bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of l‐arginine on the kidney levels of malondialdehyde in rats submitted to renal ischaemia‐reperfusion
Authors: Rhoden E.L. , Lucas M.L. , Pereira‐Lima L. , Rhoden C.R. , Souto C.A.V.
Published: March 2003

Objective To evaluate the effects of l‐arginine, a nitric oxide donor, on kidney levels of malondialdehyde (MDA, a product of cellular lipid peroxidation), serum creatinine levels, and urinary volume in rats undergoing unilateral renal ischaemia‐reperfusion.

Materials and methods Wistar rats (117) were randomly distributed into three experimental groups (of four subgroups each) in which were assessed renal cell‐lipid peroxidation (kidney levels of MDA), serum creatinine levels and urinary volume. The rats underwent unilateral nephrectomy followed by contralateral renal ischaemia‐reperfusion with or with no pretreatment with l‐arginine (200 mg/kg) given intraperitoneally.

Results Pretreatment with l‐arginine caused significantly higher kidney levels of MDA than in the untreated group (P < 0.05). Furthermore, l‐arginine given before surgery attenuated the increase in serum creatinine and significantly increased urinary volume in rats subjected to renal ischaemia‐reperfusion (P < 0.05).

Conclusion
l‐arginine tended to be of benefit for renal function during renal ischaemia‐reperfusion in rats. Pretreatment with l‐arginine (200 mg/kg intraperitoneally) seems to increase the renal damage by increasing kidney levels of MDA.
Discordant performance of assays for free and total prostate‐specific antigen in relation to the early detection of prostate cancer
Authors: Blijenberg B.G. , Yurdakul G. , Van Zelst B.D. , Bangma C.H. , Wildhagen M.F. , Schröder F.H.
Published: March 2003

Objective To assess the value of applying rigid threshold values in interpreting prostate specific antigen (PSA) results, by selecting and comparing five current methods for measuring free and total PSA.

Materials and methods Samples taken from an ongoing screening study for prostate cancer (total PSA by Tandem‐E assay, 17 334 participants; biopsy criterion a PSA of 3.0 µg/L, 4 464 men) from men with a total PSA of 1.0–6.0 µg/L were measured for free and total PSA using the Access, Immulite, Elecsys and Prostatus analysis kits, in two patient groups, i.e. with prostate cancer or no evidence of disease.

Results Both patient groups had equal means for total PSA but not for free PSA. In all, 360 samples from men with cancer and 96 from men with no evidence of disease were analysed. All methods applied to both groups deviated statistically significantly from the Tandem‐E result for total PSA, except for the Access kit. There was a close correlation among all the methods (correlation coefficients of 0.89–0.97). There were very discordant results for the combination of the Tandem‐E vs Prostatus (8% difference), representing 315 participants at a threshold of 3.0 µg/L. For free PSA (free/total PSA) the situation was worse, with extreme differences of 32% and 36% for both patient groups (Elecsys vs Access).

Conclusions Depending on the threshold value applied as an indication for biopsy, when using the total PSA alone or combined with the free/total PSA, care is needed in interpreting patient groups because of the discordance among PSA assays.
Sacral distribution of prostatic lymph nodes visualized on spiral computed tomography with three‐dimensional reconstruction
Authors: Brössner C. , Ringhofer H. , Schatzl G. , Madersbacher S. , Powischer G. , Kuber W.
Published: March 2003

Objective To evaluate the involvement of sacral lymph nodes in prostatic lymphatic drainage, using contemporary radiological imaging techniques.

Patients and methods The study included six patients (mean age 61.8 years, range 51–75) with suspected prostate cancer. First, an oil‐based contrast medium was injected into the prostate under transrectal ultrasonographic and fluoroscopic guidance, after which a standard ultrasound‐guided sextant biopsy was taken. Before injecting the contrast medium, and 20 min and 24 h thereafter, the patients underwent spiral computed tomography of the pelvic region with three‐dimensional reconstruction.

Results In all patients the prostate drained via the sacral lymphatic region. Compared with the iliac lymphatic drainage system, there were fewer and narrower sacral lymph nodes. Prostatic sacral lymph nodes were located at S2 to S5, with an emphasis on S3–4. Lymph nodes were detected as presacral and in the sacral foramen, suggesting a direct lymphatic connection to the bony pelvis.

Conclusion These results suggest that sacral prostatic lymphatics are a potential route of spread of prostate cancer cells.
Renal cell carcinoma may adapt to and overcome anti‐angiogenic intervention with thalidomide
Authors: Douglas M.L. , Reid J.L. , Hii S.I. , Jonsson J.R. , Nicol D.L.
Published: March 2003

Objective To report on the failure of thalidomide to inhibit tumour growth in an animal model of human renal cell carcinoma (RCC).

Materials and methods An orthotopic xenograft model of human RCC was used in which tumour cells were implanted in the left kidney of male ‘severe combined immunodeficient’ mice. Thalidomide was administered by intraperitoneal injection and after 34 days the mice were killed. The extent of tumour growth was compared in treated and untreated mice. Total RNA was extracted from both tumour‐affected and contralateral kidneys, and analysed by reverse transcription‐polymerase chain reaction for various genes implicated in angiogenesis and metastasis in RCC.

Results Thalidomide failed to inhibit the growth of xenograft tumours. The expression of angiogenic genes, e.g. vascular endothelial growth factor and fibroblast growth factor type 2 (FGF‐2) within normal and tumour‐affected kidney tissue was not reduced by thalidomide. Intratumoral transcription of β3‐integrin, a critical component of angiogenesis, was significantly increased in response to thalidomide treatment (P < 0.01). There was also a trend to increased expression of FGF‐2 and tumour necrosis factor‐α in thalidomide‐treated tumours.

Conclusions These findings suggest that RCC is capable of adapting to the inhibitory effects of thalidomide. The current uncertainty surrounding the action of thalidomide in vivo warrants caution about its use in humans. Further studies of thalidomide should be carried out in animal models, particularly to establish its safety and effectiveness as part of a combined therapeutic strategy.
Comparison of the bladder tumour antigen test with photodynamic diagnosis in patients with pathologically confirmed recurrent superficial urinary bladder tumours
Authors: Lipinski M. , Jeromin L.
Published: March 2003

Objective To verify the sensitivity of the bladder tumour antigen (BTAstat, Bard Urological, Covington, GA test against the sensitive procedure of photodynamic diagnosis (PDD), in which 5‐aminolaevulinic acid (5‐ALA, a precursor of fluorescent porphyrins) is absorbed by the tumour and detected by ultraviolet cystoscopy, in the early diagnosis of urinary bladder tumours.

Patients and methods Forty‐three patients (31 men and 12 women, age range 21–87 years) were assessed after transurethral resection of their bladder tumour using the BTAstat test and PDD. Sixty‐nine biopsies from suspect areas of bladder mucosa were taken during cystoscopy under ultraviolet light and all suspect lesions electrocoagulated.

Results Thirty‐five patients (81%) had a positive BTAstat test; in these patients PDD detected malignant lesions (17 Ta1G1–2, two T1G2, two T1G3 and 14 Tis). In eight patients (19%) the BTAstat was negative but PDD detected three malignant lesions (two Tis and one TaG1).

Conclusions PDD is valuable for detecting bladder malignancy and can identify small lesions not detected by the BTAstat test.
A new core‐biopsy instrument with an end‐cut technique provides prostate biopsies with increased tissue yield
Authors: Häggarth L. , Ekman P. , Egevad L.
Published: March 2003

Objective  To evaluate the tissue yield of a new core‐biopsy needle with an end‐cut mechanism when used for transrectal prostate biopsies.

Patients and methods  The end‐cut instrument has an adjustable stroke length (13, 23 or 33 mm) and an inner and an outer cannula, but no trocar. It was compared with the conventional side‐notch needle (Biopty, Bard, Covington, GA, USA) with trocar and fixed stroke length (22 mm). In 60 men, octant biopsies were taken including the apex, mid‐medial, mid‐lateral and basal positions. At random, the left side of the prostate was biopsied with one of the instruments and the right side with the other. The length and weight of the biopsy specimens were measured. In 40 men, the stroke length of the end‐cut instrument was set to 23 mm, and in 20 men it was set to 33 mm.

Results

 The weight and the weight per length of the biopsies provided by the end‐cut instrument with a stroke length of 23 mm were 18.4% and 13.7%, respectively, greater than in the biopsies from the side‐notch instrument (
P <0.001). In 21.9% of the attempts no tissue was obtained by the end‐cut needle, compared with 1.9% with the side‐notch needle. With a 33 mm stroke length, the length and weight of the end‐cut biopsies were 38.4% and 33.0%, respectively, greater than in biopsies from the side‐notch instrument.

Conclusion  The end‐cut instrument provided a greater tissue yield than the side‐notch needle, but a significant number of biopsies were lost.
Heat versus drugs in the treatment of benign prostatic hyperplasia
Authors: Djavan B. , Seitz C. , Marberger M.
Published: March 2003

The improvement in symptoms and voiding function is greater with transurethral microwave thermotherapy than with drug therapy, and the associated morbidity is low. Transient urinary retention necessitating catheterization is of short duration after targeted microwave thermotherapy. The short‐term effect of microwave thermotherapy can be improved by neoadjuvant and adjuvant α‐blockade. Microwave treatment offers greater versatility than drug therapy, allowing patients with severe baseline symptoms and small prostates to be treated successfully. Medical management improves symptoms to a more modest extent than does microwave treatment. Finasteride gives comparatively small symptom and flow rate improvements and requires several months for the maximum responses. With α‐blockers the onset of action is fast and side‐effects reversible, although they limit their utility. Finasteride or α‐blockers must be continued indefinitely to maintain improvements in patients with BPH, but they have a favourable safety and tolerability profile.
Simplified bladder training augments the effectiveness of tolterodine in patients with an overactive bladder
Authors: Mattiasson A. , Blaakaer J. , Høye K. , Wein A.J. ,   The Tolterodine Scandinavian Study Group
Published: March 2003

OBJECTIVES

To compare the efficacy of tolterodine plus simplified bladder training (BT) with tolterodine alone in patients with an overactive bladder.

PATIENTS AND METHODS

In a multicentre, single‐blind study at 51 Scandinavian centres, 505 patients aged ≥ 18 years with symptoms of urinary frequency (≥ 8 micturitions/24 h) and urgency, with or without urge incontinence, were randomized to oral treatment with either tolterodine 2 mg twice daily plus simplified BT or tolterodine alone. Changes in voiding diary variables were evaluated after 2, 12 and 24 weeks of treatment. The patients' perceptions of their bladder symptoms and tolerability (adverse events) were also determined.

RESULTS

In all, 501 patients (75% women) were evaluable on an intention‐to‐treat basis (244 on tolterodine + BT and 257 on tolterodine alone). Tolterodine significantly reduced the voiding frequency and increased the volume voided per void at all sample times; these effects were significantly increased by adding BT. At the end of the study the median percentage reduction in voiding frequency was greater with tolterodine + BT than with tolterodine alone (33% vs 25%, P < 0.001), while the median percentage increase in volume voided per void was 31% with tolterodine + BT and 20% with tolterodine alone (P < 0.001). There was a median of 81% fewer incontinence episodes than at baseline with tolterodine alone, which was not significantly different from that with tolterodine + BT (− 87%). The two groups had comparable median percentage reductions in urgency episodes. Some 76% of patients on tolterodine + BT reported an improvement in their bladder symptoms relative to baseline, compared with 71% on tolterodine alone. Tolterodine was well tolerated; the most common adverse event was mild dry mouth.

CONCLUSION

Tolterodine 2 mg twice daily is an effective and well tolerated treatment for an overactive bladder, the effectiveness of which can be augmented by a simplified BT regimen.
A posterior‐based omega‐shaped flap vaginoplasty in girls with congenital adrenal hyperplasia caused by 21‐hydroxylase deficiency
Authors: Freitas Filho L.G. , Carnevale J. , Melo C.E.R. , Laks M. , Calcagno Silva M.
Published: March 2003

OBJECTIVE

To describe a technical modification for constructing a vagina in girls with congenital adrenal hyperplasia caused by 21‐hydroxylase deficiency, using a narrower skin base but rich subcutaneous tissue, aiming to obtain both longer and larger vaginal segments with better cosmesis of the external genitalia.

PATIENTS AND METHODS

From August 1997 to February 2001, 28 girls (aged 5 months to 17 years) had a neovagina constructed using a posterior‐based omega‐shaped flap. Twenty‐six patients had a low vagina entering into the urogenital sinus and two had a high vagina that entered the urogenital sinus. In those with a high vagina the flap procedure was combined with the Passerini‐Glazel technique. All the patients were scheduled for vaginal ‘calibrations’ during the first year after surgery and, according to the result, would then undergo vaginal dilatation.

RESULTS

Six children were re‐operated; five had plastic surgery to correct genital folds that had regained a scrotal aspect, whereas one with a high vagina developed a urethral stricture, with urinary dribbling and infection, and had the urethra reconstructed. These six children are currently well. No hormone therapy was given to one child for 1 year who is scheduled for further surgery for a re‐virilized clitoris. Two patients were lost to follow‐up. Up to the last visit, 19 girls had not developed a vaginal stricture and the cosmesis of their external genitalia was deemed good.

CONCLUSION

The posterior‐based omega‐shaped flap enabled both the construction of wider vaginal segments with a low risk of developing stenosis in those with a low vagina, and increased vaginal dimension when associated with the Passerini‐Glazel technique for those with a high vagina. However, despite good cosmesis of the external genitalia, the follow‐up is too short to confirm whether this technique will meet all the expectations.
Rotoresect for bloodless transurethral resection of the prostate: a 4‐year follow‐up
Authors: Michel M.S. , Knoll T. , Trojan L. , Köhrmann K.U. , Alken P.
Published: March 2003

OBJECTIVE

To report the results and long‐term follow‐up of transurethral resection of the prostate (TURP) with a new resection device, the Rotoresect (Karl Storz, Tuttlingen, Germany).

PATIENTS AND METHODS

Most endoscopic resection techniques for benign prostatic tissue aim for high ablation rates and minimal bleeding. Available resection electrodes are effective, but cause high blood loss (loop electrode), or less bleeding but poorer ablation rates (electrovaporization). To resolve these conflicts the Rotoresect was developed in 1995; it consists of a specially designed rotating resection electrode, driven by a micromotor, and a high‐frequency current to enable simultaneous coagulation, vaporization and mechanical tissue removal during resection. To date, 84 patients with benign prostatic hyperplasia have had their prostate resected with this device (mean prostate size 46.0, sd 18.4 mL) and have been assessed for up to 4 years.

RESULTS

During resection there was very little bleeding, with no significant changes in haemoglobin or sodium levels. The mean (sd) duration of catheterization was 1.4 (1.1) days; the urinary peak flow rate was improved from 9.7 (3.2) to 24.2 (8.23) mL/s and the residual urine volume reduced from 187.3 (109.6) to 22.7 (19.5) mL. The International Prostate Symptom Score and quality‐of‐life index were both improved, from 24.0 (7.5) to 4.1 (2.7), and 4.2 (3.2) to 0.8 (0.9), respectively. Overall the results were stable during the 4 years of follow‐up.

CONCLUSION

The Rotoresect combines the advantages of standard resection (high ablation rate) by actively rotating the resection electrode, and the haemostatic effect of electrovaporization (minimal blood loss) by simultaneous tissue coagulation and vaporization.
High‐energy transurethral microwave thermotherapy: symptomatic vs urodynamic success
Authors: Osman Y. , Wadie B. , El‐Diasty T. , Larson T.
Published: March 2003

OBJECTIVE

To evaluate the subjective and objective treatment results of high‐energy transurethral microwave thermotherapy (TUMT) for symptomatic benign prostatic hyperplasia (BPH), and investigate the possible variables for predicting symptomatic and/or urodynamic success.

PATIENTS AND METHODS

Between October 1998 and October 2000, 40 men with BPH underwent high‐energy TUMT using the Targis device (Urologix, Inc., Minneapolis, MN, USA). Evaluation after treatment included a clinical determination of the symptom score, a urodynamic assessment by peak flow rate and pressure‐flow, magnetic resonance imaging (MRI), transrectal ultrasonography and endoscopy. The objective and subjective success was correlated with several variables before, during and after treatment.

RESULTS

All patients completed at least 1 year of follow‐up after TUMT as monotherapy. The symptom score improved from a median (range) of 20.5 (11–28) initially to 9 (0–28) (P < 0.001). Twenty‐two patients (55%) had a marked and 11 (28%) a moderate response, giving an overall subjective success rate of 83%. Similarly, there was a significant improvement in peak flow rate, from 9.2 (4.4–13.4) to 15 (3.3–22.9) mL/s (P < 0.001). Twenty‐one patients (53%) had a maximum flow rate of> 15 mL/s while in eight (20%) it was 10–15 mL/s. Only 20 patients changed from unobstructed on the pressure‐flow nomogram, i.e. an overall objective success rate of 50%. Gadolinium‐enhanced T1‐weighted MRI 1 week after treatment showed a median (range) perfusion defect of 20.7 (5.5–76.6)% of the total gland volume. Despite this persisting in all patients, a well‐defined cavity was apparent in only in seven (18%) at the final evaluation. Cystoscopy 1 month after therapy showed evidence of necrotic tissue occupying the prostatic fossa in all patients. Younger patients were more likely to be urodynamically successful, and a higher grade of obstruction predicted symptomatic success.

CONCLUSION

High‐energy TUMT can induce considerable necrosis of the prostate, as shown by MRI and cystoscopy. Although there was an adequate improvement in most patients' symptoms, there was a successful urodynamic change to unobstructed in only half the patients. Younger patients and those with a higher grade of obstruction were more likely to have urodynamic and symptomatic success, respectively.
The Audit Commission review of diabetes services in England and Wales, 1998–2001
Authors: Fitzsimons B. , Wilton L. , Lamont T. , McCulloch L. , Boyce J.
Published: March 2003

Aims of the Audit Commission The Audit Commission has a statutory duty to promote the best use of public money. It does this through value for money studies, such as that reported in Testing Times[1]. This work has been followed with a review of innovative practice in commissioning. These initiatives aim to support the implementation of the diabetes national service framework. The Audit Commission also appoints external auditors to NHS organizations who assess probity and value for money in the NHS; the latter by applying national studies locally and by carrying out local studies.

Methods Research for Testing Times consisted of structured visits to nine acute trusts, a telephone survey of 26 health authorities and a postal survey of 1400 people with diabetes and 250 general practitioners. Local audits used a subset of the original research tools. Case studies were identified through a cascade approach to contacts established during Testing Times and through self‐nomination.

Results Rising numbers of people with diabetes are placing increasing pressure on hospital services. Some health authorities and primary care organizations have reviewed patterns of service provision in the light of the increasing demands. These reviews show wide variations in patterns of routine care. In addition, there is a widespread lack of data on the delivery of structured care to people with diabetes. People with diabetes report delays in gaining access to services, and insufficient time with staff. There are insufficient arrangements in place for providing information and learning opportunities to support self‐management.

Conclusion As the number of people with diabetes continues to rise, the potential for providing more care in a primary care setting needs to be explored. This will enable specialist services to focus more effectively on those with the most complex needs.
Metformin‐associated lactic acidosis: a rare or very rare clinical entity?
Authors: Chan N. N. , Brain H. P. S. , Feher M. D.
Published: March 2003

Aims Lactic acidosis is a well recognized complication of biguanide therapy which is potentially serious. Although the prevalence of metformin‐associated lactic acidosis (MALA) is much lower than that associated with phenformin, it is still being reported sporadically which raises concerns for the practising clinicians. We review the currently available world‐wide data of the prevalence of MALA, the risk factors for its development and the current practical guidelines on the use of metformin to minimize the risk of this potential hazard.

Methods An extensive literature search was conducted from both Medline and Ovid (1965–98) using the following keywords: ‘Type 2 diabetes mellitus’, ‘oral hypoglycaemic drugs’, ‘biguanides’, ‘metformin‐associated lactic acidosis’ and ‘renal impairment’.

Results MALA was found to be a very rare clinical entity, being 20 times less common than phenformin‐associated lactic acidosis. Amongst all the risk factors, renal impairment appears to be the major precipitating factor for the development of MALA in metformin‐treated patients. We also found cases of MALA where no precipitating factors were identified and the underlying mechanism in these cases remains unclear. Practical recommendations of metformin use to minimize the risk of MALA have been listed based on previous reports.

Conclusions The low prevalence of MALA is comparable to the prevalence of sulphonylurea‐induced hypoglycaemia. Metformin has many beneficial metabolic effects in the management of Type 2 diabetes mellitus. Provided that the recommended guidelines for metformin use are strictly adhered to, its widespread use would be safe and the incidence of MALA will be further reduced.

Diabet. Med. 16, 273–281 (1999)
Denial of disease in Type 2 diabetes mellitus: its influence on metabolic control and associated factors
Authors: Garay‐Sevilla M. E. , Malacara J. M. , Gutiérrez‐Roa A. , González E.
Published: March 2003

Aims We have investigated denial of disease in patients with Type 2 diabetes mellitus (DM) and its possible association with metabolic control, and with psychosocial variables: satisfaction with medical care, perceived stress, social support, knowledge of diabetes and belief in conventional medicine.

Methods We studied 160 patients in a cross‐sectional design, in two groups: with (70) and without social security coverage (90). The mean age for the total group was 53.6 years, with a known diabetes duration of 8.1 years.

Results Denial of disease was similar in those with ≤ 5 years since diagnosis (73 patients) and with > 5 years (87). The group without social security had higher scores of perceived stress, and lower scores of social support, knowledge about diabetes and belief in conventional medicine; denial, however, was similar in the two groups with or without social security. Multiple regression analysis showed that denial of disease was positively associated with HbA1c in the total group (P < 0.001), in the groups with ≤ 5 and > 5 years since diagnosis, as well as in the groups with or without social security. Denial was also associated with years since diagnosis (P = 0.009) for the group with ≤ 5 years since diagnosis.

Conclusions We concluded that, in patients with Type 2 DM denial of disease increases with time during the first 5 years of evolution of diabetes; is associated with poor metabolic control; but is not associated with knowledge of diabetes, belief in conventional medicine, social support or perceived stress.

Diabet. Med. 16, 238–244 (1999)
Do diabetes clinic attendees stay out of hospital? A matched case–control study
Authors: Goyder E. C. , Spiers N. , McNally P. G. , Mdrucquer . , Botha J. L.
Published: March 2003

Aims To examine whether routine care for diabetes mellitus influences the risk of hospital admission.

Methods All people with diabetes in five randomly selected general practices in the city of Leicester were identified from medical records and prescribing information. Cases with a hospital admission between 1992 and 1995 but no admission in the preceding 2 years were compared with age‐matched controls in a nested study.

Results The variables significantly associated with an increased risk of admission were duration of diabetes in years (OR 1.07, 95% confidence interval (CI) 1.03–1.11) and number of non‐diabetic drugs prescribed (OR 1.51, 95% CI 1.27–1.79). Having attended a hospital clinic in the previous 2 years was associated with reduced risk of admission (OR 0.30, 95% CI 0.14–0.65), whilst having been seen for a diabetes review in general practice was not (OR 0.91, 95% CI 0.41–1.99). Similar results were found for both diabetes‐related and unrelated admissions.

Conclusions Although general practice‐based review was not associated with a change in the risk of admission, attendance at a hospital clinic was associated with a decreased risk of admission. These results may be explained by the characteristics of those who attend hospital clinics, as well as by the possible effectiveness of access to specialist services in reducing admissions.
Is glycation of low density lipoproteins in patients with Type 2 diabetes mellitus a LDL pre‐oxidative condition?
Authors: Moro E. , Alessandrini P. , Zambon C. , Pianetti S. , Pais M. , Cazzolato G. , Bon G. Bittolo
Published: March 2003

Aims The study aimed to evaluate whether low density lipoprotein (LDL) in diabetic patients is more glycated and susceptible to oxidation than in non‐diabetic subjects and investigated the hypothesis that LDL glycation is associated with an increased plasma concentration of LDL– (a circulating electronegatively charged LDL), proposed as an index of in vivo oxidation.

Methods LDL glycation was measured by a competitive enzyme immunoadsorbent assay, using a monoclonal antibody against glycated apoB in 24 Type 2 diabetic patients and 12 healthy controls. LDL– was separated by ion‐exchange HPLC in LDL samples obtained after sequential preparative ultracentrifugation (density range 1.019–1.063). In vitro LDL susceptibility to oxidation was evaluated by following the kinetics of conjugated diene formation and by measuring the lag‐phase time in the presence of copper (Cu2+) ions.

Results The percentages of glycated apoB (3.33 ± 2.54% vs. 1.24 ± 0.71%) and of LDL– (3.88  ± 1.49% vs. 2.34 ± 1.03%) in total LDL were significantly higher in diabetic patients (P < 0.01 for both). LDL– was positively correlated with glycated apoB (r = 0.68, P < 0.001). LDL isolated from Type 2 diabetic patients showed a significant decrease (P < 0.001) in the resistance to oxidative stress, as indicated by the shorter lag‐phase time (91 ± 12.6 vs. 120 ± 24.5 min). The lag‐phase time was inversely correlated with glycated apoB (r = –0.65, P < 0.001) and LDL– concentrations (r = –0.69, P < 0.001).

Conclusions In this population of Type 2 diabetic patients, LDL were more glycated, more susceptible to in vitro oxidation and had a higher percentage of electronegative LDL. The glycation of apoB is proposed to be associated with a significative increase of in vivo and in vitro LDL oxidation.
Insulin resistance alone does not explain the clustering of cardiovascular risk factors in southern India
Authors: Snehalatha C. , Sivasankari S. , Satyavani K. , Vijay V. , Ramachandran A.
Published: March 2003

Aims To determine whether insulin resistance (IR calculated using the HOMA model) has a dominant role in the clustering of cardiovascular risk factors in the Asian Indian population.

Methods A total of 654 non‐diabetic subjects aged ≥ 40 years (male 396: female 258) were selected from a population survey. They had estimates of fasting and 2 h plasma glucose, insulin levels, body mass index (BMI), waist‐to‐hip ratio (WHR) and blood pressure. Factor analysis was carried out using the principle components analysis (PCA) with varimax orthogonal rotation of continuously distributed variables, considered to represent the components of insulin resistance syndrome including the calculated IR.

Results There were three major clusters of cardiovascular disease (CVD) risk variables in men and four clusters in women. Insulin resistance, 2 h plasma glucose, insulin and obesity aggregated as the major domain. Insulin resistance was not linked with hypertension. BMI was a common link for all the three factors in men, and for three of the four in women.

Conclusions Insulin resistance is not the only underlying factor for the clustering of CVD risk factors in south Indians. These findings are consistent with the presence of several distinct physiological domains, as shown in other ethnic groups.
Young Chinese adults with new onset of diabetic ketoacidosis – clinical course, autoimmune status and progression of pancreatic β‐cell function
Authors: Li J. K. Y. , Chan J. C. N. , Zimmet P. Z. , Rowley M. J. , Mackay I. R. , Cockram C. S.
Published: March 2003

Aims To examine the clinical course, autoimmune status and pancreatic β cell function, over a 2‐year period, in young Chinese subjects newly presenting with diabetic ketoacidosis (DKA).

Methods A prospective study involving 562 out of 27 893 patients who were admitted to the medical ward with a principal diagnosis of diabetes mellitus during the recruitment period of 1 year.

Results Of these 562 patients, 27 were aged less than 35 years and admitted with a diagnosis of DKA and 11 (six males and five females) of these were newly diagnosed. Antibodies to glutamic acid decarboxylase (GAD) were present in five patients. Anti‐ICA 512 was not detected in any of the patients. Basal and post‐glucagon stimulated plasma C‐peptide remained in the insulin‐deficient range although showing improvement at 2 years.

Conclusions These findings confirm the relative rarity of autoimmune Type 1 diabetes in young Chinese. Even when the clinical presentation takes the extreme form of acute DKA, less than 50% have positive autoimmune markers.
Driving and insulin – consensus, conflict or confusion?
Authors: Flanagan D. E. H. , Watson J. , Everett J. , Cavan D. , Kerr D.
Published: March 2003

Aims All drivers requiring insulin treatment must be able to demonstrate satisfactory diabetic control and recognition of hypoglycaemic symptoms before being allowed to drive a motor vehicle. Clinicians have a duty to discuss fitness to drive with their patients. However, is the advice given consistent and in line with the regulations published by the Driver and Vehicle Licensing Authority (DVLA)?

Methods Six ‘real‐life’ case scenarios were posted to clinicians (consultant diabetologists, specialist registrars and diabetes specialist nurses) within Wessex, UK. The identical cases were also sent to the DVLA for their comments.

Results Sixty‐six doctors (36 consultants) and 70 diabetes specialist nurses were contacted by postal questionnaire of which replies were received from 17 consultants (47%), 17 specialist registrars (57%) and 39 diabetes specialist nurses (56%). Although there was general agreement in cases of hypoglycaemia unawareness, there was disagreement where patients had or were at risk of unstable control albeit for a short time.

Conclusions Patients treated with insulin may receive conflicting information concerning their ability to drive.
Lipoproteins and low‐dose estradiol replacement therapy in post‐menopausal Type 2 diabetic patients: the effect of addition of norethisterone acetate
Authors: Owens D. , Collins P. B. , Johnson A. , Tomkin G. H.
Published: March 2003

Aims Low‐dose continuous oestrogen/progestogen may increase patient compliance long‐term but the cardioprotective effects in diabetes are unknown. The aim of this study was to compare the effect of low‐dose oral oestrogen (1 mg, 17‐β‐estradiol) treatment with oestrogen (1 mg 17‐β‐estradiol) in combination with low‐dose (0.5 mg) continuous norethisterone acetate (NETA) on lipoproteins in Type 2 diabetic patients.

Methods Thirty‐four post‐menopausal Type 2 diabetic patients in moderate control (mean haemoglobin A1c 7.7%) who had a serum oestradiol level of < 50 pg/ml were examined over a 6‐month period. Serum lipids, and lipoprotein composition of very low density lipoprotein (VLDL), low density lipoprotein (LDL) and high density lipoprotein (HDL) were measured. Serum lipoprotein(a) was determined by an ELISA method, LDL fatty acids by gas–liquid chromatography and LDL oxidizability by thiobarbituric acid reactive substances (TBARS assay). Cholesteryl ester transfer protein (CETP), and cell cholesterol were measured.

Results There was a reduction in serum cholesterol on both treatments but no significant difference between treatment groups. LDL cholesterol decreased by 17% in each group. There was a no significant difference between the groups in serum VLDL or HDL cholesterol or serum triglycerides during the study. The change in lipoprotein(a) during the study was not significantly different between the groups. There was no significant difference in 4 h LDL oxidizability between groups. Although CETP increased with time in both groups there was no significant difference in the change between the groups.

Conclusion In this small study, the addition of continuous low‐dose NETA did not reduce the potentially beneficial effects of low‐dose 17‐β‐estradiol on the progression of atherosclerosis in diabetes.
Acute hyperglycaemia causes elevation in plasma atrial natriuretic peptide concentrations in Type 1 diabetes mellitus
Authors: McKenna K. , Smith D. , Tormey W. , Thompson C. J.
Published: March 2003

SUMMARY

Aims  To examine the effect of acute hyperglycaemia on atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) concentrations in Type 1 diabetes.

Methods  The study was two limb, randomized, and single‐blind. Eight Type 1 diabetes subjects were clamped at euglycaemia by intravenous infusion of insulin. When euglycaemia was established, the insulin infusion rate was left unaltered for the remainder of the protocol, and an intravenous infusion of either 500 ml 0.9% saline or 500 ml 10% dextrose was administered over 1 h. Blood was collected for estimation of plasma glucose, ANP and BNP concentrations at 30 min intervals for 2 h from the start of the infusion period. One week later, each subject received the alternate infusion. Results are expressed as mean ± standard deviation, and were analysed by anova.

Results  Baseline plasma glucose (P = 0.8), ANP (P = 0.8) and BNP (P = 0.8) concentrations were similar on the study days. Plasma glucose rose with dextrose (6.1 + 0.5–15.1 + 2.8 mmol/l, P = 0.9). Plasma ANP concentrations were unaltered by saline infusion (76.5 ± 14.7–77.7 ± 15.2 pg/ml, P = 0.9), but increased with dextrose infusion (79 ± 14–134 ± 17.1 pg/ml, P < 0.0001), and were higher with dextrose than saline infusion (P < 0.0001). Plasma concentrations of BNP were not significantly altered by infusion of either dextrose (5.1 ± 3.9–9.3 ± 5.4 pg/ml, P = 0.63) or saline (4.3 ± 3.5–6 ± 5.2 pg/ml, P = 0.84).

Conclusions  Plasma concentrations of ANP, but not BNP, rise in response to acute hyperglycaemia in Type 1 diabetes.
Type 2 diabetes mellitus in UK children – an emerging problem
Authors: Ehtisham S. , Barrett T. G. , Shaw N. J.
Published: March 2003

SUMMARY

Aims Type 2 diabetes mellitus has never previously been described in UK children, although an increasing incidence in childhood is recognized in international studies. The prevalence of obesity in UK children is increasing and is a recognized risk factor for the development of diabetes. The aim of this study was to identify and characterize children with Type 2 diabetes in the West Midlands and Leicester.

Methods Children were identified by contacting paediatricians responsible for diabetes in five hospitals. Details were collected on demographics, mode of presentation, investigations and treatment on a standard proforma.

Results Eight girls were identified with Type 2 diabetes, aged 9–16 years and who were of Pakistani, Indian or Arabic origin. They were all overweight (percentage weight for height 141–209%) and had a family history of diabetes in at least two generations. They presented insidiously with hyperglycaemia and glycosuria without ketosis and five were asymptomatic. Islet cell antibodies measured in seven patients were negative. Four had acanthosis nigricans which is a cutaneous marker of insulin resistance and the other four had high plasma levels of insulin and/or C peptide. These patients are distinct from those with maturity‐onset diabetes of the young (MODY). All were initially managed with dietary measures, seven have been treated with oral anti‐diabetic agents of whom two have subsequently required insulin.

Conclusions These are the first UK case reports of Type 2 diabetes in children. Paediatricians need to be aware of the risk of Type 2 diabetes developing in childhood in high‐risk ethnic groups, particularly in association with obesity and a positive family history.
Reducing hospital inpatient length of stay for patients with diabetes
Authors: Cavan D. A. , Hamilton P. , Everett J. , Kerr D.
Published: March 2003

SUMMARY

Aims  To ascertain the effect of routine review by a diabetes nurse advisor on length of stay for medical and surgical inpatients with diabetes.

Methods  Inpatients with diabetes were identified prospectively from January 1997 until December 1998 (792 in 1997 and 819 in 1998). A new post of diabetes nurse advisor was introduced in January 1998 to optimize diabetes management. Length of stay was calculated retrospectively from hospital computer records.

Results  Median length of stay in 1997 was 11 days in medicine and 8 days in surgery. In 1998, the nurse advisor made 1936 visits to 819 patients; median length of stay fell to 8 days in medicine and 5 days in surgery (P < 0.001). Bed occupancy by patients with diabetes fell from 6.8 to 4.0%. Mean length of stay across the hospital remained unchanged.

Conclusions  The introduction of a ward‐based diabetes nurse advisor was associated with significant reductions in length of stay in inpatients with diabetes. Since this study was not a randomized study, other factors may have contributed to this change. However, the consistency of the reduction across specialities suggests the post itself had an important effect.
Intra‐urban differences in the prevalence of the metabolic syndrome in southern India – the Chennai Urban Population Study (CUPS No. 4)
Authors: Mohan V. , Shanthirani S. , Deepa R. , Premalatha G. , Sastry N. G. , Saroja R.
Published: March 2003

SUMMARY

Aims  To assess the influence of socioeconomic status on the prevalence of the metabolic syndrome in an urban south Indian population in Chennai.

Methods  The Chennai Urban Population Study is an epidemiological study involving two residential colonies in Chennai (formerly Madras) in south India representing the middle and lower income groups. All individuals ≥ 20 years of age living in the colonies were invited to participate in the study. Of the total 1399 eligible subjects, 1262 individuals (479 belonging the middle income group colony and 783 from the low income group colony) participated in the study. The overall response rate was 90.2%. The main outcome measures were the prevalence rates of the various components of the metabolic syndrome.

Results  There were significant differences in the socioeconomic status and lifestyle of the inhabitants of the two areas. The mean monthly income of the Tirumangalam (middle income) group (Rs8075 ± 3859) was significantly higher than the T. Nagar (low income) group (Rs1399 ± 916). The dietary profile of the middle income group showed higher intake of calories, fat and sugar compared to low income group (P < 0.001). The age‐standardized prevalence rates of the various components of the metabolic syndrome were significantly higher in the middle compared to the low income group – diabetes (12.4 vs. 6.5%), impaired glucose tolerance (7.5 vs. 2.9%), hypertension (14.9 vs. 8.4%), obesity (males 38 vs. 13.4%, females 33.1 vs. 24.2%), hypercholesterolaemia (24.2 vs. 14.2%) and hyperinsulinaemia (16.7 vs. 6.6%) P < 0.001). Although the prevalence of coronary artery disease and hypertriglyceridaemia were higher in the middle income group, the differences did not reach statistical significance. The relative odds ratio for diabetes and impaired glucose tolerance increased significantly with increase in income while hypercholesterolaemia, hypertriglyceridaemia, hypertension and coronary artery disease showed no significant changes. Logistic regression analysis revealed that geographical area (higher social class) had a strong association with the components of the metabolic syndrome even after inclusion of other risk factors like age and body mass index in the model.

Conclusions  Significant differences exist in the prevalence of various components of the metabolic syndrome even within an urban environment and this appears to be influenced by socioeconomic status.
Human islet cell transplantation – future prospects
Authors: White S. A. , James R. F. L. , Swift S. M. , Kimber R. M. , Nicholson M. L.
Published: March 2003

Summary

Background  Islet transplantation has the potential to cure diabetes mellitus. Nevertheless despite successful reversal of diabetes in many small animal models, the clinical situation has been far more challenging. The aim of this review is to discuss why insulin‐independence after islet allotransplantation has been so difficult to achieve.

Methods  A literature review was undertaken using Medline from 1975 to July 2000. Results reported to the International Islet Transplant Registry (ITR) up to December 1998 were also analysed.

Results  Up to December 1998, 405 islet allotransplants have been reported the ITR. Of those accurately documented between 1990 and 1998 (n = 267) only 12% have achieved insulin‐independence (greater than 7 days). However with refined peri‐transplant protocols insulin indepedence at 1 year can reach 20%.

Conclusions  There are many factors which can explain the failure of achieving insulin‐independence after islet allotransplantation. These include the use of diabetogenic immunosuppressive agents to abrogate both islet allo‐immunity and auto‐immunity, the critical islet mass to achieve insulin‐independence and the detrimental effects of transplanting islets in an ectopic site. However recent evidence most notably from the Edmonton group demonstrates that islet allotransplantation still has great potential to become an established treatment option for diabetic patients.
The relationship between active renin concentration and plasma renin activity in Type 1 diabetes
Authors: Valabhji J. , Donovan J. , Kyd P. A. , Schachter M. , Elkeles R. S.
Published: March 2003

Aims
 
Circulating activity of the renin‐angiotensin‐aldosterone system (RAAS) can be assessed by measuring plasma active renin concentration (ARE), as well as by measuring plasma renin activity (PRA). We aimed to assess the relationships between ARE and PRA in Type 1 diabetic compared with non‐diabetic control subjects. We also assessed concentrations of the active renin precursor, prorenin.

Patients and methods
 
Thirty‐five Type 1 diabetic subjects and 34 non‐diabetic control subjects were assessed. Groups had similar ages, sex distributions, body mass indices, systolic and diastolic blood pressures. PRA was measured by radioimmunoassay of angiotensin I generation from endogenous substrate. ARE and total renin concentration (TRE) were measured by immunoradiometric assay (Nichols Institute Diagnostics, USA). Prorenin concentration was calculated as the difference between ARE and TRE.

Results
 
PRA was significantly lower in Type 1 diabetic than in control subjects (0.8 (0.4–1.1) vs. 1.1 (0.9–1.9) pmol/ml per h; P < 0.005), while ARE was similar (17 (9–33) vs. 18 (15–25) mU/l; P = 0.548). PRA (loge transformed) correlated strongly with ARE in diabetic (r = 0.49; P = 0.003) and control subjects (r = 0.59; P = 0.0002), but there was significant vertical separation of the regression lines for the two groups (P < 0.0001). Prorenin concentrations were significantly higher in Type 1 diabetic subjects (249 (170–339) vs. 171 (153–219) mU/l; P = 0.005). Diabetic subjects with high prorenin concentrations (> 400 mU/l (control mean + 3 sd)) were more likely to have microalbuminuria (P = 0.027) and peripheral neuropathy (P = 0.049).

Conclusions
 
Type 1 diabetes is associated with an altered relationship between ARE and PRA, such that ARE is higher for a given PRA compared with non‐diabetic control subjects. Both ARE and PRA are used to assess circulating RAAS activity. The altered relationship between the two in Type 1 diabetic subjects suggests that neither parameter alone is necessarily an adequate and reliable index of such activity. Higher prorenin concentrations, particularly in association with microvascular complications, were confirmed in the Type 1 diabetic subjects.

Diabet. Med. 18, 451–458 (2001)
Association between symptoms of depression and glycaemic control may be unstable across gender
Authors: Pouwer F. , Snoek F. J.
Published: March 2003

Aims  Lloyd and colleagues (Diabetic Med 2000; 17, 198–202) have described an association between poor glycaemic control and moderate to severe depression in male but not in female diabetes patients. However, the validity of this study may be limited by its small sample size and the influence of uncontrolled confounders. Therefore, we set out to replicate this study by investigating the associations between depression and glycaemic control in larger samples, while controlling for potential confounders.

Methods
 
Out‐patients with diabetes (n = 174) and 1437 patient members of the Dutch Diabetes Association (DDA) completed the Hospital Anxiety and Depression Scale. Demographic and clinical characteristics were obtained using medical records (out‐patients) or self‐report (DDA).

Results
 
After controlling for number of complications, years of education and body mass index, depression showed significant, low positive correlations with HbA1c in three of the four female samples and in one of the four male samples. Only for out‐patients with Type 2 diabetes was the correlation between HbA1c and depression significantly higher for women when compared with men (0.19 vs. 0.04; P = 0.02).

Conclusions
 
The association between depression and HbA1c may be stronger in women with Type 2 diabetes. Oestrogen levels and self‐care behaviours may play a mediating role in this association. Further research is required before we can conclude that the association between symptoms of depression and glycaemic control differs across gender.

Diabet. Med. 18, 595–598 (2001)