bluuebunny/crossref_metadata_2025 huggingface dataset:
The information required by patients with early‐stage prostate cancer in choosing their treatment
Authors: Feldman‐stewart D. , Brundage M.D. , Nickel J.C. , Mackillop W.J.
Published: March 2003

Objective To determine the information that men diagnosed with early‐stage prostate cancer think is necessary to choose their treatment (surgery, radiotherapy or ‘watchful waiting’).

Patients and methods All men diagnosed with early‐stage prostate cancer in a regional urology practice in an 18‐month period were surveyed. Respondents considered the treatment decision for a specific hypothetical case and judged whether each of 59 specific information items would be ‘necessary’ to know to make the treatment decision. Respondents provided basic demographic information (age, education and marital status).

Results Of 89 patients, 71 (80%) responded; the mean (sd, range) number of items that individual respondents identified as necessary was 32 (12, 9–58). Each item was considered necessary by 54 (18, 20–93)% of respondents. Of the 59 items, only five were necessary to  80% of respondents; 23 were necessary to  67% of respondents and five were not necessary to  67% of respondents. Patients were divided about the remaining 31 items. There were no strong correlations (none accounted for > 20% of the variance) between the responses and demographic characteristics.

Conclusions There appears to be large variation among patients with early‐stage prostate cancer in the number of information items deemed necessary to make a treatment decision, and little agreement on the need for most individual items. Demographic characteristics were not useful as predictors of the information needs of each patient. The process of informing patients with early‐stage prostate cancer (and their decision aids) needs to be flexible and able to accommodate a wide range of patients' information needs.
Treatment of Peyronie's disease with local interferon‐α 2b
Authors: Brake M. , Loertzer H. , Horsch R. , Keller H.
Published: March 2003

Objective To evaluate the efficacy of subcutaneous interferon‐α 2b in the treatment of Peyronie's disease.

Patients and methods Twenty‐three men (mean age 53 years, range 27–69) received interferon‐α 2b in an unrandomized prospective study. The drug was injected subcutaneously adjacent to the plaque three times a week for 3 weeks at a dose of 2 × 106 IU. The effect of interferon‐α 2b on the extent of penile deviation, plaque size and erectile pain were investigated, and the drug's side‐effects were documented. The mean (range) follow‐up was 22 (4–48) months

Results All patients had pain relief and 13 of 19 with pain before treatment became pain‐free. The penile deviation was reduced in one patient; the deviation increased despite therapy in one patient and remained stable in the others. Plaque size remained unchanged in all patients. Impaired sexual function was improved in seven (30%) of the patients. Side‐effects (myalgia, fever) occurred after only four of 207 injections (2%).

Conclusions Subcutaneous interferon‐α 2b is safe, well tolerated and relieves pain. However, with no objective reduction in penile deviation and plaque size, the outcome of interferon‐α 2b therapy is generally unconvincing and the drug cannot be recommended for the conservative treatment of Peyronie's disease.
Are dietary influences on the risk of prostate cancer mediated through the insulin‐like growth factor system?
Authors: Mucci L.A. , Tamimi R. , Lagiou P. , Trichopoulou A. , Benetou V. , Spanos E. , Trichopoulos D.
Published: March 2003

Objectives To investigate whether dietary factors that appear to affect the risk of prostate cancer may be similarly associated with serum levels of insulin‐like growth factor 1 (IGF‐1).

Patients and methods In the context of a case‐control study, 112 men were admitted to three teaching hospitals in Athens, Greece, for disorders other than cancer. Sociodemographic data and detailed histories of smoking, alcohol and coffee consumption were recorded. A validated food‐frequency questionnaire was administered by an interviewer and serological measurements of IGF‐1 and its binding protein‐3 conducted.

Results IGF‐1 declined significantly by almost 25% among men aged >75 years and there was a small reduction in IGF‐1 levels with increased alcohol intake, with a mean (95% confidence interval, CI) change of −1.6 (− 2.2 to −0.9)% for an increment of one drink per day. There was no evidence for an effect of either smoking or coffee consumption on IGF‐1 level. Among foods, the consumption of cooked tomatoes was substantially and significantly inversely associated with IGF‐1 levels, with a mean (95% CI) change of −31.5 (− 49.1 to −7.9)% for an increment of one serving per day.

Conclusions The strongest known dietary risk factor for prostate cancer (lycopene deficit, as reflected in a reduced intake of cooked tomatoes) and an important endocrine factor in the aetiology of this disease (IGF‐1) seem to be related in a way that suggests that at least one, and perhaps more, exogenous factors in the development of prostate cancer may be mediated through the IGF‐1 system.
Computerized contrast angiosonography:a new diagnostic tool for the urologist?
Authors: Reichelt O. , Wunderlich H. , Weirich T. , Schlichter A. , Schubert J.
Published: March 2003

Objectives To evaluate the diagnostic potential of echo‐enhanced ultrasonography (US) for depicting the vascularization pattern of renal cell carcinoma (RCC), and calculating the first‐pass effect using harmonic imaging, against that obtained by triphasic helical computed tomography (CT).

Patients and methods Sixty patients with surgically confirmed RCC underwent US using B‐mode and power Doppler methods with or without an intravenous microbubble echo‐enhancing agent. After depicting and defining the tumour extent by B‐mode US, the first‐pass effect/enhancement by the echo‐enhancing agent within the lesion, and that of a reference area of unaffected renal cortex, were recorded on‐line by calculating the mean pixel intensity. Time‐intensity curves, i.e. the rise time and gradient of both the suspected tumour and reference areas, were constructed.

Results Using B‐mode US, the extent of all tumours was delineated (mean tumour size 3.8 cm, sd 0.6). After applying the microbubble agent all tumours were enhanced, whereas the perfusion was decreased (in 48%), increased (in 16%) or similar (in 36%) compared with the cortical reference area. Using the Hounsfield classification, these results correlated well with the hypo/hypervascularity shown on CT.

Conclusion Ultrasonography has considerable potential in diagnosing RCC, if combined with echo‐enhancing methods, harmonic imaging and computer‐based calculation of tumour vascularization. Dynamic US studies should provide a diagnostic yield similar to that of CT.
Factors causing variation in urinary N‐nitrosamine levels in enterocystoplasties
Authors: Woodhams S.D. , Greenwell T.J. , Smalley T. , Mundy A.R.
Published: March 2003

Objective To establish the presence or absence of any diurnal or long‐term variation in N‐nitrosamine levels (which might be important in the development of cancer in enterocystoplasties) in enterocystoplasty urine, and to assess other factors that might alter enterocystoplasty N‐nitrosamine levels.

Patients, subjects and methods Thirty‐six patients with enterocystoplasties and six normal controls were assessed. Urine samples were collected every 4 h over a 24‐h period and N‐nitrosamine levels determined using a modification of the Pignatelli method. An additional urine sample was assessed by microscopy, culture and sensitivity. In a subgroup of 16 patients with an enterocystoplasty, the urinary N‐nitrosamine levels were re‐measured at 3‐monthly intervals.

Results No diurnal or long‐term variation in urinary N‐nitrosamine levels was identified. The mean N‐nitrosamine levels were significantly higher in the cystoplasty group than in the controls (1.7 vs 1.0 µmol/L; P = 0.008). Mean N‐nitrosamine levels were also significantly higher in enterocystoplasty patients with sterile pyuria than in those with no pyuria (P = 0.01). Those taking prophylactic antibiotics had significantly lower mean N‐nitrosamine levels than those not doing so (P = 0.05). Individuals with infected urine and those needing to intermittently catheterize had higher N‐nitrosamine levels than their counterparts, but this difference was not significant.

Conclusion There were no diurnal or long‐term variations in urinary N‐nitrosamine levels. Levels were consistently higher in patients with inflamed or infected cystoplasties, those using intermittent self‐catheterization and those not taking antibiotic prophylaxis.
A systematic review of intravesical bacillus Calmette‐Guérin plus transurethral resection vs transurethral resection alone in Ta and T1 bladder cancer
Authors: Shelley M.D. , Kynaston H. , Court J. , Wilt T.J. , Coles B. , Burgon K. , Mason M.D.
Published: March 2003

Objective To assess, in a systematic review, the effectiveness of intravesical bacillus Calmette‐Guérin (BCG) in preventing tumour recurrence in patients with medium/high risk Ta and T1 bladder cancer.

Patients and methods An electronic database search of Medline, Embase, DARE, the Cochrane Library, Cancerlit, Healthstar and BIDS was undertaken, plus hand searching of the Proceedings of ASCO, for randomized controlled trials, in any language, comparing transurethral resection (TUR) alone with TUR followed by intravesical BCG in patients with Ta and T1 bladder cancer.

Results The search identified 26 publications comparing TUR with TUR + BCG. Six trials were considered acceptable, representing 585 eligible patients, 281 in the TUR‐alone group and 304 in the TUR + BCG group. The major clinical outcome chosen was tumour recurrence. The weighted mean log hazard ratio for the first recurrence, taken across all six trials, was −0.83 (95% confidence interval −0.57 to −1.08, P < 0.001), which is equivalent to a 56% reduction in the hazard, attributable to BCG. The Peto odds ratio for patients recurring at 12 months was 0.3 (95% confidence interval of 0.21–0.43, P < 0.001), significantly favouring BCG therapy. Manageable toxicities associated with intravesical BCG were cystitis (67%), haematuria (23%), fever (25%) and urinary frequency (71%). No BCG‐induced deaths were reported.

Conclusion TUR with intravesical BCG provides a significantly better prophylaxis of tumour recurrence in Ta and T1 bladder cancer than TUR alone. Randomized trials are still needed to address the issues of BCG strain, dose and schedule, and to better quantify the effect on progression to invasive disease.
Treatment of primary monosymptomatic nocturnal enuresis with desmopressin: predictive factors
Authors: Kruse S. , Hellström A.L. , Hanson E. , Hjälmås K. , Sillén U.
Published: March 2003

Objective To investigate predictive factors for the outcome of treatment of primary monosymptomatic nocturnal enuresis (PMNE) with desmopressin.

Patients and methods Data from a large open multicentre study were analysed. The study comprised 399 children with PMNE who were recruited for long‐term desmopressin treatment. Before treatment a history was taken and the children observed for 4 weeks. After a 6‐week dose‐titration period with desmopressin, the children were classified into four groups depending on the response rate.

Results The children who improved during desmopressin treatment were older, had fewer wet nights during the observation period and had only one wet episode during the night, mostly after midnight. Many of them did not require the maximum dose of desmopressin to become dry. No hereditary factor for the response to desmopressin was found.

Conclusion Those most likely to be permanently dry with desmopressin treatment are older children who respond to 20 µg desmopressin and who do not wet frequently.
Capsaicin effectively prevents apoptosis in the contralateral testis after ipsilateral testicular torsion
Authors: Sarioglu‐Buke A. , Erdem S. , Gedikoglu G. , Bingol‐Kologlu M. , Tanyel F.C.
Published: March 2003

Objective To evaluate the effect of afferent nerve blockage by administration of capsaicin on apoptotic changes in the contralateral testis in rats undergoing ipsilateral testicular torsion.

Materials and methods Twenty male albino rats were randomly divided into four groups. In groups 1 and 2, rats underwent a sham operation and testicular torsion, respectively, after the intraperitoneal administration of 0.9% NaCl. Similarly, in groups 3 and 4 the rats underwent a sham operation and testicular torsion, respectively, after an intraperitoneal capsaicin injection. The testes were untwisted 24 h later and the contralateral testes harvested. Apoptosis was assessed in paraffin‐embedded sections stained for nuclear DNA fragmentation. Fifteen cells were counted in each seminiferous tubule and the apoptotic cells recorded. A score was calculated for each group and the results compared using the Kruskal‐Wallis analysis of variance and Mann Whitney U‐tests, with P < 0.05 considered to be significant.

Results The mean apoptotic score of group 2 was significantly higher than that of the other groups. There was no difference between the apoptotic scores of groups 1 and 3, 1 and 4, and 3 and 4.

Conclusion Capsaicin effectively prevented apoptosis in the contralateral testes of rats that had undergone testicular torsion.
Photodynamic therapy for superficial bladder cancer under local anaesthetic
Authors: Shackley D.C. , Briggs C. , Gilhooley A. , Whitehurst C. , O'Flynn K.J. , Betts C.D. , Moore J.V. , Clarke N.W.
Published: March 2003

Objectives To evaluate the use of local anaesthesia (LA) in 5‐aminolaevulinic acid (ALA) photodynamic therapy (PDT) for superficial transitional cell carcinoma (TCC) of the bladder, and to provide further toxicity and tolerability data on this new method within the context of a phase 1 trial.

Patients and methods ALA PDT was administered to 19 patients with recurrent superficial TCC (stage Ta/carcinoma in situ, grades 1–3) using escalating doses of ALA (3–6%) and 633 nm laser light (25–50 J/cm2) under various LA (lignocaine) protocols. Pain was assessed using a linear analogue scale from 0 to 10. The endpoints of tolerability and toxicity were assessed for the different LA, light and ALA doses, with lignocaine levels.

Results ALA PDT is painful and requires some form of anaesthesia. The discomfort was immediate, associated with bladder spasm, and was a function of the ALA concentration rather than the total light dose given. Simple passive diffusion (PD) of 2% lignocaine instilled for 40 min before PDT gave adequate anaesthesia with 3% ALA (n=8; median pain score 1, range 0–2). With 6% ALA the pain was dramatically increased using PD (n=6; median pain score 8, range 5–10) and therefore the more potent LA technique of electromotive drug administration (EMDA) of 2% lignocaine was used, with excellent results (n=3; median pain score 1, range 0–2). All patients had transient bladder irritability that typically lasted 9–12 days, with no subjective/objective change in long‐term bladder function. No other toxicity was reported. Serum lignocaine levels were minimal.

Conclusion Bladder ALA PDT is both safe and feasible under LA. At a dose of 3% ALA, the procedure was well‐tolerated using PD of lignocaine. At higher doses (6% ALA) more effective anaesthesia is required and this can be obtained satisfactorily with EMDA of lignocaine. With refinement, ALA PDT may be feasible as an outpatient treatment for superficial bladder TCC.
A preliminary report on a patient‐preference study to compare treatment options in early prostate cancer
Authors: Uro‐oncology Group The North West
Published: March 2003

Objectives To prospectively record prognostic factors, quality‐of‐life and outcome data in a patient‐preference controlled study comparing radical prostatectomy with radical radiotherapy for the treatment of early prostate cancer.

Patients and methods All patients suitable for radical treatment of early prostate cancer were identified and provided with information from a urologist, oncologist and nurse to allow them to choose a treatment option. Prognostic and demographic data were recorded for all patients and patients followed up uniformly, with the additional collection of quality‐of‐life data.

Results In a 38‐month period, 196 patients were recruited to the trial; of these, 81 chose surgery, 81 radiotherapy, 30 brachytherapy and four ‘watchful waiting’. The distribution of acknowledged prognostic factors was similar between the groups.

Conclusion If patient preference continues to divide this population into roughly equal and comparable arms, it should be possible to answer the underlying questions on the treatment of early prostate cancer using this study design.
The quality of life in men after radical cystectomy with a continent cutaneous diversion or orthotopic bladder substitution: is there a difference?
Authors: Månsson Å. , Davidsson T. , Hunt S. , Månsson W.
Published: March 2003

Objective  To compare the quality of life (QoL) in men after radical cystectomy who had either a continent cutaneous diversion or orthotopic bladder substitution.

Patients and methods  Eighty men with at least 6 months of follow‐up and with no signs of recurrent disease after radical cystectomy for bladder carcinoma, and who had either a continent cutaneous diversion or orthotopic bladder substitution, were sent two types of questionnaire, the Functional Assessment of Cancer Therapy–Bladder Cancer (FACT‐Bl) and the Hospital Anxiety and Depression Scale (HADS), to determine their QoL.

Results

 The FACT‐Bl and HADS questionnaires were returned by 90% and 71% of the patients, respectively (
P

 < 0.05). In the replies to the generic version of FACT‐Bl there were no differences between the groups in any domain, the scores being high in all. In questions covering intestinal, urinary and sexual items, patients with continent diversion had less trouble controlling urine (
P

 < 0.0001), had to empty less often (
P

 < 0.001), and had fewer symptoms when emptying (
P

 < 0.05). Patients with neobladders had a better appreciation of appearance and better preserved erectile function (both
P  < 0.05). In the answers to the HADS, the mean scores were low (within the normal ranges) and did not differ between the groups.

Conclusion  Using two instruments tested for validity and reliability, there were no differences between patients with continent diversion and those with orthotopic substitution.
Effects of dimethyl sulphoxide and heparin on stretch‐activated ATP release by bladder urothelial cells from patients with interstitial cystitis
Authors: Sun Y. , Chai T.C.
Published: March 2003

Objective  To determine whether dimethyl sulphoxide (DMSO) and heparin reduce the greater stretch‐activated ATP release in interstitial cystitis (IC), as ATP serves as a nocio‐neurotransmitter in the bladder, and thus explain their beneficial effects in patients with IC (a disease characterized by hypersensory bladder symptoms).

Materials and methods  Bladder epithelia in IC release more ATP in response to stretch than do control samples. Both DMSO and heparin are used intravesically to treat IC; such agents can modulate urothelial function because they directly contact bladder urothelium. Biopsies taken from patients with IC and from control subjects were grown in primary cultures using established cell‐culture techniques. Cultured urothelial cells were stretched with the Flexcell device (Flexcell International Corp., McKeesport, PA, USA) and supernatant ATP was measured, using a luciferin‐luciferase assay. DMSO (0.1%, 0.5% and 1%) or heparin (50, 200, 800 and 1600 U) was added to the cells at the start of the stretch experiments and the ATP released into the supernatant measured. Cell viability was also determined using Trypan Blue staining.

Results  IC cells released significantly more ATP in response to stretch than did control cells. This increased release of ATP by stretched IC cells was significantly blocked by adding DMSO or heparin at all concentrations used. Heparin appeared to have a greater dose‐dependent effect on ATP release than did DMSO.

Conclusions  These findings are consistent with the hypothesis that the urothelium provides sensory input via ATP release and that this process is increased in IC. Furthermore, stretch‐activated ATP release was blocked by adding DMSO and heparin, both intravesical agents commonly used to treat the symptoms of IC. This study supports the notion that purinergic‐targeted therapy is warranted in treating IC. Further studies are needed to determine the mechanisms of increased ATP release by IC urothelial cells.
Magnesium status of patients with renal stones and its effect on urinary citrate excretion
Authors: Reungjui S. , Prasongwatana V. , Premgamone A. , Tosukhowong P. , Jirakulsomchok S. , Sriboonlue P.
Published: March 2003

Objectives  To assess the magnesium status and its effect on urinary citrate excretion in patients with renal stones, as they have a low muscular magnesium content.

Patients, subjects and methods  Using a magnesium‐tolerance test (0.1 mmol/L MgSO4/kg body weight, delivered intravenously), the magnesium status was assessed in 17 patients with renal stones from rural North‐east Thailand, and in three groups of normal subjects from different environments (i.e. 17 from rural Central Thailand, 16 from urban and 14 from rural North‐east Thailand). Participants with magnesium deficiency (magnesium retention > 50%) were supplemented with 300 mg chelated magnesium daily for 1 month and reassessed. Their urinary citrate excretion was also measured before and after supplementation.

Results  Nine of the patients with renal stones were magnesium deficient, as were six normal subjects from the same area, whereas only one and two of the rural Central and urban North‐east Thais had magnesium deficiency. The magnesium status of the 13 deficient subjects significantly improved (P = 0.003) after supplementation with chelated magnesium. The supplement also caused a significant increase in mean (sd) urinary citrate excretion, from 237.7 (173.1) to 361.3 (284.1) mg/day (P= 0.012).

Conclusions  These results indicate that magnesium deficiency is common among patients with renal stones in rural North‐east Thailand, and that the probable cause is environmental. The increase in urinary citrate excretion after magnesium supplementation suggests that magnesium is important in renal stone formation, through its effect on citrate metabolism.
Long‐term efficacy and safety results of the two‐stage implantation technique in sacral neuromodulation
Authors: Scheepens W.A. , Van Koeveringe G.A. , De Bie R.A. , Weil E.H.J. , Van Kerrebroeck Ph.E.V.
Published: March 2003

Objective  To assess the long‐term efficacy and safety of two‐stage sacral neuromodulation with an implantable pulse generator (IPG) in patients treated for urinary urge incontinence (UI) and/or urinary retention (UR).

Patients and methods  The two‐stage technique is used if patients have a good response during the acute phase of the percutaneous nerve evaluation (PNE) test, but have a poor response during the following 4–7 days (subchronic phase). In the first stage only the permanent electrode was implanted and connected to a temporary external stimulator, allowing patients to be assessed for longer. If the main symptoms improved by more than half the patient proceeded to the second stage, the insertion of the IPG. We reviewed all patients who underwent two‐stage implantation; all had signed an informed consent and were asked to complete voiding diaries and a questionnaire to assess the subjective effects of the therapy. Safety was assessed from relevant medical events, management, and relative to the thera‐py and resolution. Residual urine was assessed by self‐catheterization. The long‐term voiding diary results were compared with baseline estimates and analysed statistically using the two‐sided Student's t‐test.

Results  Between 1991 and 1998, 15 patients (13 women and two men, mean age 53 years, range 44–66) underwent the two‐stage technique; the mean (median, range) follow‐up was 4.9 (5.2, 2.5–7.5) years. Seven patients had UI and seven had UR, with one having both. The mean (range) number of PNEs undertaken in each patient was 2.1 (1–4) and these all failed in the subchronic phase. All patients underwent a first‐ and second‐stage implant after a mean (range) screening period of 12.2 (2–29) days. One patient was explanted after implantation of only the first stage, and two others explanted in a later phase because the IPG was ineffective during the follow‐up. The voiding diary results of the remaining 12 patients showed improvement in all the main variables, and in the subjective assessment 11 reported an improvement and were satisfied with the therapy. There were 17 adverse events, 14 of which were resolved and seven of which required surgical intervention.

Conclusion  The long‐term results of the two‐stage implantation show clinically and statistically significant improvements, probably because the implantation of the lead (first stage) more closely resembles the final therapy. If a temporary PNE test is not optimal (lead migration, longer testing needed), the two‐stage technique can offer a good and safe alternative of comparable efficacy in the long‐term. If the two‐stage technique had not been available to these 12 patients they would not have been offered neuromodulation.
Virtual reality flexible cystoscopy: a validation study
Authors: Shah J. , Darzi A.
Published: March 2003

Objectives  To validate a flexible cystoscopy simulator by determining if it could differentiate between expert and novice cystoscopists.

Subjects and methods  Seventeen subjects (10 novices with no previous endoscopic experience and seven urologists who had all carried out > 1000 flexible cystoscopies each) were asked to undertake a flexible cystoscopy task on the URO Mentor (Simbionix, Israel) virtual reality (VR) machine. In the task used the bladder mucosa has 10 flags (numbered 1–10) at key positions in the bladder; by visualizing each of the 10 flags and photographing them the subject will have indirectly visualized the entire mucosa. Subjects were asked to carry out the task 10 times, to allow their rate of acquisition of skill to be assessed. The total time taken for the task and the number of flags visualized were used as measures of performance.

Results  The experienced urologists were significantly better at flexible cystoscopy than the medical students on the first trial for the mean number of flags seen (9.57 vs 8.0, P = 0.01) and the mean time to complete the task (2.33 vs 4.89 min, P = 0.03). At the 10th trial there was still a significant difference for the time taken, between the medical students and the urologists (2.33 vs 0.81 min, P = 0.01) but not for the number of flags seen (9.2 vs 9.6, P = 0.46). The medical students improved between the first and the 10th attempt, being significantly quicker for trial 10 than trial 1 (P = 0.005). However, although the medical students appeared to see more flags (8.0 vs 9.2) this was not significant (P = 0.05). The urologists did not differ in the number of flags visualized between the first and 10th trial, although they were significantly quicker in completing the task (P = 0.02). The urologists were significantly faster in trial 2 than trial 1, but no faster thereafter (P = 0.04).

Conclusions  Using the URO Mentor simulator, it was possible to assess the level of experience of flexible cystoscopy, and therefore the system has construct validity. As in the real situation there is a period of learning during which the subject becomes familiar with the computer/machine/human interface, the task and the handling of the instruments. These results support the view that there is a role for VR simulators in urological training.
Posterior urethral injuries and the Mitrofanoff principle in children
Authors: Freitas Filho L.G. , Carnevale J. , Melo Filho A.R. , Vicente N.C. , Heinisch A.C. , Martins J.L.
Published: March 2003

OBJECTIVE

To report our experience of children with trauma causing posterior urethral injury who at some stage underwent a Mitrofanoff intervention, as post‐traumatic urethral injuries can demand long‐term treatment which (regardless of the surgical intervention) requires a period of dilatation of the reconstructed urethra.

PATIENTS AND METHODS

From 1992 to 2001, 14 patients with urethral injuries underwent a Mitrofanoff procedure. Thirteen had been run over by a motor vehicle and had severe hip injuries, and one had a direct non‐penetrating perineal impact lesion (13 boys and one girl, aged 2–13 years at the time of the accident). In all cases the Mitrofanoff procedure involved interposing the appendix between the bladder and the umbilicus. Only one of the children (because of extremely high bladder filling pressures) also underwent an augmentation cystoplasty and closure of the bladder neck because there were bony fragments in the urethra.

RESULTS

The Mitrofanoff technique was considered useful in most cases. All patients during a given period used the Mitrofanoff conduit to empty their bladder every 3 h; 10 of the 14 are currently voiding urethrally, with an adequate flow, and four are not, but emptying the bladder periodically via the appendicovesicostomy. The only girl in the group has a major hip deformity and is unlikely to undergo urethroplasty; two patients are expecting definitive treatment and the other, although having a patent urethra, has no urinary flow. He is currently 19 years old and has no erections.

CONCLUSIONS

The treatment of posterior urethral injuries represents a challenge to surgical teams. Although primary suturing of the separated urethral ends is accepted as the best treatment, the construction of a temporary continent urinary diversion may be considered in the most severe cases.
Spontaneous tibial compartment syndrome in Type 1 diabetes mellitus
Authors: Smith A. L. , Laing P. W.
Published: March 2003

We present a case of a patient with Type 1 diabetes mellitus (DM) who spontaneously developed severe bilateral anterior tibial compartment syndromes which required extensive surgical treatment. While infarction of skeletal muscle in Type 1 DM remains rare and usually affects the larger compartments of the thigh, this diagnosis must be entertained in any patient presenting with acute leg pain. If a patient displays any features of acute compartment syndrome, prompt fasciotomy must be undertaken.

Diabet. Med. 16, 168–169 (1999)
Troglitazone in combination with sulphonylurea improves glycaemic control in Type 2 diabetic patients inadequately controlled by sulphonylurea therapy alone
Authors: Buysschaert M. , Bobbioni E. , Starkie M. , Frith L. , Group For The Troglitazone Study
Published: March 2003

Aim The aim of this study was to investigate the effectiveness of troglitazone (a peroxisome proliferator‐activated receptor‐γ agonist developed primarily for the treatment of Type 2 diabetes mellitus (DM)), 100 or 200 mg/day, in terms of glycaemic control, lipid profile and tolerability, when given in addition to existing sulphonylurea therapy.

Methods A 16‐week, randomized, parallel‐group placebo‐controlled trial in 259 Type 2 diabetic patients already on sulphonylurea therapy.

Results At week 16, adjusted geometric mean HbA1c with troglitazone 100 mg (7.7%; P = 0.023) and 200 mg (7.4%; P < 0.001) was lower with sulphonylurea alone (8.2%). At all weeks, adjusted geometric mean fasting serum glucose levels were lower in both troglitazone groups, compared with sulphonylurea alone (P = 0.007 to P < 0.001). At week 16, both troglitazone groups showed reductions in immune reactive insulin compared with sulphonylurea alone (200 mg, 13%; P = 0.032: 100 mg, 5%; NS). Troglitazone reduced serum levels of nonesterified fatty acids at week 16 (100 mg, 12%; P = 0.042) and at all weeks (200 mg, 17–24%; P = 0.014 to P < 0.001). The incidence of drug‐related adverse events was similar in all groups (23–24% of patients). There was no apparent association between hypoglycaemia and the addition of troglitazone to sulphonylurea therapy.

Conclusions Troglitazone 100 or 200 mg added to usual sulphonylurea therapy in patients with Type 2 DM is associated with a significant improvement in glycaemic control, without altering the adverse‐event profile of the sulphonylurea.

Diabet. Med. 16, 147–153 (1999)
A population‐based survey of frequencies of self‐reported spontaneous and induced abortions in Danish women with Type 1 diabetes mellitus
Authors: Lorenzen T. , Pociot F. , Johannesen J. , Kristiansen O. P. , Nerup J. , Epidemiology The Danish IddM. , Group Genetics
Published: March 2003

Aims Whether pregnant women with Type 1 diabetes mellitus (Type 1 DM) have an increased risk of abortions is controversial. The aim of the present Danish population‐based study of 33% of the Danish population was to describe the pattern of self‐reported miscarriage and stillbirths from 1304 women with Type 1 DM.

Methods Data were obtained by questionnaire. The current age of the women was 20–65 years and their age at diabetes onset was 30 years or less.

Results The frequency of spontaneous abortions (SA) and induced abortions (IA) reported from women diagnosed with Type 1 DM prior to pregnancy was 17.5% (95% CI 15.5–19.9%) and 18.0%. (95% CI 16.0–20.0%), respectively. No significant differences in abortion frequencies before or after 1980 were reported. Previous findings of a decreasing stillbirth‐rate in diabetic pregnancies during the last decades were supported.

Conclusions The reported SA frequency of 17.5% (95% CI 15.5–19.9%) in pregnant women with Type 1 DM is higher than previously reported SA rates of 10–12% in Danish nondiabetic women and the SA rate is more than twice the SA rate found in a previous Danish study from a highly specialized obstetrical centre for diabetic women. These data suggest an urgent need for further improvement in the general management of Danish pregnant women with Type 1 DM.
Contra‐indications to metformin therapy are largely disregarded
Authors: Holstein A. , Nahrwold D. , Hinze S. , Egberts E. ‐H.
Published: March 2003

Aims To investigate the current metformin treatment practice and in particular to examine the consideration given to its contraindications.

Methods A cross‐sectional analysis of 308 consecutive Type 2 diabetic patients (mean age 66 ± 11.3 years) previously treated with metformin on an outpatient basis and admitted to a German general hospital during the period from 1 January 1995 to 31 May 1998 because of acute disease or in order to optimize their diabetes management. All patients underwent a basic investigation comprising a documentation of their medical history, a physical examination, an electrocardiogram, and an extensive laboratory profile; 34% also had acute coronary angiography.

Results On admission to hospital, 73% of the patients were found to have contra‐indications, risk factors, or intercurrent illnesses necessitating discontinuation of metformin; 51% of these patients had several of these conditions. As major contra‐indications to metformin, renal impairment was present in 19% of all patients, heart failure in 25%, respiratory insufficiency in 6.5%, and hepatic impairment in 1.3%. The risk factors to metformin included advanced coronary heart disease in 51%, atrial fibrillation in 9.8%, chronic alcohol abuse in 3.3%, advanced peripheral vascular disease in 2%, and pregnancy in 0.7%. As intercurrent illnesses, cerebral ischaemia occurred in 9.8% under metformin treatment and malignancies were diagnosed in 6.5%. The patients with contra‐indications or requiring caution to metformin were significantly older and had previously been treated with more cardiovascular medication than those without such reservations (P < 0.001).

Conclusions Despite the considerable risk of lactic acidosis in the majority of patients, no cases were observed.
Metformin treatment leads to an increase in basal, but not insulin‐stimulated, glucose disposal in obese patients with impaired glucose tolerance
Authors: Morel Y. , Golay A. , Perneger T. , Lehmann T. , Vadas L. , Pasik C. , Reaven G. M.
Published: March 2003

Aims This study was initiated to test the hypothesis that metformin treatment leads to enhanced glucose disposal at ambient insulin concentrations.

Methods Nineteen obese patients with impaired glucose tolerance (IGT) were treated with either metformin or placebo in a randomized, double‐blind, placebo‐controlled, cross‐over study. Insulin secretion and insulin resistance were quantified using the homeostasis model assessment (HOMA) and insulin‐stimulated glucose disposal were measured by determining the steady‐state plasma glucose (SSPG).

Results The average benefit of metformin was 0.6 mmol/l for glucose (95% confidence interval (CI) 0.2–0.9 P = 0.002), 2.8 pmol/l for insulin (95% CI 0.2–5.4, P = 0.019). Insulin resistance, as quantified by HOMA, was improved by 1.1 (95% CI 0.2–2.0, P = 0.004), without any change in insulin secretion. Basal and insulin‐stimulated glucose oxidation were comparable in the placebo and metformin‐treated groups at the end of each treatment period, as was the SSPG concentration. However, both systolic and diastolic blood pressures fell significantly following metformin administration as compared to treatment with placebo.

Conclusions These results indicate that metformin administration to patients with IGT is associated with enhanced glucose disposal at baseline insulin concentrations and a fall in blood pressure. In contrast, neither glucose oxidation nor glucose disposal were increased in association with metformin treatment under conditions of physiological hyperinsulinaemia.
Endothelial dysfunction in Type 1 diabetes mellitus: relationship with LDL oxidation and the effects of vitamin E
Authors: Pinkney J. H. , Downs L. , Hopton M. , Mackness M. I. , Bolton C. H.
Published: March 2003

Aims To examine the hypothesis that increased susceptibility of low density lipoproteins (LDL) to oxidation predisposes to endothelial dysfunction in patients with Type 1 diabetes mellitus.

Methods A cross‐sectional study of 46 non‐nephropathic diabetic and 39 control subjects and in the diabetic patients, a 3‐month duration, randomized, placebo‐controlled double‐blind trial of vitamin E 500 U/day. Flow‐mediated vasodilatation (FMD) was measured in the forearm by high resolution ultrasound. LDL oxidation by Cu2 +  was measured in vitro.

Results Diabetic patients had greater basal and reactive forearm blood flow (geometric mean (
sd%) flow (ml/min) 110.15 (19.19%) vs. 74.99 (23.17%); P=  0.045, and 344.35 (20.84%) vs. 205.17 (21.48%); P=  0.007), compared with controls, but there was no difference in FMD (median (interquartile range) 0.00 ( − 0.01–0.02) vs. 0.02 ( − 0.01–0.02) cm2; P=  0.78). Diabetic LDL oxidation lag time correlated with postdilatation brachial artery area (r=  0.32; P=  0.05) but not with FMD. Lag‐times and total LDL oxidation by Cu2 + , lipoprotein and vitamin E concentrations were similar in diabetic and control groups. Antibody titres to oxidized LDL (oxLDL) were higher in non‐diabetic than diabetic subjects, and were unrelated to FMD. In diabetic patients, vitamin E increased mean (
sd) plasma vitamin E levels (24.0 (6.5) to 47.5 (7.5) μmol/l; P=  0.0006) and resulted in increased FMD (Δ 0.00 ( − 0.02–0.01) vs. 0.01 (0.01–0.02)) cm2; P=  0.0036), but no changes in LDL Cu2 +  oxidation profiles were observed.

Conclusions FMD is no different in Type 1 diabetic and non‐diabetic subjects and nor are indices of lipid peroxidation and in vitro LDL oxidation although levels of antibody to oxLDL are lower in diabetes. Vitamin E supplementation increases plasma vitamin E levels and may enhance FMD in diabetes but, in the absence of changes in LDL oxidation, this may not be mediated by reduced oxidation of LDL.
Macular oedema with associated uveitis and cataract following presentation of Type 1 diabetes mellitus in severe ketoacidosis
Authors: Gordon D. , Browne B. H.
Published: March 2003

We present a case of cystoid macular oedema presenting in a newly diagnosed diabetic teenager. She had developed anterior uveitis prior to diabetes and whether this contributed to the subsequent ocular complications remains speculative. The macular changes resolved spontaneously over 6 months without the use of grid laser photocoagulation.
Screening for Type 2 diabetes mellitus: a decision analytic approach
Authors: Goyder E. C. , Irwig L. M.
Published: March 2003

Aims Screening for asymptomatic Type 2 diabetes mellitus has been advocated on the grounds that diabetes is a common condition associated with increased morbidity and mortality, but uncertainty remains about the impact of early treatment. This study aimed to determine whether the potential benefits of screening are likely to outweigh the potential harm and to explore which variables significantly influence the balance of benefit and harm resulting from screening.

Methods A decision analysis comparing the relative impact of using a single fasting blood glucose screening test, between the ages of 45 and 60 years, with the impact of not screening. The model weighs the increase in quality adjusted life years (QALYs) from reduction in microvascular and cardiovascular complications against the potential decrease in QALYs associated with earlier diagnosis and treatment in an asymptomatic population.

Results The baseline model suggests a saving of 10 QALYs for every 10 000 individuals screened: a gain of four from postponed microvascular complications and 17 from avoided cardiovascular complications, as opposed to a loss of 11 as a result of earlier diagnosis in screening detected cases. The balance of benefit and harm is sensitive to baseline cardiovascular risk, the effectiveness of cardiovascular interventions and the relative disutility assigned to early diagnosis and treatment for an individual without symptoms.

Conclusions The immediate disutility of earlier diagnosis and additional treatment may be greater than the potential long‐term benefit from postponing microvascular complications. Screening decisions should therefore be based largely on consideration of cardiovascular risk and the availability of evidence based interventions to reduce cardiovascular risk.
Socio‐economic status, obesity and prevalence of Type 1 and Type 2 diabetes mellitus
Authors: Evans J. M. M. , Newton R. W. , Ruta D. A. , MacDonald T. M. , Morris A. D.
Published: March 2003

Aims  The influence of socio‐economic status on the prevalence of Type 1 and Type 2 diabetes mellitus, and on obesity, was explored using routinely collected healthcare data for the population of Tayside, Scotland.

Methods  Among 366 849 Tayside residents, 792 and 5474 patients with Type 1 and Type 2 diabetes, respectively, were identified from a diabetes register. The Carstairs Score was used as a proxy for socio‐economic status. This is a material deprivation measure derived from the UK census, using postcode data for four key variables. Odds ratios for diabetes prevalence, adjusted for age, were determined for each of six deprivation categories (1 – least deprived, 6/7 – most deprived). The mean body mass index (BMI) in each group was also determined, and the effect of deprivation category explored by analysis of covariance, adjusting for age and sex.

Results
 The prevalence of Type 2 diabetes, but not Type 1 diabetes, varied by deprivation. People in deprivation category 6 and 7 were 1.6‐times (95% confidence interval 1.4–1.8) more likely to have Type 2 diabetes than those least deprived. There was no relationship between deprivation and BMI in Type 1 diabetes (P = 0.36), but there was an increase in BMI with increasing deprivation in Type 2 diabetes (P < 0.001; test of linearity P < 0.001).

Conclusions  The study confirms the relationship between deprivation and the prevalence of Type 2 diabetes. There are more obese, diabetic patients in deprived areas. They require more targeted resources and more primary prevention.
Joint liaison psychiatry–diabetes clinic: a new specialist service
Authors: Mitchell C. , Catalan J. , McIntosh C. , Feher M. D.
Published: March 2003

Aims  Specialist diabetes clinics have an established role in prevention and management of complications. As psychological problems are usually treated separately from diabetes centres, the role of a specialist psychiatrist within a teaching hospital was assessed. The aims of the study were to describe referral patterns, specific psychiatric conditions and treatments offered.

Results  During weekly outpatient sessions over a 12‐month period, 31 patients were referred with a wide range of psychiatric diagnoses. One‐third of patients were seen on the day and two‐thirds within 2 weeks of referral. Treatments included anti‐depressant medication, counselling and cognitive behaviour therapy. Successful discharge was obtained in 10 subjects and eight were undergoing continued treatment.

Conclusions  The range of specific diagnoses requiring psychiatric supervision supported the role of specifically trained personnel as seen in a joint liaison psychiatry–diabetes service.

Keywords diabetes mellitus, joint clinic, liaison psychiatry
Adaptation of the Diabetes Health Profile (DHP‐1) for use with patients with Type 2 diabetes mellitus: psychometric evaluation and cross‐cultural comparison
Authors: Meadows K. A. , Abrams C. , Sandbæk A.
Published: March 2003

SUMMARY

Aims  To adapt the Diabetes Health Profile (DHP‐1) for use with English speaking patients with Type 2 diabetes mellitus and to evaluate the psychometric properties of the adapted measure in a UK and Danish sample of insulin, tablet and diet‐treated patients with Type 2 diabetes.

Methods  Following linguistic adaptation using the forward–backward translation procedure, the 32‐item DHP‐1 was sent to 650 and 800 consecutively selected UK and Danish patients with Type 2 diabetes. Construct validity was assessed using principal axis factoring. Factor stability was assessed across language groups using the coefficient of congruence. Reliability was evaluated using Cronbach's alpha and multi‐trait analysis, including item convergent/discriminant validity. Subscale discriminant validity was assessed through known groups with one‐way
anova and post hoc Scheffe tests for multiple comparisons.

Results  Eighteen items (56.25%) were retained following initial item analysis. A three‐factor solution accounting for 45.6% and 40.3% of the total explained variance was identified in the UK and Danish samples, respectively. Factors were interpreted as psychological distress (PD), barriers to activity (BA) and disinhibited eating (DE). Factor congruence between language groups ranged from 0.98 to 0.99 and Cronbach's alpha ranged between 0.70 and 0.88. Item scaling success for both language versions was 88.9%. BA scores discriminated between treatment groups in both language groups (F = 24.24, P < 0.001; F = 7.68, P < 0.001) and PD scores in the UK sample (F = 20.97, P < 0.001).

Conclusions  The DHP‐18 developed for use with patients with Type 2 diabetes has been shown to have satisfactory internal reliability and validity and measurement equivalence across language groups.