bluuebunny/crossref_metadata_2025 huggingface dataset:
TREATMENT OF DUODENAL ADENOMAS WITH ENDOSCOPIC ARGON PLASMA COAGULATION
Authors: Lienert Andrew , Bagshaw Philip F
Published: May 2007

Background:  Surgical resection has been the standard treatment for duodenal adenomas. It has a high associated morbidity rate and a significant recurrence rate. The aim of this study was to evaluate endoscopic treatment of these lesions with argon plasma coagulation.

Methods:  We retrospectively identified patients with non‐ampullary duodenal adenomas without a polyposis syndrome and who were treated endoscopically between 1st January 1999 and 31st December 2003. Their management, follow up and outcomes were reviewed.

Results:  Fifteen patients were included, with mean age 72 years (range 46–85 years). All were treated with at least one session of argon plasma coagulation. Initially, 13 adenomas were macroscopically cleared. Of these, eight (61%) had no recurrence during mean follow up of 40 months (26–68 months). The mean time to recurrence was 14 months (6–30 months). Eradication was possible a second time in four of five recurrent adenomas. There was one complication, of haemorrhage, from 37 sessions of argon plasma coagulation. No patient developed duodenal adenocarcinoma during the study period.

Conclusion:  Argon plasma coagulation may be safe and effective for the treatment of duodenal adenomas, but further research is required. Progression of adenomas is slow and perhaps no treatment is required.
NERVE STIMULATION IN THYROID SURGERY: IS IT REALLY USEFUL?
Authors: Loch‐Wilkinson Thorbjorn J , Stalberg Peter L. H , Sidhu Stan B , Sywak Mark S , Wilkinson James F , Delbridge Leigh W
Published: May 2007

Background:  Monitoring of the recurrent laryngeal nerve (RLN) has been claimed in some studies to reduce rates of nerve injury during thyroid surgery compared with anatomical dissection and visual identification of the RLN alone, whereas other studies have found no benefit. Continuous monitoring with endotracheal electrodes is expensive whereas discontinuous monitoring by laryngeal palpation with nerve stimulation is a simple and inexpensive technique. This study aimed to assess the value of nerve stimulation with laryngeal palpation as a means of identifying and assessing the function of the RLN and external branch of the superior laryngeal nerve (EBSLN) during thyroid surgery.

Methods:  This was a prospective case series comprising 50 consecutive patients undergoing total thyroidectomy providing 100 RLN and 100 EBSLN for examination. All patients underwent preoperative and postoperative vocal cord and voice assessment by an independent ear, nose and throat surgeon, laryngeal examination at extubation and all were asked to complete a postoperative dysphagia score sheet. Dysphagia scores in the study group were compared with a control group (n = 20) undergoing total thyroidectomy without nerve stimulation.

Results:  One hundred of 100 (100%) RLN were located without the use of the nerve stimulator. A negative twitch response occurred in seven (7%) RLN stimulated (two bilateral, three unilateral). Postoperative testing, however, only showed one true unilateral RLN palsy postoperatively (1%), which recovered in 7 weeks giving six false‐positive and one true‐positive results. Eighty‐six of 100 (86%) EBSLN were located without the nerve stimulator. Thirteen of 100 (13%) EBSLN could not be identified and 1 of 100 (1%) was located with the use of the nerve stimulator. Fourteen per cent of EBSLN showed no cricothyroid twitch on EBSLN stimulation. Postoperative vocal function in these patients was normal. There were no instances of equipment malfunction. Dysphagia scores did not differ significantly between the study and control groups.

Conclusion:  Use of a nerve stimulator did not aid in anatomical dissection of the RLN and was useful in identifying only one EBSLN. Discontinuous nerve monitoring by stimulation during total thyroidectomy confers no obvious benefit for the experienced surgeon in nerve identification, functional testing or injury prevention.
Herbicidal and fungicidal activities and identification of potential phytotoxins from Bidens pilosa L. var. radiata Scherff
Authors: DEBA FARAH , XUAN TRAN DANG , YASUDA MASAAKI , TAWATA SHINKICHI
Published: May 2007

This study was carried out to examine the possibility of utilizing Bidens pilosa, a weed widely distributed in the subtropics and the tropics, for weed and plant fungus control. The extract of B. pilosa shows strong phytotoxic action against the growth of Raphanus sativus and Echinochloa crus‐galli and antifungal activity against phytopathogens in bioassays. The extract of the roots exhibited plant growth inhibitory activity more than those of the leaves and stems. Fifteen phenolic compounds, including pyrocatechin, salicylic acid, p‐vinylguaiacol, dimethoxyphenol, eugenol, 4‐ethyl‐1,2‐benzenediol, iso‐vanillin, 2‐hydroxy‐6‐methylbenzaldehyde, vanillin, vanillic acid, p‐hydroxybenzoic acid, protocatechuic acid, p‐coumaric acid, ferulic acid, and caffeic acid were identified by gas chromatography–mass spectrometry. Caffeic acid was in the highest amount among the detected substances. Dimethoxyphenol and vanillic acid were found only in the roots of B. pilosa. Ferulic acid and p‐hydroxybenzoic acid were higher in the roots than in the leaves and stems. These identified constituents might be responsible for the phytotoxic and fungitoxic activities of B. pilosa.
Molecular basis of diverse responses to acetolactate synthase‐inhibiting herbicides in sulfonylurea‐resistant biotypes ofSchoenoplectus juncoides
Authors: UCHINO AKIRA , OGATA SHIGERU , KOHARA HIROSHI , YOSHIDA SHUICHI , YOSHIOKA TOSHIHITO , WATANABE HIROAKI
Published: May 2007

Sulfonylurea‐resistant biotypes ofSchoenoplectus juncoideswere collected from Nakafurano, Shiwa, Matsuyama, and Yurihonjyo in Japan. All of the four biotypes showed resistance to bensulfuron‐methyl and thifensulfuron‐methyl in whole‐plant experiments. The growth of the Nakafurano, Shiwa, and Matsuyama biotypes was inhibited by imazaquin‐ammonium and bispyribac‐sodium, whereas the Yurihonjyo biotype grew normally after treatment with these herbicides. The herbicide concentration required to inhibit the acetolactate synthase (ALS) enzyme by 50% (I50), obtained usingin vivoALS assays, indicated that the four biotypes were > 10‐fold more resistant to thifensulfuron‐methyl than a susceptible biotype. The Nakafurano, Shiwa, and Matsuyama biotypes exhibited no or little resistance to imazaquin‐ammonium, whereas the Yurihonjyo biotype exhibited 6700‐fold resistance to the herbicide. The Nakafurano and Shiwa biotypes exhibited no resistance to bispyribac‐sodium, but the Matsuyama biotype exhibited 21‐fold resistance and the Yurihonjyo biotype exhibited 260‐fold resistance to the herbicide. TwoS. juncoidesALS genes (ALS1andALS2) were isolated and each was found to contain one intron and to encode an ALS protein of 645 amino acids. Sequencing of the ALS genes revealed an amino acid substitution at Pro197in either encoded protein (ALS1 or ALS2) in the biotypes from Nakafurano (Pro197→Ser197), Shiwa (Pro197→His197), and Matsuyama (Pro197→Leu197). The ALS2 of the biotype from Yurihonjyo was found to contain a Trp574→Leu574substitution. The relationships between the responses to ALS‐inhibiting herbicides and the amino acid substitutions, which are consistent with previous reports in other plants, indicate that the substitutions at Pro197and Trp574are the basis of the resistance to sulfonylureas in theseS. juncoidesbiotypes.
Factors in the suppression of weeds by squash interplanted in corn
Authors: FUJIYOSHI PHILLIP T. , GLIESSMAN STEPHEN R. , LANGENHEIM JEAN H.
Published: May 2007

In order to examine the weed‐suppressive properties of squash interplanted in corn, we compared different planting densities and weeding regimens, measuring the weed biomass, light interception by crop canopy, and yield. The corn was machine‐planted at a normal monocrop density, while the squash was hand‐planted at or above a normal monocrop density in an irrigated and otherwise mechanized system. A simulated intercrop consisting of corn with an artificial squash canopy was included. Interplanted squash reduced the biomass of the total weeds and of the dominant weeds, Amaranthus retroflexus and Convolvulus arvensis. The corn yield was not necessarily reduced in the intercrop, except at a higher squash density or under limited moisture. Shading by the squash was the major mechanism of weed suppression, but the analysis suggested that other factors, such as allelopathy, might contribute. Additional hand weeding had no effect on the corn yield.
Repeated grading of weed abundance and multivariate methods to improve the efficacy of on‐farm weed control trials
Authors: NKURUNZIZA LIBÈRE , MILBERG PER
Published: May 2007

We evaluated whether new information could be drawn from additional data collection and unconventional statistical analyses of an on‐farm trial. First, we compared a conventional sampling method using a biomass estimate of weed abundance to repeated visual assessment of the percentage ground cover of weeds. The biomass was sampled once after the treatment, whereas the ground cover was repeatedly sampled once before weed control plus several occasions after weed control. Second, we contrasted the outcomes from analysis of variance (anova), taking samples from a single point in time with repeated measures (rm)anova and a multivariate method. As the outcomes and conclusions drawn were relatively similar, we conclude that the ground cover estimate of weed abundance was as reliable as the biomass estimate. The rmanova enabled us to follow the temporal trend in response to treatments in the most abundant species, including possible initial differences. Multivariate analysis went even further, by clearly displaying species‐wise responses and treatment selectivity.
The National Pediatric Epidural Audit
Authors: LLEWELLYN N , MORIARTY A.
Published: May 2007

Background:  This paper describes a prospective audit of children receiving epidural infusion analgesia (EIA) in Great Britain and Ireland. The aim was to quantify the risks associated with this technique.

Methods:  In order to obtain sufficient data on the number of pediatric epidurals performed and the incidence of unwanted events, a decision was taken, at an Annual Meeting of Great Britain and Ireland Paediatric Pain Services, to establish a national audit of EIA practice in these centers. Each site sent a monthly return of the numbers of EIA performed to the coordinating center. If an incident occurred then the referring site completed a more detailed form and the child was followed up for 1 year if possible. Incidents were graded by severity 1–3, serious to minor.

These data were collected over the 5‐year period (2001–2005).

Results: 

 Ninety six incidents were reported in 10 633 epidurals performed.

 Fifty six were associated with the insertion or maintenance of EIA; most were of low severity (1 : 189).

 Five incidents were graded as 1 (serious) (approximately 1 : 2000).

 Nine incidents were graded as 2 (approximately 1 : 1100).

 Only one child has residual effects from a grade 1 incident 12 months after surgery (approximately 1 : 10 000).

 Forty incidents were also reported that were felt to be associated with the use of EIA; 33 of these incidents were the development of pressures sores. Four incidents of compartment syndrome were reported, in each of these cases the presence of EIA did not mask the condition.

Conclusions:  Epidural infusion analgesia in children does have risks associated with the technique. The occurrence of compartment syndrome does not appear to be masked by the presence of working EIA.

As a result of this audit we can now provide parents with better information, thereby improving the process of informed consent.
Percutaneous transtracheal emergency ventilation with a self‐made device in an animal model
Authors: SCHAEFER RAIK , HUETER LARS , PREUSSLER NIELS‐PETER , SCHREIBER TORSTEN , SCHWARZKOPF KONRAD
Published: May 2007

Background:  Special equipment for emergency percutaneous transtracheal ventilation is often not immediately available. We used a self‐made device consisting of a three‐way stopcock connected between a G‐15 transtracheal airway catheter and an oxygen supply in a simulated ’cannot intubate, cannot ventilate’ scenario and tested the hypothesis that the effectiveness of the device depends on the body weight of the experimental animals.

Methods:  With approval of the local animal protection committee, two groups of six pigs each with a body weight of 21 ± 2 and 36 ± 6 kg, respectively, were tracheally intubated and mechanically ventilated after induction of anesthesia. Hemodynamic monitoring included cardiac output and arterial, central venous and pulmonary artery pressures. An emergency transtracheal airway catheter was inserted into the trachea and a situation of partial expiratory airway obstruction was created. Each animal was ventilated for 15 min via the transtracheal airway catheter with the self‐made device (FiO2 1.0 at an oxygen flow of 15 l·min−1; respiratory rate of 60 min−1; I/E ratio approximately 1 : 1).

Results:  Whereas satisfactory oxygenation was achieved in all animals, sufficient ventilation was obtained only in the lightweight animals.

Conclusions:  Adequate oxygenation could be provided by jet‐like transtracheal ventilation with a simple self‐made device using easily available materials. Sufficient ventilation depends on the body weight of the animals.
Clonidine disposition in children; a population analysis
Authors: POTTS AMANDA L , LARSSON PETER , EKSBORG STAFFAN , WARMAN GUY , LÖNNQVIST PER‐ARNE , ANDERSON BRIAN J
Published: May 2007

Background:  There are few data describing clonidine population pharmacokinetics in children (0–15 years) despite common use. Current pediatric data, described in terms of elimination half‐life or Cmax and Tmax, poorly explain variability in drug responses among individuals representative of those in whom the drug will be used clinically.

Methods:  Published data from four studies investigating clonidine PK after intravenous (i.v.), rectal and epidural administration (n = 42) were combined with an open‐label study undertaken to examine the pharmacokinetics of i.v. clonidine 1–2 μg·kg−1 bolus in children after cardiac surgery (n = 41). A population pharmacokinetic analysis of clonidine time–concentration profiles (380 observations) was undertaken using nonlinear mixed effects modeling. Estimates were standardized to a 70‐kg adult using allometric size models.

Results:  Children had a mean age of 4 (sd 3.6 years, range 1 week–14 years) years and weight 17.8 (sd 12.6, range 2.8–60) kg. A two compartment disposition model with first‐order elimination was superior to a one compartment model. Population parameter estimates (between subject variability) were clearance (CL) 14.6 (CV 35.1%) l·h−1 70 kg−1, central volume of distribution (V1) 62.5 (71.1%) l 70 kg−1, intercompartment clearance (Q) 157 (77.3%) l·h−1 70 kg−1 and peripheral volume of distribution (V2) 119 (22.9%) l 70 kg−1. Clearance at birth was 3.8 l·h−1 70 kg−1 and matured with a half‐time of 25.7 weeks to reach 82% adult rate by 1 year of age. The volumes of distribution, but not clearance, were increased after cardiac surgery (V1 123%, V2 126%). There was a lag time of 2.3 (CV 73.2%) min before absorption began in the rectum. The absorption half‐life from the epidural space was slower than that from the rectum (0.98 CV 24.5% h vs 0.26 CV 32.3% h). The relative bioavailability of epidural and rectal clonidine was unity (F = 1).

Conclusions:  Clearance in neonates is approximately one‐third that described in adults, consistent with immature elimination pathways. Maintenance dosing, which is a function of clearance, should be reduced in neonates and infants when using a target concentration approach.
Safety and efficacy of patient controlled epidural analgesia following pediatric spine surgery
Authors: Saudan S , Von Ungern‐Sternberg B.S , Ceroni D , Meyer P.A. , Kaelin A , Habre W
Published: May 2007

Background:  Patient controlled epidural analgesia (PCEA) is uncommon in paediatric anaesthesia particularly for extensive spinal surgery. Since PCEA has been shown to offer superior pain control compared with continuous epidural infusions in adults, we prospectively evaluated the analgesia efficacy and safety of PCEA in children and adolescents following extensive spinal surgery.

Methods:  Following approval of the local Ethics Committee, 100 consecutive children [age median (range) 14 (6–19) years] undergoing spinal surgery were included, and 98 children benefited from PCEA. One or two epidural catheters were set in place by the surgeon under direct vision based on the number of vertebral segments operated. The epidural solution consisted of bupivacaine 0.0625%, fentanyl 1 μg·ml−1 and clonidine 0.6 μg·ml−1, delivered at a rate of 0.2 ml·kg−1·h‐1 and a bolus of 0.1 ml·kg−1·h‐1 (max 2 per h). On the 4th postoperative day, PCEA was stopped and analgesia was continued with patient controlled analgesia with morphine (PCA). After surgery, all patients were followed by the paediatric anaesthesia acute pain team for the duration of the administration of the PCEA (day 1–4) and PCA morphine (day 4–7). Pain was assessed at rest every 6 h and during mobilization every 24 h by the means of the Revised Facial Scale (RFS). All patients were continuously monitored with pulse oximetry, and every 6 h the respiratory frequency was assessed. The Bromage scale was used to evaluate motor blockade (0 = no paralysis; 1 = inability to lift the thigh; 2 = inability to flex the knee; 3 = inability to move any joint in the legs). The occurrence of postoperative nausea and vomiting (PONV), pruritus, cardiac and pulmonary complications were reported.

Results:  During the PCEA regimen, the maximal scores of the revised facial scale were below four at rest with a very high satisfaction rate (>90%). Pain scores were higher during mobilization on the first postoperative day and when PCEA was switched to PCA (Table 1). The overall incidence of adverse events was low and consisted primarily in technical problems and postoperative nausea and vomiting (Table 2). Only two children experienced a complication requiring the discontinuation of the PCEA but there were no consequent adverse sequelae: One child with known childhood epilepsy presented with a focal epileptic episode and one child had a suspected leak of the anaesthetic solution into the spinal space. The switch from PCEA to PCA was associated with a significant increase in PONV values as well as a decrease in satisfaction rates from 98% to 83%.

Conclusions:  The present study demonstrates that PCEA provides excellent pain relief following extensive spinal surgery and is associated with a low incidence of adverse events. Therefore, the use of PCEA should be encouraged in children and adolescents following extensive spine surgery.
Optimal spectral irradiance for laryngoscopy
Authors: Lewis E , Sheraton T.E. , Hampson M.A. , Wilkes A.R. , Gildersleve C. , Hall J.E.
Published: May 2007

Introduction:  Changing the colour of light produced by laryngoscopes may improve the view at laryngoscopy and facilitate intubation. This could be crucial in children with anatomically difficult airways and in acute airway emergencies. Infra red light has been shown to be detrimental to optimal laryngoscopy (1). Anaesthetists have expressed a preference for blue/white light output to facilitate intubation (2). Blue light corresponds to peak haemoglobin absorption (415 nm) and therefore enhances the view of capillary vessels within the surface mucosa.(3) Green light defines deeper structures more clearly (3). Specific combinations of blue and green light spectra may provide the best conditions for intubation. Light Emitting Diodes (LEDs) have the advantage of producing light in a more appropriate part of the spectrum. LEDs are not currently used in laryngoscopes available in the UK. The aim of this study was to compare the spectral irradiance of the ProAct Miller 1 Paediatric blade laryngoscope (containing an incandescent bulb) with a custom‐made laryngoscope containing an LED.

Methods:  The light spectral irradiance from the laryngoscope blades was measured under standardised conditions using the Bentham spectroradiometer. Blackout conditions were applied to eliminate background light. The tip of each laryngoscope blade was placed in contact with the sample port of the spectroradiometer. A mains voltage supply was set at 3 V for the Miller 1 blade (A) and 3.6 V for the blade with the LED (B), as specified by the manufacturers.

Results:  The Miller 1 paediatric blade produced spectral irradiance mainly in the infrared region (>660 nm) in contrast with the LED which produced most irradiance in the blue/green region of the spectrum (400–550 nm).

image
[  Spectral irradiance from the Miller 1 blade (A) and the blade with the LED (B). ]

Discussion and conclusions:  Paediatric laryngoscopes with LEDs may provide superior intubating conditions than that currently available with incandescent light sources. LEDs can be further modified to emit the optimal spectral irradiance required for laryngoscopy. This may prove invaluable when presented with a difficult airway.

References  1 Crosby E, Cleland M. An assessment of the luminance and light field characteristics of used direct laryngoscopes. CanJ Anesth 1999; 46: 792–796.

2 Scholz A, Farnum N, Wilkes AR et al. Minimum and optimum light output of Mackintosh size 3 laryngoscopy blades: a manikin study. Anaesthesia 2007; 62: 163–168.

3 Watanabe A, Tsujie H, Taniguchi M, Hosokawa M, Fujita M, Sasaki S. Laryngoscopic detection of pharyngeal carcinoma in situ with narrow band imaging. Laryngoscope 2006; 116: 650–654.
Clonidine disposition in children: a population analysis
Authors: Potts AL , Larsson P , Eksborg S , Warman G , Lönnqvist P‐A , Anderson BJ
Published: May 2007

Background:  There are few data describing clonidine population pharmacokinetics in children (0–15 years) despite common use. Current paediatric data, described in terms of elimination half‐life or Cmax and Tmax, poorly explain variability in drug responses among individuals representative of those in whom the drug will be used clinically.

Methods:  Published data from four studies investigating clonidine PK after intravenous, rectal and epidural administration (n = 42) were combined with an open‐label study undertaken to examine the pharmacokinetics of IV clonidine 1–2 μg·kg−1 bolus in children after cardiac surgery (n = 30, EC approval granted). A population pharmacokinetic analysis of clonidine time‐concentration profiles (380 observations) was undertaken using nonlinear mixed effects modelling. Estimates were standardised to a 70 kg adult using allometric size models.

Results:  Children had a mean age of four (SD 3.6 years, range 1 week–14 years) year and weight 17.8 (SD 12.6, range 2.8–60 kg). A two compartment disposition model with first order elimination was superior to a one compartment model. Population parameter estimates (between subject variability) were clearance (CL) 14 (CV 28.3%) 1 h–1·70 kg−1, central volume of distribution (V1) 56.7 (67.5%) l·70 kg−1, inter‐compartment clearance (Q) 143 (19.1%) l h–1 70 kg−1 and peripheral volume of distribution (V2) 123 (72.8%) l.70kg−1. Clearance at birth was 4.7 l·h–1·70kg−1 and matured with a half‐time of 25.5 weeks to reach 85% adult rate by 1 year of age. The volumes of distribution, but not clearance, were increased after cardiac surgery (V1 180%, V2 117%). There was a lag time of 2.6 (CV 64%) min before absorption began in the rectum. The absorption half‐life from the epidural space was slower than that from the rectum 1.04 (CV31%) h vs 0.28 (CV24%) h. The relative bioavailability of epidural and rectal clonidine was unity (F = 1).

Conclusions:  Clearance in neonates is approximately one third that described in adults, consistent with immature clearance pathways. Maintenance dosing, which is a function of clearance, should be reduced in neonates and infants when using a target concentration approach.
Species abundance distributions over time
Authors: Magurran Anne E.
Published: May 2007

It has been known for 50 years that the time period over which data are collected affects the shape of empirical species abundance distributions. However, despite a recent resurgence of interest in characterizing and explaining these patterns the temporal component of species abundance distributions has been largely ignored. I argue that it is essential to take account of time, and not only because sampling duration can have a profound influence on the perceived shape of the distribution. Partitions of species abundance distributions based on temporal occurrence in the record will facilitate tests of both biological and neutral models and may lead to a better understanding of rarity. These temporal partitions also have interesting, but as yet barely explored, parallels with spatial ones such as the core‐satellite division. Moreover, changes in abundance distributions across all three of Preston's temporal scales (sampling time, ecological time and evolutionary time) present rich opportunities for ecological research.
Biased data reduce efficiency and effectiveness of conservation reserve networks
Authors: Grand Joanna , Cummings Michael P. , Rebelo Tony G. , Ricketts Taylor H. , Neel Maile C.
Published: May 2007

Complementarity‐based reserve selection algorithms efficiently prioritize sites for biodiversity conservation, but they are data‐intensive and most regions lack accurate distribution maps for the majority of species. We explored implications of basing conservation planning decisions on incomplete and biased data using occurrence records of the plant family Proteaceae in South Africa. Treating this high‐quality database as ‘complete’, we introduced three realistic sampling biases characteristic of biodiversity databases: a detectability sampling bias and two forms of roads sampling bias. We then compared reserve networks constructed using complete, biased, and randomly sampled data. All forms of biased sampling performed worse than both the complete data set and equal‐effort random sampling. Biased sampling failed to detect a median of 1–5% of species, and resulted in reserve networks that were 9–17% larger than those designed with complete data. Spatial congruence and the correlation of irreplaceability scores between reserve networks selected with biased and complete data were low. Thus, reserve networks based on biased data require more area to protect fewer species and identify different locations than those selected with randomly sampled or complete data.
Four decades of opposing natural and human‐induced artificial selection acting on Windermere pike (Esox lucius)
Authors: Carlson Stephanie M. , Edeline Eric , Asbjørn Vøllestad L. , Haugen Thrond. O. , Winfield Ian J. , Fletcher Janice M. , Ben James J. , Stenseth Nils Chr.
Published: May 2007

The ability of natural selection to drive local adaptation has been appreciated ever since Darwin. Whether human impacts can impede the adaptive process has received less attention. We tested this hypothesis by quantifying natural selection and harvest selection acting on a freshwater fish (pike) over four decades. Across the time series, directional natural selection tended to favour large individuals whereas the fishery targeted large individuals. Moreover, non‐linear natural selection tended to favour intermediate sized fish whereas the fishery targeted intermediate sized fish because the smallest and largest individuals were often not captured. Thus, our results unequivocally demonstrate that natural selection and fishery selection often acted in opposite directions within this natural system. Moreover, the two selective factors combined to produce reduced fitness overall and stronger stabilizing selection relative to natural selection acting alone. The long‐term ramifications of such human‐induced modifications to adaptive landscapes are currently unknown and certainly warrant further investigation.
Real‐time elastography for detecting prostate cancer: preliminary experience
Authors: Pallwein Leo , Mitterberger Michael , Struve Peter , Pinggera Germar , Horninger Wolfgang , Bartsch Georg , Aigner Friedrich , Lorenz Andreas , Pedross Florian , Frauscher Ferdinand
Published: May 2007

OBJECTIVE

To assess the use of real‐time elastography (RTE) for detecting prostate cancer in patients scheduled for radical prostatectomy (RP), as most solid tumours differ in their consistency from the deriving tissue, and RTE might offer a new tool for cancer detection.

PATIENTS AND METHODS

We examined 15 patients (mean age 56 years, sd 6.2, range 46–71) with RTE, using an ultrasonography (US) system with a 7.5‐MHz transrectal probe as a transducer. RTE is capable of visualizing displacements between pairs of US images of tissues when placed under axial compression. The stiffness of the lesion was displayed from blue (soft) to black (hard). Hard lesions with a diameter of ≥ 5 mm were considered as malignant. All patients had the diagnosis of prostate cancer confirmed by biopsy and had a mean (range) prostate specific antigen (PSA) level of 4.6 (1.4–16.1) ng/mL; all were scheduled for RP. US was performed by two investigators and interpreted by consensus. Cancer location and size was determined in the RTE mode only. One pathologist classified tumour location, grade and stage. The RTE findings were compared with the pathological findings.

RESULTS

There were no major complications during RP in any patient; all had a pT2 tumour on histopathological examination, the Gleason score was 5–9 and the mean (range) tumour size 1.1 (0.6–2.5) cm. Thirty‐five foci of prostate cancer were present at the pathological evaluation; multiple foci were found in 11 of the 15 glands. RTE detected 28 of 35 cancer foci (sensitivity 80%). The per‐patient analysis showed that RTE detected at least one cancer area in each of the 15 patients. Only four sites with false‐positive findings on RTE and no histopathological correlation were detected; these findings were obtained in the first five patients (period of learning).

CONCLUSIONS

RTE can be used to visualize differences in tissue elasticity. Our results show that RTE allows the detection of prostate cancer and estimation of tumour location and size. RTE of the prostate is a new imaging method with great potential for detecting prostate cancer.
The reliability of the frequency‐volume chart in assessing lower urinary tract symptoms
Authors: Yap Tet L. , Cromwell David A. , Brown Christian , Emberton Mark , Van Der Meulen Jan
Published: May 2007

OBJECTIVE

To assess the test‐retest reliability of a 1‐day frequency‐volume chart (FVC) in men with lower urinary tract symptoms (LUTS).

PATIENTS AND METHODS

Men with uncomplicated LUTS presenting to a urology clinic were asked to complete FVCs on three consecutive days. Standard measures of voiding frequency and volume were derived using International Continence Society definitions. Test‐retest reliability of 1‐day voiding behaviour was evaluated with an intraclass correlation coefficient (ICC). We also derived 95% confidence intervals (CI) for each measure, thereby indicating the precision of the measurements produced by a 1‐day chart.

RESULTS

Of 140 patients with LUTS enrolled, 96 patients (69%) completed three 1‐day FVCs. The frequency and volume measures typically had ICCs of 0.7–0.8; the ‘number of urgent voids’ had the highest ICC. Nocturnal frequency and nocturnal volume were less reliable, with ICCs of 0.59 and 0.60, respectively. However, the 95% CIs around patient measurements tended to be wide. For 24‐h voiding frequency, the true value for a patient might be up to ± three voids away from the observed value for 95% of patients.

CONCLUSION

The measures of voiding behaviour derived from 1‐day FVCs had sufficient test‐retest reliability to differentiate between high and low levels of voiding symptoms. However, individual measurements could be imprecise, suggesting that, in men with LUTS, a 1‐day FVC cannot be used for diagnosis, or monitoring changes in symptom scores after treatment.
Laparoscopic radical cystectomy for cancer: oncological outcomes at up to 5 years
Authors: Haber Georges‐Pascal , Gill Inderbir S.
Published: May 2007

Associate Editor

Ash Tewari

Editorial Board

Ralph Clayman, USA

Inderbir Gill, USA

Roger Kirby, UK

Mani Menon, USA

OBJECTIVE

To report the oncological outcomes at ≤ 5 years after laparoscopic radical cystectomy (LRC), as open RC is the reference standard treatment for muscle‐invasive bladder cancer, but interest in LRC is increasing at selected centres worldwide and as yet there are no long‐term follow‐up data.

PATIENTS AND METHODS

Between December 1999 and January 2005, 37 patients (mean age 66 years) had LRC with urinary diversion for invasive bladder cancer; 26 patients (70%) also had an extended pelvic lymphadenectomy. Overall and cancer‐specific survival data were obtained from patient charts, radiographic reports, telephone contact, and a check of the Social Security Death Index.

RESULTS

Most tumours were transitional cell carcinoma (32, 86%), high‐grade (grade III in 29, 78%) and high‐stage (≥pT2 in 26, 70%). Two patients had a positive surgical margin. The median (range) number of lymph nodes excised was 14 (2–24); seven patients (17%) had node‐positive disease (pN1). Follow‐up data were available for 35 patients (95%); eight (22%) completed ≥ 5 years of follow‐up, and the mean (range) follow‐up was 31  (1–66) months. At the last follow‐up, 24 patients (65%) were alive with no evidence of disease and 11 (30%) were dead, two (5%) from metastasis and nine (24%) from unrelated causes. The 5‐year actuarial overall, cancer‐specific and recurrence‐free survival was 63%, 92% and 92%, respectively.

CONCLUSION

To our knowledge, this is the first report of ≤ 5‐year follow‐up after LRC; the data suggest that LRC provides oncological outcomes comparable to contemporary series of open RC.
Penile‐preserving surgery for male distal urethral carcinoma
Authors: Smith Yuko , Hadway Paul , Ahmed Shwan , Perry Matthew J. , Corbishley Catherine M. , Watkin Nicholas A.
Published: May 2007

OBJECTIVE

To evaluate medium‐term outcome data from patients with distal urethral cancers treated with penile‐preserving surgery.

PATIENTS AND METHODS

We analysed prospectively 18 consecutive men referred for the management of urethral carcinoma. All had a specialist review in a supra‐regional multidisciplinary team meeting, where the histology findings were reviewed by one pathology consultant. Tumours were staged according to the Tumour‐Node‐Metastasis classification and the patients offered penile‐preserving surgery when tumours were limited to the glanular or penile urethra.

RESULTS

All 18 patients were suitable for penile‐preserving surgery; the procedures were: three hypospadias formation with or without topical chemotherapy; four buccal mucosa urethroplasty; three glansectomy and reconstruction; six glansectomy, distal corporectomy, reconstruction and hypospadias formation; two urethrectomy with or with no excision of adjacent tunica albuginea. The mean (median, range) follow‐up was 26 (20.5, 9–58) months. There were no local recurrences; four patients with regional nodal disease progressed and of these, two died from metastatic disease, and one died from an unrelated condition.

CONCLUSION

Medium‐term data show that penile‐preserving surgery is a feasible treatment for men with distal urethral carcinoma, providing excellent local control without prejudicing survival; a longer follow‐up is needed.
The utility of lactate dehydrogenase in the follow‐up of testicular germ cell tumours
Authors: Venkitaraman Ramachandran , Johnson Bernadette , Huddart Robert A. , Parker Chris C. , Horwich Alan , Dearnaley David P.
Published: May 2007

OBJECTIVE

To evaluate the utility of lactate dehydrogenase (LDH), a tumour marker that is frequently elevated at diagnosis and relapse of testicular germ cell tumours (TGCTs), in the follow‐up of TGCTs for detecting tumour relapse, as it has role as a prognostic factor but its role in follow‐up is less certain.

PATIENTS AND METHODS

We retrospectively reviewed 499 patients with TGCT who were followed from 1 January 2004 to 31 December 2005, with no clinical evidence of disease after a complete response to treatment or on surveillance for stage I disease.

RESULTS

Of patients attending for follow‐up or surveillance, in 26 of 1777 (1.4%) ‘patient‐visits’ there was a high LDH level related to disease, and in 137 of 1777 (7.7%) such visits there was a high LDH from unrelated causes. Of the 499 patients who were followed, 15 relapsed; the LDH level was high in six of 15 who relapsed, with LDH being one of the first elevated markers in four and the only elevated marker in one (seminoma). Of the 449 patients, 41 (9.1%) had a persistent false‐positive increase in LDH. The sensitivity of LDH was 40%, the specificity 90.5% and the positive predictive value 12.8% to detect relapse of disease during the follow‐up of TGCTs. When the series of 116 relapsed patients from 1992 to 2005 was analysed, an increase in LDH facilitated the detection of relapse in 2% of non‐seminomatous GCTs and 11% of seminomas, independent of other markers.

CONCLUSION

LDH has limited sensitivity, specificity and positive predictive value for detecting relapse of TGCT and false‐positive increases are common. An elevated LDH level contributed to the detection in six of 15 relapses, suggesting that its value in the follow‐up of TGCT might be useful if interpreted cautiously. High LDH levels during the follow‐up might require repeat serial LDH estimates to confirm the elevation, and imaging to detect a relapse.
Management of calyceal diverticular stones with extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy: long‐term outcome
Authors: Turna Burak , Raza Asif , Moussa Sami , Smith Gordon , Tolley David A.
Published: May 2007

In this section this month, we have two papers. The first is from authors from Scotland. They present a review of patients with an extended follow‐up who have undergone extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL) for calyceal diverticular stones over a 15‐year period to assess long‐term outcome, irrespective of treatment. They concluded that PCNL is an effective and durable means of treating calyceal diverticular stones, regardless of stone size or location of the diverticulum. Despite low stone‐free rates with ESWL, most patients are rendered symptom‐free with minimal complications. The second paper is from the USA; the authors discuss the new generation of flexible ureteroscopes, which provide exaggerated active deflection to facilitate intrarenal manipulation. They compared the relative ease of manipulation around a calyceal model. The authors concluded that the Wolf Viper proved superior for manipulation in the hands of experienced endoscopists.

OBJECTIVE

To review patients with an extended follow‐up after extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL) for calyceal diverticular stones (CDS), over a 15‐year period, assessing the long‐term outcome.

PATIENTS AND METHODS

In all, 56 patients were treated for symptomatic CDS disease by ESWL (38) or PCNL (18). The stone‐bearing diverticula were in the upper calyces in 26, middle calyces in 24 and lower calyces in six patients, and in the right kidney in 22 and in the left in 34. The most frequent symptom was ipsilateral flank pain (84%) and 32% of patients presented with associated chronic urinary tract infections. In a retrospective analysis, we assessed stone size, diverticulum location, stone‐free rate, symptom‐free rate, complications and extended follow‐up.

RESULTS

In the short‐term in the ESWL group, 21% of patients were stone‐free and 61% were asymptomatic; 8% developed symptoms and 8% developed recurrence or stone‐growth in the long term. There were six minor complications. In the PCNL group, 15 patients (83%) were stone‐free in the short term; two had a recurrence (11%) and two had stone growth (11) in the long term. There were three complications after PCNL.

CONCLUSIONS

This series shows that PCNL is an effective and durable means of treating CDS, regardless of stone size or location of the diverticulum. Despite low stone‐free rates with ESWL, most patients were rendered symptom‐free with minimal complications. The long‐term recurrence rates, 8% for ESWL and 11% for PCNL, were comparable.
An α‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazolepropionate glutamate‐receptor antagonist can inhibit premicturition contractions in rats with bladder outlet obstruction
Authors: Kitta Takeya , Kakizaki Hidehiro , Tanaka Hiroshi , Sano Hiroshi , Furuno Tsuyoshi , Mitsui Takahiko , Moriya Kimihiko , Nonomura Katsuya
Published: May 2007

OBJECTIVE

To explore the possible involvement of α‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazolepropionate (AMPA) glutamate‐receptors in bladder dysfunction associated with bladder outlet obstruction (BOO), as detrusor overactivity (DO) is common in men with benign prostatic hyperplasia.

MATERIALS AND METHODS

Proposed mechanisms of DO include the myogenic or neurogenic theory, and the autonomous bladder hypothesis. In rats, BOO produces premicturition contractions (PMCs) that are assumed to be a consequence of inappropriate non‐micturition activity during the filling phase. Using pharmacology, we explored the cause of PMCs to provide new insights into DO in humans. BOO was created in female Wistar rats; 6 weeks after obstruction we evaluated them using conscious‐filling cystometry. A specific AMPA receptor antagonist, 1‐(4′‐aminophenyl)‐ 3,5‐dihydro‐7,8‐dimethoxy‐4H‐2,3‐benzodiazepin‐4‐one (CFM‐2) was administered intravenously (i.v.) (0.003–3 mg/kg) or intrathecally (i.t.) (0.01–10 µg).

RESULTS

The i.v. administration of CFM‐2 in rats with BOO significantly decreased the threshold pressure and micturition pressure. The most remarkable findings were that i.v. administration of CFM‐2 in rats with BOO significantly and dose‐dependently decreased the amplitude and number of PMCs. The highest dose of CFM‐2 almost completely eliminated PMCs. The i.t. administration of CFM‐2 had no significant effect on PMCs.

CONCLUSION

AMPA receptors have never been suggested as a neural mechanism of bladder dysfunction associated with BOO. Although PMCs in rats with BOO have been assumed to be mainly of myogenic origin, PMCs were suppressed by the i.v. administration of CFM‐2. Thus, we think that PMCs have neurogenic components that are linked with AMPA receptors. In the present study, i.v. but not i.t. administration of CFM‐2 suppressed PMCs, suggesting peripheral and/or supraspinal sites of inhibitory action of CFM‐2 on PMCs.
Laparoscopic partial nephrectomy for selected central tumours: omitting the bolster
Authors: Weight Christopher J. , Lane Brian R. , Gill Inderbir S.
Published: May 2007

Associate Editor

Ash Tewari

Editorial Board

Ralph Clayman, USA

Inderbir Gill, USA

Roger Kirby, UK

Mani Menon, USA

OBJECTIVE

To describe an alternative technique of laparoscopic partial nephrectomy (LPN) for selected central tumours that avoids bolstered renorrhaphy, LPN for such tumours often requires a substantial resection, including collecting‐system entry, and renal reconstruction typically requires oversuturing the tumour defect and bolstered renorrhaphy, increasing the warm ischaemia time.

PATIENTS AND METHODS

After excising the tumour, the tumour bed defect in 23 selected patients was closed with intraparenchymal sutures and biological gelatine matrix‐thrombin sealant, with no bolstered renorrhaphy. Data on outcomes during and after surgery were collected prospectively.

RESULTS

The median (range) tumour size was 2.5  (1.7–5) cm, the warm ischaemia time 20  (9–44) min, the estimated blood loss 150  (50–1000) mL, and 80 (45–95)% of the kidney was spared. Complications occurred in four patients (17%), i.e. one each with a postoperative haemorrhage with a lateral tumour, requiring surgical re‐exploration, a urine leak that resolved spontaneously, postoperative anaemia, and atrial fibrillation.

CONCLUSIONS

In properly selected patients with a central tumour extending to the collecting system, the LPN defect can be reconstructed safely with a running intraparenchymal haemostatic suture and thrombin sealant, with no bolstered renorrhaphy. The operation is simplified and the warm ischaemia time significantly less. A lateral tumour, wherein the resultant LPN defect faces away from the surgeon, precluding uniform contact of sealant with the entire tumour bed, has the potential for postoperative haemorrhage, and is a contraindication for this technique.
The impact of preoperative serum C‐reactive protein on the prognosis of patients with upper urinary tract urothelial carcinoma treated surgically
Authors: Saito Kazutaka , Kawakami Satoru , Ohtsuka Yukihiro , Fujii Yasuhisa , Masuda Hitoshi , Kumagai Jiro , Kobayashi Tsuyoshi , Kageyama Yukio , Kihara Kazunori
Published: May 2007

OBJECTIVE

To assess the impact of preoperative C‐reactive protein (CRP) levels on the prognosis in patients with upper urinary tract (UUT) urothelial carcinoma (UC) primarily treated surgically, as it is increasingly recognized that a systemic inflammatory response is associated with the prognosis for patients with various malignancies.

PATIENTS AND METHODS

The clinical records of 130 patients treated surgically for UUT‐UC were reviewed retrospectively. An elevated CRP was defined as >0.5 mg/dL. Actuarial survival curves were calculated by Kaplan–Meier method, with the difference between curves evaluated using the log‐rank test. A multivariate analysis was used to identify prognostic factors, with Cox’s proportional hazard model.

RESULTS

The median (range) follow‐up was 47 (3–190) months. The preoperative serum CRP level was elevated in 24 patients (23%). There were significant associations between CRP level and haemoglobin concentrations, pathological T stage, tumour grade, lymph node involvement and lymphovascular invasion. The 5‐year disease‐specific and recurrence‐free survival rates of 24 patients with elevated CRP were significantly worse than those of the 106 with no CRP elevation (both P < 0.001). On multivariate analysis, preoperative CRP level, pathological T stage and lymph node involvement were significant prognostic factors for disease‐specific and recurrence‐free survival.

CONCLUSION

This study indicated that an elevated preoperative CRP level predicts a poor survival in patients with UUT‐UC.
Intermediate comparison of partial nephrectomy and radiofrequency ablation for clinical T1a renal tumours
Authors: Stern Joshua M. , Svatek Robert , Park Sangtae , Hermann Michael , Lotan Yair , Sagalowsky Arthur I. , Cadeddu Jeffrey A.
Published: May 2007

OBJECTIVE

To compare the intermediate‐term outcomes of patients with clinical T1a renal tumours who were treated with nephron‐sparing surgery by partial nephrectomy (PN), the preferred approach for small (cT1a) renal tumours, or radiofrequency ablation (RFA), recently offered to selected patients as an alternative, less morbid technique.

PATIENTS AND METHODS

We identified patients with stage T1a renal masses who had ≥ 2 years of follow‐up; those with bilateral synchronous or metachronous tumours, metastatic disease at presentation, or a family history of renal cell carcinoma were excluded. From July 1996 to January 2004 110 PNs were identified in our database; 37 patients who fulfilled the inclusion criteria had either open (30) or laparoscopic PN (seven) and 40 had either percutaneous (26) or laparoscopic (14) RFA.

RESULTS

The mean (range) follow‐up for the RFA and PN groups was 30 (18–42) and 47 (24–93) months, respectively; the respective mean tumour size was 2.41 and 2.43 cm. There was one incomplete ablation and two local recurrences in the RFA group, and two recurrences in the PN group (one local and one in the contralateral kidney). There were no disease‐specific deaths. The overall actuarial disease‐free probability for the PN and RFA groups, respectively, was 95.8% and 93.4% (P = 0.67).

CONCLUSIONS

This initial 3‐year actuarial analysis showed that RFA for cT1a renal tumours has comparable oncological outcomes to PN; however, longer term data are still needed.