, 0.748 for γSP/PSA, 0.885 for γSP/PSA in patients with a prostate volume <40 mL, while it was 0.817 for PSAT in patients with a prostate volume of ≥40 mL. Using a PSAT threshold of 0.17 in patients with a prostate volume of 40 mL, the number of biopsies was reduced by 56% (66 of 118) and 22 of the 25 cancers (88%) were detected. In addition, a γSP/PSA ratio threshold of 40% in patients with a prostate volume of <40 mL decreased the number of biopsies by 75% (88 of 117) and detected 32 of the 37 cancers (87%).

Conclusions

 Prostate volume was significantly and positively correlated with γSP/PSA and negatively correlated with PSAT. Among patients with a PSA level of 4–10 ng/mL, a low γSP/PSA was most useful for detecting prostate cancer when the prostate volume was <40 mL and a high PSAT was useful when the prostate volume was ≥40 mL.
Can preoperative psychological defensive strategies, mood and type of lower urinary tract reconstruction predict psychosocial adjustment after cystectomy in patients with bladder cancer?
Authors: MÅnsson Å. , Christensson  , Johnson  , Colleen
Published: March 2003

Objectives

 To assess if there is relationship between: (i) preoperative psychological defensive strategies, mood and type of lower urinary tract reconstruction, and (ii) psychosocial adaptation after radical cystectomy for bladder cancer.

Patients and methods

Fifty‐seven consecutive patients (44 men and 13 women, mean age 62 years, range 34–81) undergoing radical cystectomy (ileal conduit urinary diversion in 17, continent cutaneous diversion in 22 and orthotopic bladder replacement in 18) were assessed preoperatively using the meta‐contrast technique (MCT), a projective test to reveal individual defensive strategies. From the results the patients were classified as hypothetical ‘at risk’ or ‘no risk’ patients for postoperative psychosocial complications. An ‘at risk’ patient was designated as one who showed neurotic defensive strategies in coping with threats, i.e. primitive, immature or regressive strategies or even lack of defence in connection with pronounced anxiety. All patients completed a questionnaire and were interviewed; 10 questions dealt with mood, five reflecting anxiety and five the depressive states. The questionnaire and the interview were repeated 3 and 12 months, and 5 years after surgery.

Results

The remembered difficulties during the first month after discharge from hospital differed between the ‘risk’ and ‘no risk’ groups after 1 and 5 years. On a visual analogue scale (VAS) the ‘risk’ patients had very low scores (less difficulty) or very high, while the ‘no risk’ patients had intermediate scores. VAS scores were also higher, although not significantly so, in patients using primitive defence strategies. The psychosocial situation did not differ between the groups in the first year, but at 5 years there were differences in self‐esteem and interpersonal contact‐seeking. High depression scores before surgery were associated with high VAS scores at 3 months when recalling the first month after discharge, but the anxiety score was not predictive. Men with orthotopic bladder replacement adapted less well throughout the 5 year follow‐up. Elderly patients with stereotypy (the commonest defensive strategy at these ages) adapted relatively well to ileal conduit diversion. About 20% of patients had difficulty in accepting the postoperative situation, regardless of urinary diversion modes.

Conclusion

The combination of defensive strategies assessed using the MCT and selected on hypothetical grounds was less discriminatory than expected for those at risk of postoperative psychosocial problems. However, those with primitive strategies apparently had a long‐term risk of poor adaptation. The search for an optimal instrument for the identification of patients at risk is warranted. In this study, patients with a ‘wet’ stoma did not seem to fare less well than those with a continent reconstruction.
In vitro assessment of a collagen sponge for engineering urothelial grafts
Authors: Sabbagh  , Masters  , Duffy  , Herbage  , Brown
Published: March 2003

Objective

 To investigate the deposition of urinary crystals and the growth characteristics of urothelial cells on a collagen sponge, as a preliminary step in engineering urothelial autologous grafts.

Materials and methods

 Collagen sponges were exposed to a continuous flow of urine at pH 5.3 and 6.3 for 1 week. The sponges were examined microscopically for crystal deposition and analysed for their calcium content. Two cell lines, RT112, derived from a well‐differentiated transitional cell carcinoma, and UROtsa, an immortalized urothelial cell line, were seeded on the collagen sponges. Cells were cultured for 6, 12 and 21 days. The pattern of growth was analysed by histology and immunostaining with a pan‐cytokeratin antibody. Growth was assayed to quantify cell proliferation on the sponges.

Results

 No crystals were evident on any of the collagen sponges. Calcium deposition was negligible at pH 5.3. Although calcium levels were measurable at pH 6.3, the levels were very low. Both cell lines attached and grew in a stratified manner on the collagen sponge, RT112 forming a layer 6–8 cells thick, and UROtsa a layer 4–6 cells thick; cell proliferation was maximal at 5–10 days. The sponge remained easy to handle after 3 weeks in culture.

Conclusion

 These findings show that collagen sponges support the growth and stratification of urothelial cells, and indicate that the collagen sponge is a suitable substrate for developing urothelial autologous grafts.
Experimental pyeloureterectomy and calyceal neck transection with autotransplantation and bladder advancement
Authors: Teng  , Hardie  , Samaratunga  , Gardiner
Published: March 2003

Objective

 To determine whether Dexon mesh, closely applied to the kidney, provides purchase for sutures to permit bladder/parenchymal apposition on autotransplantation and that, if this line of apposition were some distance from but surrounding renal papillae, urothelium would proliferate to cover exposed parenchyma to form a widely patent lumen; this should facilitate removal of the whole of an upper tract collecting system, retaining renal parenchyma alone.

Materials and methods

 To test this possibility and explore the practicability of the concept, nine dogs underwent bilateral nephrectomy followed by unilateral autotransplantation; the other kidney was discarded. Because the canine renal pelvis is intrarenal, the ureter was stretched maximally before passing fine scissors into the renal hilum to transect the collecting system as close to the kidney as possible in six of the nine dogs. In the remaining three dogs, partial nephrectomy was performed with division of the calyceal necks under vision. Thinned bladder wall was sutured to Dexon mesh some distance from the collecting tubules; omentum was applied to the suture line.

Results

 Three dogs were killed prematurely at <2 weeks because of perioperative complications. Four were killed at 2, 4, 5 and 8 weeks and two at 12 months. Dexon mesh proved to be an effective anchoring fabric, providing close apposition of bladder wall and parenchyma. There was no adhesion of the kidney to peritoneal contents. Urothelial proliferation to cover exposed parenchyma occurred early and by 12 months, a thin stroma was interposed between parenchyma and epithelium. The kidney was preserved in all but one removed electively, this dog having both cystitis and pyelonephritis at 12 months.

Conclusions

 This study showed that autotransplantation of a kidney after removal of its collecting system and advancement of thinned bladder wall to renal parenchyma is practicable, with regenerated urothelium bridging the deficiency by covering exposed parenchyma, to create a widely patent lumen.
A novel in vitro bladder pelvic nerve afferent model in the rat
Authors: Namasivayam  , Eardley  , Morrison
Published: March 2003

Objective

 To develop an in vitro model to allow electrophysiological recordings from pelvic nerve afferents of the urinary bladder in the rat and to ascertain the stability and reproducibility of the model with time.

Materials and methods

 Six male Wistar rats (body weight ≈100 g) were used in the study. The bladder (complete with accessory organs of prostate and seminal vesicles), urethra and penis, together with the attached pelvic nerve and L6/S1 nerve trunk, were removed intact and placed in a specially designed recording chamber containing oxygenated Krebs solution maintained at 30 °C. The bladder was catheterized urethrally and attached to a continuous‐infusion pump and a pressure transducer. The L6/S1 nerve trunk was placed across a silicone‐gel wall into a separate chamber containing liquid paraffin, in which multiunit recordings from pelvic nerve afferents originating from the bladder were made. The afferent nerve activities in response to repeated bladder distension with saline, at 0.04 mL/min for 8 min over 3 h, were compared using the paired t‐test to assess the reproducibility of the model. Conduction velocity studies were also carried out to ascertain the proportion of C‐ and Aδ‐fibres in the multiunit recordings.

Results

 Repeated bladder distension with saline over 3 h produced consistent and reproducible afferent nerve responses, signifying that the afferent nerves recorded in this study neither sensitize nor desensitize over time. This is an essential prerequisite when using this model to study the effects of pharmacological manipulation of the bladder on its afferent nerve response. Conduction velocity studies showed that ≈30% of the afferent fibres recorded from were C‐fibres with the remaining being Aδ‐fibres.

Conclusions

 An in vitro bladder pelvic nerve afferent model for the rat was developed successfully; it is stable and produces reproducible results with repeated bladder distension over at least 3 h.
Neuroanatomical changes in the rat bladder after bladder outlet obstruction
Authors: Sutherland  , Baskin  , Kogan  , Cunha
Published: March 2003

Objective

 To investigate the histological changes in bladder innervation in response to partial bladder outlet obstruction in a rat model.

Materials and methods

 Forty‐eight adult female rats had their bladder outlet partially obstructed by ligating the proximal urethra over a 20 G angiocatheter; 18 sham‐operated rats served as controls. Animals were killed after 1, 2 and 4 weeks, and their bladders evaluated using computerized morphometry. Immunohistochemical staining for neuronal protein gene‐product 9.5 (PGP, a general neuronal marker) and enzyme histochemical staining of acetylcholinesterase, adrenergic fibres and nitric oxide synthase were performed.

Results

 Bladder wall changes after obstruction consisted of a six‐ to sevenfold increase in bladder volume and weight. Smooth muscle hypertrophy was evident equally at all sample times. Cystometry showed functional alterations in bladder capacity and voided pressures; obstructed animals had markedly increased bladder capacities and higher voiding pressures (obstructed, 80–100 cmH2O; normal, 30–40 cmH2O). Neuronal changes in the obstructed bladder were most dramatic within the cholinergic and adrenergic neurotransmitter systems within and surrounding the smooth muscle bundles, where there was less staining than in control animals. PGP immunoreactivity increased slightly. The l‐arginine‐nitric oxide pathway appeared unperturbed after obstruction.

Conclusions

 These histological findings suggest that neuropathic changes in the bladder after outlet obstruction, including detrusor instability, are mainly the result of anatomical perturbations in the cholinergic and adrenergic pathways.
Surgical management of urethral damage in neurologically impaired female patients with chronic indwelling catheters
Authors: Andrews  , Shah
Published: March 2003

Objective

 To evaluate the clinical outcome of female patients with spinal cord injury who underwent a variety of surgical procedures to treat urethral injury and incontinence from prolonged indwelling urethral catheterization.

Patients and methods

 The study included 18 female patients (mean age 53.6 years, range 17–75), most of whom had spinal cord injury, who had indwelling urethral catheterization for a mean of 3.5 years (range 6 months to 30 years); they presented with severe urethral injury and intractable incontinence despite catheterization. Several different surgical operations were used to correct the incontinence, including urethral reconstruction (urethrocleisis) and urethral closure both transvaginally and suprapubically, in association with permanent suprapubic catheterization. The patients were followed for a mean of 4.6 years.

Results

 Four patients who underwent transabdominal urethral closure were dry. Four of eight patients who underwent urethral closure transvaginally developed urethral fistulae; these occurred within 3 months of their operation, two being corrected at subsequent operations. Two of six patients who underwent urethral reconstruction were incontinent and this was corrected via a transabdominal closure. Overall, the 18 patients underwent 22 procedures and 16 are dry, i.e. ≈90% success.

Conclusion

 Where the urethra is irrecoverably damaged, closure via the transvaginal approach is the preferred approach because it has low morbidity and is tolerated by these severely disabled patients. Urethrocleisis and urethral preservation provide a better option only in a select group of patients.
A comparison of prelubricated hydrophilic and non‐hydrophilic polyvinyl chloride catheters for urethral catheterization
Authors: Pachler  , Frimodt‐Møller
Published: March 2003

Objective

To evaluate whether patients performing clean intermittent self‐catheterization (CISC) for a short period preferred a prelubricated, hydrophilic, disposable polyvinyl chloride (PVC) catheter or a non‐hydrophilic PVC catheter which could be used several times and that had to be lubricated by the patient.

Patients and methods

In a prospective cross‐over study, 32 patients used each type of catheter for 3 weeks. After each 3‐week period, the patients completed a questionnaire to assess comfort and preference, and urine specimens were obtained for culture.

Results

There was no significant difference between the groups in the frequency of CISC, discomfort when used, opinion on handling the catheters, preference toward one of the catheters, or of infection.

Conclusion

Non‐hydrophilic PVC catheters may be used safely and with no discomfort to the patient. In addition it may be possible for the healthcare system to save money, as the non‐hydrophilic PVC catheters are much cheaper.
Renal cell carcinoma in children under 14 years old: long‐term survival
Authors: Androulakakis  , Polychronopoulou‐Androulakaki  , Michael  , Stephanidis  , Yannakis
Published: March 2003

Objectives

To assess the treatment and long‐term survival of children under 14 years old operated upon for renal cell carcinoma (RCC).

Patients and methods

The records of five patients (aged 2, 4, 6, 9 and 13 years) who had been treated for RCC between 1982 and 1993 were reviewed. All had undergone nephrectomy with (two) or without (three) regional lymphadenectomy. After surgery four patients received chemotherapy (vincristine with actinomycin‐D, three, vinblastine, one), and two with advanced‐stage disease received other agents (interferon α, interleukin‐2). They were followed for 5 to 15 years.

Results

Three patients with stage I‐II RCC were well at 13, 15 and 15 years after treatment. Of the two patients with regional lymph node involvement (stage III), one was well 5 years after surgery while the other developed hepatic, lung and bone metastases, and died 2 years after presentation.

Conclusion

The prognosis and long‐term survival of children under 14 years old with RCC is very good for those with low‐stage tumours. Nephrectomy with complete tumour extirpation is the main mode of treatment. For advanced‐stage tumours, the role of adjuvant chemotherapy and/or biological agents must be defined more clearly.