bluuebunny/crossref_metadata_2025 huggingface dataset:
Random Bone Marrow Biopsy in the Staging of Carcinoma of the Prostate
Authors: CRISP JOHN
Published: December 2008

Random bone marrow biopsies were examined in 28 patients with proven carcinoma of the prostate. In 6 cases (28.5%) bony metastases were demonstrated and in 2 of these X‐ray skeletal surveys were negative.

It is suggested that bone marrow biopsy should be done in the staging of carcinoma of the prostate when other investigations are negative, especially when an occult primary is suspected, when radical treatment is contemplated and in clinical trials.
Diuresis and Renal Functional Recovery in Chronic Retention
Authors: BISHOP M. C.
Published: December 2008

Summary— Fifty‐five patients with chronic urinary retention and incipient or actual renal failure were studied. In the majority of patients renal function improved after bladder decompression, irrespective of whether or not a diuresis occurred. Excessive loss of salt and water was rarely a matter of concern and most patients did not require intravenous fluid replacement. Several lost weight and experienced a fall in blood pressure during the period of diuresis without adverse effect upon renal functional recovery. A profound fall in blood pressure occurred in only three patients, all of whom required long‐term sodium supplementation. It is concluded that the problem of salt and water loss after bladder decompression in patients with renal failure is exaggerated and difficult to predict. Over‐enthusiastic replacement of fluid in strict accordance with output could readily lead to fluid overload and prolongation of the diuretic period. Therefore fluid replacement should be determined by the clinical condition of the patient and measurement of improving renal function with less emphasis on urine output and its electrolyte content.
Low Temperature and Conventional Scanning Electron Microscopy of Human Urothelium
Authors: STAFF W. G. , MIDDLETON J. F. S. , MORRIS J. A. , OATES K.
Published: December 2008

Summary— The appearance of fixed dehydrated non‐neoplastic human urothelium viewed by conventional scanning electron microscopy (CSEM) is different from that of frozen hydrated human urothelium viewed by low temperature scanning electron microscopy (LTSEM). In the fixed dehydrated material the surface is formed by well defined, polygonal, domed superficial urothelial cells which have prominent surface microridges. In places intermediate urothelial cells are visible and they have surface microvilli. In the frozen hydrated material viewed by LTSEM most of the surface is smooth. This is formed in part by a glutaraldehyde soluble extracellular secretion which may be a mucin barrier to bacteria. We believe that the rest of the smooth surface is formed by superficial urothelial cells which are not well defined and which lack microridges. There are islands of rounded cells lacking microvilli which are probably intermediate urothelial cells as they correspond in appearance with the intermediate urothelial cells seen in freeze fractured material.

It seems likely that fixation and dehydration will cause some change in surface configuration and in theory the frozen hydrated material should more closely resemble the natural state. We believe that LTSEM will be of value in investigating normal and diseased urothelium.
Inhibition of Spontaneous Contractile Activity in Isolated Human Detrusor Muscle Strips by Vasoactive Intestinal Polypeptide
Authors: KINDER R. B. , MUNDY A. R.
Published: December 2008

Summary— In a study of 75 isolated human detrusor muscle strips, spontaneous contractions and an associated sustained rise in basal tension were observed in 43 (57%). Vasoactive intestinal polypeptide (VIP) caused significant reductions in the frequency and amplitude of spontaneous contractions and a fall in basal tension. The results suggest that VIP may have a role as an inhibitor of spontaneous activity in the human detrusor.
Female Chronic Urinary Retention
Authors: DEANE A. M. , WORTH P. H. L.
Published: December 2008

Summary— Thirty‐seven cases of female chronic retention are reviewed. Only 13 patients had neurological disease. The problems encountered in diagnosis and management are presented.
Functional Bladder Neck Obstruction. Results of Endoscopic Bladder Neck Incision in 131 Consecutive Patients
Authors: CHRISTENSEN M. G. , NORDLING J. , ANDERSEN J. T. , HALD T.
Published: December 2008

Summary— Endoscopic diathermy incision of the bladder neck was carried out as a routine procedure in 131 consecutive male patients with an established diagnosis of functional bladder neck obstruction. Follow‐up after 3 months revealed excellent symptomatic and urodynamic results. Morbidity was low and the post‐operative stay in hospital short (median 2 days). Patients must be informed of the risk of retrograde ejaculation associated with the procedure and objective evidence of the diagnosis is essential.
Abnormal Electromyographic Activity (Decelerating Burst and Complex Repetitive Discharges) in the Striated Muscle of the Urethral Sphincter in 5 Women with Persisting Urinary Retention
Authors: FOWLER CLARE J. , KIRBY R. S.
Published: December 2008

Summary— In five women with urinary retention, recordings from the striated muscle of the urethral sphincter revealed highly abnormal electromyographic (EMG) activity. Using a concentric needle electrode, recordings revealed very striking bursts of activity, referred to here as decelerating burst (DB) and complex repetitive discharges (CRD). Such EMG activity is exceedingly unusual in skeletal striated muscle and resembles most closely the rarely encountered condition of “pseudomyotonia”.

We suggest that this abnormal activity is associated with a failure of relaxation of the striated muscle of the urethral sphincter, which results in chronic retention.
Teflon Injection in Stress Incontinence
Authors: DEANE A. M. , ENGLISH P. , HEHIR M. , WILLIAMS J. P. , WORTH P. H. L.
Published: December 2008

Summary— Forty‐six patients, 28 females and 18 males, underwent periurethral or perurethral Teflon injection. The results in females were satisfactory, especially where resting anatomy was normal. Male results were disappointing, no patients with post‐prostatectomy stress incontinence being cured.
Priapism: a Three‐phase Concept of Management According to Aetiology and Prognosis
Authors: POHL J. , POTT B. , KLEINHANS G.
Published: December 2008

Summary— Priapism is a persistent, painful erection of the penis unassociated with sexual stimulation or desire, and detumescence does not occur following ejaculation. Prolonged pathological erections may occur and it is only when they are painful that the term priapism should be used. The erection is limited to the corpora cavernosa.

Although the syndrome was named after Priapos, the mythical Greek god of fertility, impotence persists in one half of patients treated for priapism. The disease is rare; the literature consists mainly of case reports and comprehensive reviews are seldom found. Permanent sequelae cause a psychological and physical handicap and justify the present review, which is based upon recent literature as well as personal clinical experience of 15 patients. We have reviewed 170 reports describing 1400 cases of priapism and have based the analysis upon the 230 single case reports found in the literature.
Trophoblastic Metaplasia in Urothelial Carcinoma of the Bladder
Authors: BURRY A. F. , MUNN S. R. , ARNOLD E. P. , McRAE C. U.
Published: December 2008

Summary— Trophoblastic differentiation in bladder carcinoma is reported in four patients. Plasma gonadotrophin (beta subunit of HCG), measured in three patients, was elevated. In one patient treated with cisplatin, vinblastine and bleomycin, the β HCG level fell significantly but progression of malignant disease was not arrested.
Incidental Carcinoma of the Prostate: Factors Influencing Prognosis
Authors: AKDAS A. , ÖZEN H. A. , TUNCER I. , TASAR C. , REMZI D.
Published: December 2008

Summary— Thirty‐four patients with TO carcinoma of the prostate were revived in an attempt to correlate their clinical progress with the histopathological features of the tumour at presentation. Two different grading systems were used. It was found that no matter which system was used, the poorer the histopathological grade the poorer the prognosis.
Significance of Dipstick Haematuria. 1. Correlation with Microscopy of the Urine
Authors: ARM J. P. , PEILE E. B. , RAINFORD D. J. , STRIKE P. W. , TETTMAR R. E.
Published: December 2008

Summary— The reliability of a chemical test for haematuria has been evaluated in patients referred for investigation of suspected renal or urological disease. Red blood cells in concentrations of 10/μl or greater were found in 24% of urines giving a negative dipstick result, 82% of urines giving a trace positive result and nearly 100% of urines giving dipstick results greater than this. The accuracy of the reagent strip in predicting the presence or absence of significant haematuria was improved by testing several urines from each patient. On the basis of this study, if significant haematuria is present, reagent strip urine testing is an efficient method for its detection.
Ureteroscopic Pyelolysis for Pelviureteric Junction Obstruction
Authors: INGLIS J. A. , TOLLEY D. A.
Published: December 2008

Summary— The development of endourological techniques for the treatment of upper urinary tract disease has concentrated mainly on the endoscopic treatment of upper urinary tract stones. The relief of pelviureteric junction obstruction (PUJ) by percutaneous pyelolysis has recently been reported and the use of the flexible uretero‐pyeloscope has also been described. We describe the use of a rigid uretero‐renoscope to relieve strictures causing secondary pelviureteric junction obstruction in two cases.
Analysis of Urinary Calculi Using Photon Induced X‐ray Fluorescence (XRF)
Authors: CESAREO R. , BISCEGLIE V. , PEDRAZA L. J. , GALLUCCI M. , ALPI G. , SILVERIO F. DI
Published: December 2008

Summary— Photon induced X‐ray fluorescence has been employed to determine trace elements in urinary calculi. Twenty‐one urinary stones, classified in four groups, have been analysed. Besides Ca, elements Fe, Zn and Pb were detected, and Cr and Mn were also detected in some cases.

No clear differences were found between the four groups.
Analysis of the Pattern of Urine Loss in Women with Incontinence as Measured by Weighing Perineal Pads
Authors: SUTHERST J. R. , BROWN M. C. , RICHMOND D.
Published: December 2008

Summary— Three hundred and thirty‐five women with urinary incontinence underwent a pad‐weighing test for quantifying urine loss. Each one wore a series of pre‐weighed sanitary towels for a total of 1 h. The pads were weighed again after use. The test results gave information about the severity of the incontinence which was not easy to obtain either from patient interview or from clinical examination. The type of activity was the main factor determining urine loss, although patients with detrusor instability lost more on average than the others. Voiding during the test period did not appear to influence the overall test results. Reproducibility of the test has been studied in 50 patients.
A High Risk Factor Score in the Management of Benign Prostatic Hyperplasia
Authors: GUPTA N. P. , MOHANTY N. K. , REDDY P. S. , WADHWA S. N. , SINGH SARINDER MAN
Published: December 2008

Summary— To evaluate high risk factors in the management of benign prostatic hyperplasia, a scoring system has been devised which includes associated medical diseases and such complications as retention, infection and uraemia. A score of 1 to 3 was given for each high risk factor. Patients with a total score of 1 to 3 were regarded as grade 1, 4 to 6 as grade II and more than 7 as grade III. Three hundred and fifty cases of benign prostatic hyperplasia were evaluated and the patients' hospital stay, complications and mortality compared.
Horseshoe Kidney in Children
Authors: WILSON C. , AZMY A. F.
Published: December 2008

Summary— Twenty children with horseshoe kidney have been reviewed, Fifteen were symptomatic and nine required surgery. Associated renal and other abnormalities were common. The surgery of horseshoe kidney is discussed.
Bladder Stone Disease in Children in Afghanistan
Authors: SRIVASTAVA R. N. , HUSSAINY M. A. A. , GOEL R. G. , ROSE G. A.
Published: December 2008

Summary— Of 132 children with bladder stones seen in 1 year, 94% were boys and 73% were aged between 1 and 5 years. Significant malnutrition and evidence of vitamin deficiency were absent. Wheat bread was the dietary staple, while the intake of milk and dairy products, eggs and meat was very low. Analysis of 29 stones showed them to consist mainly of calcium oxalate and uric acid, with small amounts of calcium phosphate and magnesium ammonium phosphate in some cases. The composition of the surface and central parts of the stones, examined in 20 cases, was usually different. The nucleus was formed almost entirely of calcium oxalate and uric acid in four and three cases respectively, whereas the surface layers were composed of other ingredients. In another case the nucleus was composed entirely of xanthine, which indicated a diagnosis of xanthinuria.
Uroflowmetry in Asymptomatic Elderly Males
Authors: JØRGENSEN J. BALSLEV , JENSEN K. M.‐E. , BILLE‐BRAHE N. E. , MOGENSEN P.
Published: December 2008

Summary— Uroflowmetry is important in the evaluation of prostatism. We have investigated 93 men, selected at random from the National Register, who had no subjective voiding problems but who fell within the appropriate age range. The sample was representative of the male metropolitan population.

Uroflowmetry was carried out and the data are presented graphically in nomograms where the Qmax/volume, Qaverage/volume and Qmax time/volume relations are given. Flow variables were evaluated to delineate possible correlations to age. It was found that the median Qmax decreased from 18.5 ml/s at the age of 50 years to 6.5 ml/s at 80 years. Only one‐third of the group had a Qmax exceeding 15 ml/s. The median voided volume was 208 ml. Half of the subjects voided less than 200 ml and one‐third less than 150 ml.
The Oestrogenic Effects of Ethinyl Oestradiol/Polyoestradiol Phosphate and Estramustine Phosphate in Patients with Prostatic Carcinoma A Comparative Study of Oestrogen Sensitive Liver Proteins, Gonadotrophins and Prolactin
Authors: DAEHLIN L. , DAMBER J.‐E. , von SCHOULTZ B. , BERGMAN B.
Published: December 2008

Summary— Thirty previously untreated patients with carcinoma of the prostate were prospectively randomised to one of the following treatments: (1) ethinyl oestradiol (Etivex®) combined with polyoestradiol phosphate (Estradurin®); (2) estramustine phosphate (Estracyt®); (3) bilateral orchiectomy. Oestrogenic effects were measured by blood levels of pregnancy zone protein, sex hormone binding globulin, LH, FSH and prolactin.

During a follow‐up period of 6 months, estramustine phosphate and ethinyl oestradiol/polyoestradiol phosphate induced comparable changes in these proteins, suggesting comparable oestrogenic effects of these two forms of treatment in patients with prostatic carcinoma.
Penile Erections in Myelomeningocele Patients
Authors: DIAMOND D. A. , RICKWOOD A. M. K. , THOMAS D. G.
Published: December 2008

Summary— Of 52 post‐pubertal male myelomeningocele patients, 36 (70%) appeared to have penile erections. In relation to spinal neurology, erections occurred in all of those with a positive anocutaneous reflex, 64% of those with a negative anocutaneous reflex and a level at or below the sympathetic outflow and 14% of those with a negative anocutaneous reflex and a level above the sympathetic outflow. The physiological implications of these findings are discussed.
Immunohistochemical Identification of Lymphocyte Subsets and Macrophages in Normal Human Urothelium Using Monoclonal Antibodies
Authors: EI‐DEMIRY M. I. M. , HARGREAVE T. B. , BUSUTTIL A. , JAMES K. , CHISHOLM G. D.
Published: December 2008

Summary— Monoclonal antibodies were used to examine the pattern of distribution of lymphocyte subpopulations and macrophages in normal human urothelium. T lymphocytes (T11‐positive cells) were demonstrated within the epithelium and within the lamina propria of both the ureter and the urinary bladder. Suppressor/cytotoxic T cells (T8‐positive cells) predominated, with the average ratio of suppressor/cytotoxic T cells to the helper/inducer T cells being approximately 8.9 in the epithelium and 1.5 in the lamina propria. Leu M3+ cells (monocytes/macrophages) were detected in both epithelium and lamina propria. The character and distribution of these immunocompetent cells within the urothelium suggest a protective function, especially against infection and in tumour surveillance.
Intravesical Prostaglandin F2 for Promoting Bladder Emptying after Surgery for Female Stress Incontinence
Authors: TAMMELA T. , KONTTURI M. , KÄÄR K. , LUKKARINEN O.
Published: December 2008

Summary— Prostaglandin F2α 10 mg was administered intravesically in a double‐blind placebo‐controlled study to promote micturition in cases of urinary retention after operative treatment of urinary stress incontinence in women. Fifteen of 18 patients (83%) succeeded in voiding after treatment with prostaglandin F2α, but the placebo was ineffective in all 18 patients (P<0.001). Although the effect of prostaglandin F2α on bladder muscle contraction was short‐lived, it seemed to enhance the restoration of bladder motor function with no serious side effects, and thus to be clinically useful in the treatment of post‐operative urinary retention.
Radical Cystectomy and Ileocaecal Bladder Reconstruction for Carcinoma of the Urinary Bladder A Study of 130 Patients
Authors: KHAFAGY M. M. , EL‐KALAWY M. , IBRAHIM A. , SAFA M. , MEGUID H. A. , BASSIONI M.
Published: December 2008

Summary— One hundred and thirty patients underwent radical cystectomy and ileocaecal bladder reconstruction for carcinoma of the urinary bladder.

The actuarial 5‐year survival rate was 45%. Local pelvic recurrence was noted in 26.3% of patients. Most of those in the series (81.9%) had perfect control of micturition. Intravenous urography performed up to 10 years post‐operatively showed preservation of renal configuration in 92.2%. The normal flow curves recorded showed that it was possible to achieve a balanced vesicourethral unit.

Ileocaecal bladder reconstruction is less disabling than urinary diversion after radical cystectomy.
Effects of Catheter Size on Urodynamic Measurements in Men Undergoing Elective Prostatectomy
Authors: NEAL D. E. , RAO C. V. S. , STYLES ROSEMARY A. , NG T. , RAMSDEN P. D.
Published: December 2008

Summary— Thirty men undergoing prostatectomy for symptoms of bladder outflow obstruction and low measured maximum flow rates (20 before and 10 after operation) were studied by means of urodynamic investigation. Paired studies were performed on each patient using a large catheter assembly (4 and 10 F) and a small catheter assembly (epidural line, outside diameter 1.1 mm). The order in which the studies were performed was varied randomly.

Detrusor pressure at maximum flow rate was significantly greater in the large catheter study (73 ±30 cm H2O) than in the small catheter study (65 ±27 cm H2O; P < 0.003). The maximum flow rate was significantly smaller in the large catheter study (8.9 ± 9.5 ml/s) than in the small catheter study (12±7 ml/s; P<0.001).

The increase in detrusor pressure at maximum flow that was noted during the large catheter study was confirmed in the 20 men who were studied before prostatectomy (mean increase 11 ± 11 cm H2O; P<0.001) but no difference was found between the two methods in the 10 men studied after prostatectomy (50 ± 19 cm H2O and 49± 15 cm H2O).

Using a large catheter assembly to perform urodynamic investigations has the advantage that repeated studies can be performed without recatheterisation, but it has the disadvantage of producing a small increase in detrusor pressure at maximum flow in men with symptoms of bladder outflow obstruction. Few errors in diagnosis should result, however, if laboratories using such catheters are aware of this effect and establish their own limit of normal for voiding pressures.
Methodology, Results and Complications in 2000 Extracorporeal Shock Wave Lithotripsy Procedures
Authors: SOFRAS F. , KARAYANNIS A. , KOSTAKOPOULOS A. , DELAKAS D. , KASTRIOTIS J. , DIMOPOULOS C.
Published: December 2008

Summary— Since the installation of an extracorporeal shock wave lithotriptor (ESWL) unit 12 months ago, 2000 lithotripsy procedures have been performed. Overall, 68.4% of patients were stone‐free by the end of the first month. Residual lithiasis (fragments < 0.5 cm) was seen in 19.7% of patients and significant lithiasis (fragments > 0.5 cm) was observed in 10.1%. Complications were obstruction, infection, headache due to the epidural anaesthesia, anuria, renal failure, perirenal haematoma and cardiac arrest. A number of patients required additional operative treatment; this was always endoscopic and no open procedures were performed. Hospitalisation averaged 1 day.
Internal Iliac Artery Embolisation for the Control of Severe Bladder and Prostate Haemorrhage
Authors: APPLETON D. S. , SIBLEY G. N. A. , DOYLE P. T.
Published: December 2008

Summary— Embolisation of the internal iliac artery was performed under local anaesthesia in eight patients with severe bladder haemorrhage and in two with severe bleeding from the prostatic bed after prostatectomy.

Good and effective control of the bleeding was achieved in six of the patients with bladder haemorrhage, with a partial response in the other two. Both patients with post‐prostatectomy bleeding responded well to embolisation, with prompt cessation of the bleeding.

This technique is recommended for the control of severe bleeding from the bladder or prostate in the seriously ill patient.
Pedicled Preputial Patch Urethroplasty
Authors: MUNDY A. R. , STEPHENSON T. P.
Published: December 2008

Summary— Pedicled preputial patch urethroplasty has been used in 48 patients for the treatment of urethral strictures that have not responded to endoscopic surgery. The procedure is simple to perform and almost universally applicable. It avoids the problems associated with the use of scrotal skin. Its wider use is recommended.
An Evaluation of Urologist‐operated Ultrasound and its Use in the Urological Out‐patient Clinic
Authors: VESEY S. G. , LUMB G. N. , O'BOYLE P. J.
Published: December 2008

Summary— The value of urologist‐operated real time ultrasound scanning was assessed in the urological out‐patient clinic. In terms of accuracy, the urologists' ultrasound scans of the genitourinary tract proved comparable with those of the radiologists. The techniques were quickly learned and scanning added little to the consultation time. Scanning during clinic time was shown to be both time‐saving and cost‐effective by allowing more rapid assessment of the patient and a speedier diagnosis. In economic terms considerable savings could be made by reducing the need for formal ultrasound referrals, since patients scanned at the out‐patient clinic would be spared two further trips to hospital, one for the formal examination and another for the out‐patient clinic review. Clinic turnover thus becomes more efficient and inconvenience to the patient and transport costs are lessened.
‘Prostate‐related symptoms’ in Canadian men 50 years of age or older: prevalence and relationships among symptoms
Authors: NORMAN R. W. , NICKEL J. C. , FISH D. , PICKETT S. N.
Published: December 2008

Objectives To determine the prevalence of symptoms associated with benign prostatic hyperplasia (BPH) in Canadian men, and to establish whether the traditional separation of these symptoms into obstructive and irritative categories is valid.

Subjects and methods A probability sample of 508 Canadian men 50 years of age or older was surveyed by telephone. The survey questions and scoring system used were devised to allow estimation of symptom prevalence and were based on the frequency and severity of the symptoms. Using the data from respondents who had moderate to severe symptoms, a cluster analysis was utilized to analyse relationships among symptoms.

Result The most prevalent symptoms were nocturia (62%), weak stream (61%) and urinary frequency (46%). Urgency was reported by 18%, a sense of incomplete bladder emtying by 23% intermittency by 18% and hesitancy by 13%. Using predefined cutoff scores. 23% of the respondents experienced moderate to severe symptoms associated with BPH; the prevalence of moderate to severe symptoms increased with age. The clusters were grouped on the basis of the symptoms driving them, with oen cluster designated as ‘moderates’, two clusters designated as ‘irritatives’ and two designated as ‘obstructives’. The moderates cluster was driven by respondents who had lower symptom scores evenly distributed across all symptoms. The irritatives and obstructives clusters were driven by respondents with higher scores for symptoms considered by convention to be irritative or symptoms considered by convention to be irritative or obstructive in nature and, thus, were designated accordingaly, Not all symptoms were discriminatory for irritative and obstructive symptom domains.

Conclusions A large percentage of Canadian men 50 years of age or older experience symptoms commonly associated with BPH, The theoretical concept of irritative and obstructive symptom domains was supported partially by the cluster analysis. A clear typology of men with BPH symptoms could prove useful if treatments were found to be more effective for certain types of BPH symptoms. Thus these observations warrant further investigastion into the differential effects of management approaches for BPH symptoms according to symptom clusters.
The Bristol prostate cancer pilot screening study — a 3‐year follow‐up
Authors: BREWSTER S. F. , KEMPLE T. , MacIVER A.G. , ASTLEY J.P. , GINGELL J.C.
Published: December 2008

Objective To undertake a follow‐up study of 472 men who were screened 3 years previously, in genral practice, forprostate cancer, and to investigate the efficacy and patient acceptability of a 3‐year screening interval.

Subjects and methods Eligible men (n=472) were sent postal invitations to attend their Health Centre in North Bristol. Serum prostate‐specific antigen (PSA) was the initial screening test. Men with PSA >4 ng/ml (Hybritech) were referred to the Department of Urology for digital rectal examintation and trasectal ultrasound ± biopsy.

Results A total of 132 (28%) men were excluded because of intercurrent illness, death and migration. Two hundred of 340 (59%) men were re‐screened. Thirty seven men had an elevated PSA and were referred as above. Seventeen men had prostatic biopsies, resulting in the diagnosis of six carcinamas; five were localized to the prostate and one was metastatic. In the latter patient, the PSA had risen from 2 to 120 ng/ml over 3 years.

Conclusion Serum PSA alone can be used as an acceptable repeat screening test to detect prostate cancer in genral practice, but 3‐year repeat screening will not always protect the individual against the interval development of metastatic disease.
Deaths and complications following prostatectomy in 1400 men in the Northern Region of England
Authors: THORPE A. C. , CLEARLY R. , COLES J. , VERNON S. , REYNOLDS J. , NEAL D.E.
Published: December 2008

Objective To determine the degree of variation in mortality and major mornidity following trasurethral resection of the prostate (TURP), and to assess intersite variation for mortality and morbidity over 12 sites within the Northern Region. Further, to determine whether the previously observed effects on morbidity of unit size, patient through‐put and emergency admission were borne out in contemporary urological practice in the Northern Region.

Patients and methods For an 8 month period, 1 April 1991‐31 Novemebr 1991, an independent audit of TUROP was performed on 12 different hospital sites throughout the Northern Region. a constant data set was designed which was collected on each patient before and 3 months after operation by two independent clinical co‐ordinators who travelled to each of the sites. All case notes were reviewes at 3 months after operation by two independent clinical co‐ordinators who travelled to each of the sites. All case notes were reviewes at 3 months after operation by the co‐ordinators using a standard proforma, rather than depending upon self reporting by medical staff. Fata on factors potentially affecting mortality and morbidity were collected, including emergency admission, diagnosis of prostate cancer, American Society of Anesthesiologists co‐morbidity scores, and age and differences in though‐put in the 12 sites. The effect of through‐put or ‘volume’ on mortality and morbidity was assessed by comparing morbidity and the number of cases performed.

Results The early mean death rate was 13 of 1396 patients (0.9%) with an inter‐site variation ranging from 0% to 3.8%. a mean of 2.0% of men were returned to theatre after TURP, 2.4% of parients received a blood transfusion (>2 units) after operation, and 8.0% of patients developed post‐operative sepsis; these complications varied sixfold, sevenfold and 17 fold across the different sites respectively. Those units performing ≤ 100 operations over the audit period (equivalent to<150 operation per year) had a significantly increased rate of deaths and complications which was not related to population differences. though some low volume units had good results. Elderly men who were particularly vulnerable to comlications.

Conclusions The overall early mortality rate after TURP for benign prostatic hyperpalsia across the Region compares well with other reported large series. The significant variantion in morbidity rates found in this study suggests that careful attention needs to be paid by Urologists, Purchasers and Providers to morbidity rates after prostatectomy.
Update evaluation of benign prostatic hyperplasia: when should we offer prostatectomy?
Authors: CETINEL B. , TURAN T. , TALAT Z. , YALÇIN V. , ALICI B. , SOLOK V.
Published: December 2008

Objective To investigate correlations between traditional and urodynamic critera in the evaluation of prostatism and to try to establish an update evaluation of patients with benign prostatic hyperplasia (BPH) with the aim of preventing unnecessary prostatectomies.

The series constituted 96 patients aged 43–86 years (mean 63.41±9.25) with prostatism and BPH. All were assessed by symptom analysis, digital rectal examination, residual urine determinations, uroflowmetry and further multichannel urodynamic testing (medium fill cystometry pressure flow study).

Results Residual urine determination was not a reliable criterion for selection of patients for surgery. A striking statistically significantly correlation was eveident when symptomatology and the results from multichannel urodynamic study were compared. No correlation was found between irritative symptoms and detrusor instablity.

Conslucion A significant proportion (23%) of the whole patient population was classified as a urodynamically unobstructed group to which we think prostatectomy should not be offered. We recommend that a pressure flow study is performed in all patients with BPH with dominant irritative symptoms to identify those who are unobstructed.
Pharmacological characterization of α1‐adrenoceptor subtypes in the human prostate: functional and binding studies
Authors: MURAMATSU I. , OSHITA M. , OHMURS T. , KIGOSHI S. , AKINO H. , GOBARA M. , OLADA K.
Published: December 2008

ObjectiveTo characterize the α1,‐adrenoceptor subtypes of the human benignly enlarged prostate using functional and binding studies.

Material and methodsStrips of prostatic tissue taken from nine patients with benign prostatic hypertrophy who were undergoing open prostatectomy were used in the styudy.

ResultsThe strips isolated from five prostates produced a large contraction in response to noradrenaline and phenylphrine but not to clonidine. The contractile response induced by noradrenaline was competitively antagonized by representative α1‐adrenoceptor antagonists (prazosin, WB4101, 5‐methylurapidil and HV723), the dissociation constants (pKb) being <.5. Pre‐treatment with chloroethyclonidine was without effect on the contractile response to noradrenaline. In saturation experiments with five prostates. [3H]‐prazosin bound to the prostate membranes with two distinct affinities (pKd‐9.95±0.07 and 8.71±0.04, Bmax=151±8 and 138±3 fmol/mg protein, respectively). Unlabelled prazosin and WB4101 biphasically displaced the binding of 200 pM [3H]‐prazosin; the resulting high and low pK1values for each of the antagonists were consistent with the two pKDvalues obtained for [3H]‐prazosin in the saturation experiments. 5‐Methylurapidil and HV723 displaced the [3H]‐prazosin binding monophasically with an affinity (pKI) close to 8.5.

These results suggest the presence of at least two distinct α‐adrenoceptor subtypes (presumably an αICsubtype with a high affinity for prazosin and WB4101, and a putative αILsubtype with a low affinity for the antagonists) in the human prostate, in which the latter subtype may be predominantly involved in the contractile response to noradrenaline.
Ultrasound evaluation of the paediatric prostate
Authors: IINGRAM S. , HOLLMAN A. S. , AZMY A. F.
Published: December 2008

Objective To document the shape, echogenicity and volume range of the normal paediatric prostate on transabdominal ultrasound, and to determine the feasibility of imaging the seminal vesicles and prostatic urethra with transabdominal ultrasound.

Patients and methods Transabdominal ultrasound of the prostate was performed in 36 boys, aged 7 months‐13.5 years (mean 7.7 years), with normal prostates.

Results Generally the prostate was hypoechoic, ellipsoidal in shape with a volume range of 0.4–5.2 ml (mean 1.2). The seminal vesicles were demonstrated in 56% of boys but only occasionally could the urethra be visualized. No colour flow was demonstrated within the prostate.

Conclusion The paediatric prostate can be easily visualized by transabdominal ultrasound. This technique may be of value in the investigation of incontinence, posterior urethral valves and seminal vesicle pathology, and in the monitoring of prostatic volume in hypogonadal boys.
Role of radiation therapy in the treatment of carcinoma of the penis
Authors: RAVI R. , CHATURVEDI H. K. , SASTRY D. V. L. N.
Published: December 2008

Objective To study the effectiveness of radiation therapy (RT) for the primary tumour and for groin node and distant metastases in patients with squamous cell carcinoma of the penis.

Subjects and methods Between January 1959 and June 1988. 156 patients with negative lymph nodes in the groin underwent RT of the primary tumour. RT was also administered to 120 patients with lymph node involvement in the groin and to nine with distant metastases.

Results Local control of the primary tumour was achieved in 65% of patients with RT alone and in another 33% with salvage surgery. Lymph node recurrence in the groin was seen in 11% of patients and the corrected 5‐year disease‐free survival was 87%. Pre‐operative inguinal RT was useful in patients with mobile lymph nodes ≥4 cm in size in the groin, with only 8% of such lymphadenectomy specimens showing perinodal infiltration and only 3% of such patients having post‐operative groin recurrences. Pelvic and/or para‐aortic RT was ineffective in patients with pelvic node metastases. Palliative RT resulted in amelioration of symptoms in 56% of patients with fixed lymph nodes in the groin, all five patients with painful bony metastases and one of two patients with cord compression and paraplegia.

Conclusion Radiation therapy is ideal for patients with T1 and T2 primary cancers of the penis. Pre‐operative RT is useful for patients with mobile lymph nodes ≥4 cm in size in the groin. RT provides effective palliation in patients with advanced regional disease and/or distant metastases.
Quality of life in patients treated for penile cancer. A follow‐up study
Authors: OPJORDSMOEN S. , FOSSÅ S. D.
Published: December 2008

Objectives To study the long‐term psychosocial wellbeing of patients following successful physical treatment for cancer of the penis.

Patients and methods Thirty patients (median age at follow‐up 57 years, range 28–75) were followed up for a median of 80 months after treatment for penile cancer (local excision/laser beam treatment, 5; radiotherapy, 12; partial penectomy, 9; total penectomy, 4). They underwent a semi‐structured interview and completed the Impact of Events Scale, General Health Questionnaire and the EORTC QLQ C‐30 questionnaire. Global scales for measuring sexual function, subjective well‐being and social activity were constructed and found reliable and valid.

Results There was a strong correlation between the well‐being scale and the EORTC scales for overall quality of life and psychological distress. Patients treated with partial or total penectomy had a worse outcome with regard to sexual function than patients treated conservatively, but there was no difference in the other domains of quality of life, indicating that even the more radically treated patients usually adapted adequately. Half of the individuals had mental symptoms at follow‐up, and these patients were less satisfied and showed less social activity. Seven men reported that, if asked again, they would choose treatment with lower long‐term survival to increase the chance of remaining sexually potent, but the majority gave priority to higher long‐term survival.

Conclusion Before treatment of penile cancer, physicians should thoroughly discuss the expected outcome and consequences of the different treatment options with the patient. Psychosocial treatment might be helpful for patients with mental symptoms.
When You and I Share Perspectives
Authors: Brunyé Tad T. , Ditman Tali , Mahoney Caroline R. , Augustyn Jason S. , Taylor Holly A.
Published: December 2008

Readers mentally simulate the objects and events described in narratives. One common assumption is that readers mentally embody an actor's perspective; alternatively, readers might mentally simulate events from an external “onlooker” perspective. Two experiments examined the role of pronouns in modulating a reader's adopted perspective when comprehending simple event sentences. Experiment 1 demonstrated that readers embody an actor's perspective when the pronoun you or I is used, but take an external perspective when he is used. Experiment 2 , however, found that a short discourse context preceding the event sentence led readers to adopt an external perspective with the pronoun I. These experiments demonstrate that pronoun variation and discourse context mediate the degree of embodiment experienced during narrative comprehension: In all cases, readers mentally simulate objects and events, but they embody an actor's perspective only when directly addressed as the subject of a sentence.
EXISTENCE OF THE STANDARD SYSTEM IN THE MULTIPLE‐PRODUCTION CASE: A SOLUTION TO THE MANARA PROBLEM
Authors: Dupertuis Michel‐Stéphane , Sinha Ajit
Published: December 2008

In this paper we show that the Manara problem in the case of Sraffa's generalized multiple‐production case arises due to the presence of superfluous processes of production. We argue that ‘goods’ should be defined from the perspective of the system and not the observer. We provide a mathematical procedure to remove superfluous processes from the construction of Sraffa's Standard system. Once this is done, the Manara problem disappears.
Are Weekly Inflation Forecasts Informative?*
Authors: Amstad Marlene , Fischer Andreas M.
Published: December 2008

Are weekly inflation forecasts informative? Although several central banks review and discuss monetary policy issues on a bi‐weekly basis, there have been no attempts by analysts to construct systematic estimates of core inflation that supports such a decision‐making schedule. The timeliness of news releases are recognized to be an important information source in real‐time estimation. We incorporate real‐time information from macroeconomic releases and revisions into our weekly updates of monthly Swiss core inflation using a common factor procedure. The weekly estimates for Swiss core inflation show that it is worthwhile to update the forecast at least twice a month.
Normobaric hyperoxia attenuates early blood–brain barrier disruption by inhibiting MMP‐9‐mediated occludin degradation in focal cerebral ischemia
Authors: Liu Wenlan , Hendren Jill , Qin Xu‐Jun , Shen Jiangang , Liu Ke Jian
Published: December 2008

Early blood–brain barrier (BBB) disruption resulting from excessive neurovascular proteolysis by matrix metalloproteinases (MMPs) is closely associated with hemorrhagic transformation events in ischemic stroke. We have shown that normobaric hyperoxia (NBO) treatment reduces MMP‐9 increase in the ischemic brain. The aim of this study was to determine whether NBO could attenuate MMP‐9‐mediated early BBB disruption following ischemic stroke. Rats were exposed to NBO (95% O2) or normoxia (30% O2) during 90‐min middle cerebral artery occlusion, followed by 3‐hour reperfusion. NBO‐treated rats showed a significant reduction in Evan’s blue extravasation in the ischemic hemisphere compared with normoxic rats. Topographically, Evan’s blue leakage was mainly seen in the subcortical regions including the striatum, which was accompanied by increased gelatinolytic activity and reduced immunostaining for tight‐junction protein, occludin. Increased gelatinolytic activities and occludin protein loss were also observed in isolated ischemic microvessels. Gel gelatin zymography identified that MMP‐9 was the main enzymatic source in the cerebral microvessels. Incubation of brain slices or isolated microvessels with purified MMP‐9 revealed specific degradation of occludin. Inhibition of MMP‐9 by NBO or MMP‐inhibitor, BB1101, significantly reduced occludin protein loss in ischemic microvessels. These results suggest that NBO attenuates early BBB disruption, and inhibition of MMP‐9‐mediated occludin degradation is an important mechanism for this protection.
The proteome of the presynaptic active zone: from docked synaptic vesicles to adhesion molecules and maxi‐channels
Authors: Morciano Marco , Beckhaus Tobias , Karas Michael , Zimmermann Herbert , Volknandt Walter
Published: December 2008

The presynaptic proteome controls neurotransmitter release and the short and long term structural and functional dynamics of the nerve terminal. Using a monoclonal antibody against synaptic vesicle protein 2 we immunopurified a presynaptic compartment containing the active zone with synaptic vesicles docked to the presynaptic plasma membrane as well as elements of the presynaptic cytomatrix. Individual protein bands separated by sodium dodecyl sulfate–polyacrylamide gel electrophoresis were subjected to nanoscale‐liquid chromatography electrospray ionization‐tandem mass spectrometry. Combining this method with 2‐dimensional benzyldimethyl‐n‐hexadecylammonium chloride/sodium dodecyl sulfate‐polyacrylamide gel electrophoresis and matrix‐assisted laser desorption ionization time of flight and immunodetection we identified 240 proteins comprising synaptic vesicle proteins, components of the presynaptic fusion and retrieval machinery, proteins involved in intracellular signal transduction, a large variety of adhesion molecules and proteins potentially involved in regulating the functional and structural dynamics of the pre‐synapse. Four maxi‐channels, three isoforms of voltage‐dependent anion channels and the tweety homolog 1 were co‐isolated with the docked synaptic vesicles. As revealed by in situ hybridization, tweety homolog 1 reveals a distinct expression pattern in the rodent brain. Our results add novel information to the proteome of the presynaptic active zone and suggest that in particular proteins potentially involved in the short and long term structural modulation of the mature presynaptic compartment deserve further detailed analysis.
When is it safe to discontinue AED treatment?
Authors: Camfield Peter , Camfield Carol
Published: December 2008

When people with epilepsy become seizure‐free with daily antiepileptic drug (AED) management, there is a very individual decision to be made about discontinuing this treatment. After 1–6 years of seizure‐freedom, it is estimated that 69% of children and 61% of adults remain seizure‐free when AEDs are tapered and stopped. The length of time that a patient is seizure‐free does not influence the success rate in children but may in adults. The epilepsy syndrome does not seem to influence the chance of success in 75% of children; however, several prediction schemes based on risk factors for recurrence may be useful. There are two major risks in discontinuing treatment—a tiny risk that the epilepsy will not be controlled again and a tiny risk of death during a recurrence. Children who have had 1–2 years seizure‐free deserve a chance to discontinue their AED treatment, whereas in adults this decision probably should wait until there have been at least 4 years of seizure‐freedom.
Neurologic birth defects after prenatal exposure to antiepileptic drugs
Authors: Uziel Daniela , Rozental Renato
Published: December 2008

Maternal epilepsy has a potential for fetal injury, either antiepileptic drug (AED)–induced or as a consequence of seizures per se. The intent of this article is to explore this relationship, discussing similar patterns of malformations seen with AEDs or different disease exposure during pregnancy, and the potential role of gap junctional intercellular communication in abnormal morphogenesis.
When drugs and surgery don’t work
Authors: Cascino Gregory D.
Published: December 2008

Epilepsy is a chronic disorder characterized by recurrent and unprovoked seizures (Dreifuss, 1987; Hauser & Hesdorffer, 1990). It is one of the most common neurologic disorders in the adult. The lifetime risk of developing epilepsy is 3.2% (Mattson, 1992). Approximately 90% of the incident cases in adults have symptomatic partial or localization‐related epilepsy (Camfield & Camfield, 1996; Hauser & Hesdorffer, 1990; Hauser, 1992). The medial temporal lobe is the most epileptogenic region of the brain (Luby et al., 1995; Jeong et al., 1999; Wiebe et al., 2001). Pathologic lesions underlying the epileptogenic zone include mesial temporal sclerosis (MTS), tumor, vascular anomaly, malformations of cortical development (MCDs), and head trauma (Cascino et al., 1993; Radhakrishnan et al., 1998). The initial response to medication is of prognostic importance (Hauser, 1992). Patients with a remote symptomatic neurologic disease, foreign‐tissue lesion, developmental delay, or abnormal neurologic examination are less likely to be rendered seizure‐free. The goals of treatment are to render the individual seizure‐free without producing antiepileptic drug (AED) toxicity, allowing the individual to become a participating and productive member of society (Engel & Ojemann, 1993). Despite the introduction of “newer” AEDs, nearly one‐half of patients with partial epilepsy will not attain a seizure remission with pharmacotherapy (Kwan & Brodie, 2003). This discussion focuses on management of the adult patient with intractable partial seizure disorders that are medically refractory and may not be surgically remediable. It is estimated that 400,000 of the 2 million individuals with partial epilepsy in the United States have a medically refractory partial seizure disorder (Hauser & Hesdorffer, 1990; Hauser, 1992). An estimated 1,500 patients in the United States undergo epilepsy surgery each year. A UK study indicated that 30,000 patients develop epilepsy each year and approximately 6,000 have medically refractory seizures (Lhatoo et al., 2003). However, there are only about 400 epilepsy surgeries performed annually in the UK. Therefore, the number of patients with intractable partial epilepsy that is both medically refractory and possibly not a surgically remediable epileptic syndrome is significant.