bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of cellular tumour rejection mechanisms in the peritumoral bladder wall after bacillus Calmette‐Guérin treatment
Authors: Saint F. , Patard J.J. , Groux Muscatelli B. , Lefrere Belda M.A. , Gil Diez de Medina S. , Abbou C.C. , Chopin D.K.
Published: March 2003

Objective To compare the immunological status of normal and peritumoral bladder walls, and to characterize immunocompetent cells before and during intravesical instillations of bacillus Calmette‐Guérin (BCG).

Patients and methods Twenty‐three patients with superficial urothelial bladder carcinoma (stages pTa to pT1, grades 1–3) were treated with six weekly instillations of 150 mg of BCG (Pasteur strain). Biopsies of cystoscopically normal bladder wall were taken before, 3 weeks and 3 months after BCG instillation. The controls comprised bladder biopsy specimens from 13 brain‐dead ventilated kidney donors. Local infiltrating cell types, i.e. lymphocyte infiltrates (CD4, CD8, CD20, CD3, interleukin‐2‐receptor‐positive, natural killer, γδ), macrophages and dendritic cells, adhesion and costimulatory molecules (ICAM‐1 and B7‐BB1) and major histocompatibility complex (MHC) class I and class II antigens were assessed using semi‐quantitative immunohistochemical analysis.

Results Before BCG the peritumoral bladder wall had fewer macrophages than control bladder wall. BCG treatment restored normal numbers of macrophages and enhanced T helper lymphocytes, B lymphocytes, natural killer cells, activated lymphocytes, dendritic cells, normal MHC class I, adhesion (ICAM‐1) and costimulatory (B7‐BB1) expression. The enhancement of these immunological variables was transient, with a return to baseline 3 months after BCG instillation.

Conclusions These results support the concept that there is a host‐immune escape associated with bladder cancer. BCG therapy may temporarily restore impaired tumour rejection mechanisms in the peritumoral bladder wall, suggesting a need for maintenance therapy after the first course of BCG.
The role of 18fluoro‐2‐deoxyglucose positron emission tomography in initial staging and re‐staging after chemotherapy for testicular germ cell tumours
Authors: Spermon J.R. , De Geus‐Oei L.F. , Kiemeney L.A.L.M. , Witjes J.A. , Oyen W.J.G.
Published: March 2003

Objective To investigate the role of 18fluoro‐2‐deoxyglucose positron emission tomography (FDG‐PET) in the initial staging of clinical stage I and II nonseminomatous germ cell tumours (NSGCTs) and in re‐staging (non)seminomatous GCTs after chemotherapy.

Patients and methods FDG‐PET studies were undertaken in 50 patients. FDG uptake was interpreted visually and when possible the standardized uptake value was determined. A FDG‐PET scan was taken in five patients with clinical stage I and in seven with stage II NSGCT. The scans were validated by histology. Stage I patients underwent a retroperitoneal lymph node dissection because of vascular invasion in the primary tumour. Thirty‐eight scans were taken after completing chemotherapy (28 NSGCTs and 10 seminomatous GCTs), and validated by histology or clinical follow‐up.

Results In stage I NSGCT, FDG‐PET staging was equivalent to computed tomography (CT) staging. One small lesion, consisting of mature teratoma, was missed by both FDG‐PET and CT. In stage II NSGCT, FDG‐PET missed two lesions (mature teratoma and retroperitoneal mass with a small component of embryonal cell carcinoma) whereas CT correctly classified all. In 20 of 28 patients with NSGCT, histology was obtained after chemotherapy. In one of three patients with viable tumorous residual mass the FDG‐PET scan was clearly positive; in four of 12 with mature teratoma and inflammation components retroperitoneally, the FDG‐PET was also positive. In contrast, eight patients with solitary mature teratoma had a negative PET result. In four of five patients with necrosis after chemotherapy the PET result was correctly negative. All eight patients on surveillance had a negative PET scan and were free of disease at median (range) of 14 (8–18) months. Interestingly, of the 12 patients with a correct negative PET result, 11 had no mature teratoma in their primary tumour. Nine of 10 patients with SGCT were correctly staged. Two FDG‐PET studies showed increased uptake; in one, a viable seminomatous mass was found and in the other there was inflammation in the residual mass. In all other patients the FDG‐PET scan correctly predicted absence of viability in the residual mass.

Conclusions In primary staging, FDG‐PET has no benefit over CT. In re‐staging, a negative FDG‐PET result predicts fibrotic residual mass in seminomatous GCT. Moreover, it could be useful to predict fibrotic residual mass in NSGCT in those patients with no teratoma component in their primary tumour.
Contribution of grade, vascular invasion and age to outcome in clinically localized renal cell carcinoma
Authors: Griffiths D.F.R. , Verghese A. , Golash A. , Kynaston H.G. , Matthews P.N. , Hart A.J.L. , Court J.B.
Published: March 2003

Objective  To determine the relative prognostic importance of microvascular invasion in apparently localized renal cell carcinoma (RCC).

Patients and methods A retrospective clinical and pathological review was conducted of 176 consecutive patients identified from pathology records who had a nephrectomy for RCC with a median follow‐up of 44 months. Vascular invasion was recorded and categorized by the level of microvascular invasion (MVI), renal vein invasion (RVI) and inferior vena cava invasion (IVCI). Tumour type, grade and size were also assessed. These variables were assessed by univariate and multivariate analysis to determine their effect on disease‐free survival.

Results  In the univariate analysis tumour size, grade, vascular invasion and young age each predicted reduced disease‐free survival. On multivariate analysis for all 176 patients, grade, vascular invasion and young age were the significant independent predictors of reduced disease‐free survival. In a subgroup of 149 patients from whom those with very high risk determinants were excluded (those with grade 4 tumours and/or IVCI) most of the risk of metastasis could be accounted for by vascular invasion and young age alone (MVI vs no vascular invasion, hazard ratio 3.18, 95% confidence interval 1.29–7.84; RVI vs no vascular invasion 2.41, 0.989–5.89; and age per year 0.963, 0.94–0.992).

Conclusions  Grade, vascular invasion and young age are the main independent predictors of relapse in clinically localized RCC after nephrectomy. For most patients, who do not have very high risk indicators, the main adverse predictors are vascular invasion and young age. These findings are important when selecting patients for trials of adjuvant therapy and have implications for pathological staging.
The effect of Phyllanthus niruri on urinary inhibitors of calcium oxalate crystallization and other factors associated with renal stone formation
Authors: Freitas A.M. , Schor N. , Boim M.A.
Published: March 2003

Objective To evaluate the effect of an aqueous extract of Phyllanthus niruri (Pn), a plant used in folk medicine to treat lithiasis, on the urinary excretion of endogenous inhibitors of lithogenesis, citrate, magnesium and glycosaminoglycans (GAGs).

Materials and methods The effect of chronic (42 days) administration of Pn (1.25 mg/mL/day, orally) was evaluated in a rat model of urolithiasis induced by the introduction of a calcium oxalate (CaOx) seed into the bladder of adult male Wistar rats. The animals were divided into four groups: a sham control (16 rats); a control+Pn (six); CaOx+water instead of Pn (14); and CaOx+Pn (22). Plasma and urine were collected after 42 days of treatment for biochemical analysis and the determination of urinary excretion of citrate, magnesium and GAGs. The animals were then killed and the calculi analysed.

Results The creatinine clearance or urinary and plasma concentrations of Na+, K+, Ca2+, oxalate, phosphate and uric acid were unaffected by Pn or the induction of lithiasis. Treatment with Pn strongly inhibited the growth of the matrix calculus and reduced the number of stone satellites compared with the group receiving water. The calculi were eliminated or dissolved in some treated animals (three of 22). The urinary excretion of citrate and magnesium was unaffected by Pn treatment. However, the mean (sd) urinary concentration of GAGs was significantly lower in rats treated with CaOx+Pn, at 5.64 (0.86) mg/g creatinine, than when treated with CaOx + water, at 11.78 (2.21) mg/g creatinine. In contrast, the content of GAGs in the calculi was higher in the CaOx + Pn rats, at 48.0 (10.4) g/g calculus, than in the CaOx + water group, at 16.6 (9.6) g/g calculus.

Conclusion These results show that Pn has an inhibitory effect on crystal growth, which is independent of changes in the urinary excretion of citrate and Mg, but might be related to the higher incorporation of GAGs into the calculi.
Influence of nitric oxide signalling pathways on pre‐contracted human detrusor smooth muscle in vitro
Authors: Moon Annick
Published: March 2003

Objectives To assess the effects of nitric oxide (NO) donors on human detrusor strips in vitro under conditions which attempt to mimic those occurring in vivo during the tonic phase of bladder contraction, as NO may promote relaxation by modulating parasympathetic excitation contraction coupling.

Materials and methods With ethical approval from the local ethics committee, human detrusor tissue was obtained from a heterogeneous clinical group after obtaining informed consent. Detrusor strips were dissected and mounted in a 1‐mL, superfused organ bath. After pre‐contraction with carbachol, the effect of NO donors, sodium nitroprusside (SNP) and S‐nitro‐N‐acetylpenicillamine, a cell‐permeable cyclic nucleotide analogue (dibutyl‐cGMP), and inhibitors (methylene blue and ibuprofen) on isometric tension were assessed. All drugs were dissolved in Tyrode solution (pH 7.4), passed through a thermostatically controlled (36 °C) warming jacket and bubbled with 95% O2/5% CO2.

Results Both NO donors and db‐cGMP evoked a complex response in pre‐contracted tissue, i.e. relaxation, contraction or a transient relaxation followed by contraction. Inhibition of soluble guanylyl cyclase significantly attenuated NO‐mediated contraction, indicating the involvement of cGMP, but this inhibition did not significantly affect the relaxant response. The relaxant response was also potentiated by ibuprofen. SNP and db‐cGMP evoked similar responses, although the occurrence of the responses (relaxation, contraction or biphasic) was significantly different in normal and pathological human detrusor.

Conclusion NO donors and db‐cGMP modulate carbachol‐evoked contraction of human detrusor smooth muscle in vitro. There is probably a NO/cGMP signalling pathway, with inhibition of endogenous cGMP by methylene blue, suggesting that SNP evokes contraction via cGMP. However, NO donors and db‐cGMP evoked a complex response (relaxant, contractile or biphasic), suggesting that NO and cGMP may also act independently and/or via several pathways.
Antisense Bcl2 oligonucleotide in cisplatin‐resistant bladder cancer cell lines
Authors: Hong J.H. , Lee E. , Hong J. , Shin Y.J. , Ahn H.
Published: March 2003

Objective  To determine the change of expression of Bcl2 in cisplatin‐resistant bladder cancer cell lines and the reversibility of chemoresistance to cisplatin with antisense oligonucleotide against Bcl2, as higher expression of Bcl2 is associated with drug resistance in many different cancer cell lines.

Materials and methods  In the cisplatin‐resistant bladder tumour cell lines T24R1 and T24R2, the expression of Bcl2 was determined by reverse transcription‐polymerase chain reaction and Western blot assay, and antisense oligonucleotide targeting of the Bcl2 coding sequence was administered with lipofectin.

Results  The expression of Bcl2 mRNA and protein was greater in T24R1 and T24R2 cells than in the parent T24 cells. Short‐term exposure to cisplatin up‐regulated Bcl2 mRNA and protein expression in parent T24 cells. Treatment with antisense oligonucleotide down‐regulated Bcl2 protein expression and significantly enhanced the cytotoxicity of cisplatin.

Conclusions  Up‐regulation of Bcl2 protein expression might be one of the mechanisms of cisplatin resistance in bladder cancer cells, and antisense Bcl2 oligonucleotide may be helpful in chemotherapy for bladder cancer by reversing cisplatin resistance.
Changing treatments for primary urolithiasis: impact on services and renal preservation in 16 679 patients in Western Australia
Authors: Holman C.D.J. , Wisniewski Z.S. , Semmens J.B. , Bass A.J.
Published: March 2003

Objectives  To examine changing treatments for the primary presentation of urinary lithiasis and their effects on re‐admissions, repeat procedures, cumulative hospital use and renal preservation.

Patients and methods  Linked hospital morbidity records were used to identify first‐time admissions for renal and ureteric calculi from 1980 to 1997 in the population of Western Australia. The cases were followed to mid‐1999 and actuarial methods used to estimate risks of further hospital admissions and procedures, including the loss of a renal moiety.

Results  Between 1980 and 1997 the total rate of inpatient procedures for urinary stones more than doubled, at a time when the rate of first‐time hospital admissions increased by only 13% and the conservative management of stones remained constant at ≈ 59%. The predominant procedure for stone management was initially open lithotomy, replaced in the early 1980s by percutaneous nephrolithotomy and soon supplemented by extracorporeal shock wave lithotripsy (ESWL). The changes in technology led to a four‐fold increase in procedural re‐admissions within 30 days of primary separation. This was a result of repeated, staged or postponed interventions, often involving the use of stents or a second treatment with ESWL. The risk of surgical intervention decreased from 48% to 32%, whilst the cumulative length of stay over the first year decreased from 7.8 to 3.9 days. The risk of kidney loss declined significantly from 2% to <0.1% during the period.

Conclusions  The main reason for more interventions were short‐term procedural re‐admissions. ESWL reduced the need for invasive procedures and decreased cumulative hospital stay, despite more re‐admissions. Renal preservation improved by a factor of 10.
End‐to‐end urethroplasty: long‐term results
Authors: Micheli E. , Ranieri A. , Peracchia G. , Lembo A.
Published: March 2003

Objective  To retrospectively review patients with strictures (<3 cm) of the bulbous urethra who had undergone urethroplasty with excision of the stenotic segment and end‐to‐end anastomosis.

Patients and methods The review included 74 patients (all men, mean age 39 years, range 18–70) treated between 1989 and 1999 for strictures 5–30 mm long. Forty‐one of the patients (55%) had been treated previously, 39 endoscopically (urethrotomy and/or dilatation) and two surgically. Surgical access was perineal, with the patient in an exaggerated lithotomy position; the stenotic segment was excised and the stumps spatulated for end‐to‐end anastomosis. The mean (range) duration of surgery was 140 (75–280) min. There were no complications during or after surgery, and none related to the duration in the lithotomy position.

Results  At a mean follow‐up of 60 months, 93% of the patients had no recurrence of the stricture and were therefore considered cured. There were no treatment‐related complications.

Conclusion  End‐to‐end anastomosis is confirmed as the treatment of choice for short bulbous urethral strictures, giving cure rates close to 100%.
The ‘top 10’ urological procedures: a study of hospital episodes statistics 1998–99
Authors: Lee F. , Patel H.R.H. , Emberton M.
Published: March 2003

Objective  To summarize the urological procedures recorded in Hospital Episodes Statistics (HES, 1998–99) and to examine the accuracy of coding and HES.

Materials and methods

 Data on the 10 commonest urological procedures from the Department of Health website (
www.doh.gov.uk/hes ) were extracted, summarized and presented.

Results  Urethral catheterization, endoscopic procedures on the bladder, prostate, urethra and ureter (excluding ureteric stone extraction), minor open procedures on the foreskin and the vas, bladder instillation, extracorporeal shockwave lithotripsy and prostatic biopsy are the 10 commonest procedures, according to finished consultant episodes. There is published evidence that the data from coding and HES are not completely accurate.

Conclusion  This study highlights shortfalls in the HES data (1998–99) which may directly affect the funding of urological services.
The effect of perioperative distal vasal lavage on subsequent semen analysis after vasectomy: a prospective randomized controlled trial
Authors: Pearce I. , Adeyoju A. , Bhatt R.I. , Mokete M. , Brown S.C.W.
Published: March 2003

Objective To determine the effect of perioperative distal vasal lavage with 50 mL of normal saline on subsequent time to azoospermia after vasectomy.

Patients and methods Seventy‐two patients were prospectively enrolled and randomized to undergo vasectomy with or without vasal lavage. Infertility rates at 8, 10 and 12 weeks were compared for both groups and for those undergoing the procedure under local or general anaesthesia. Patient compliance for returning postoperative semen for analysis was also assessed.

Results There was no statistically significant difference in infertility rates at 8, 10 or 12 weeks after vasectomy with or without vasal lavage. Vasectomies performed under local and general anaesthesia had comparable rates of infertility at 12 weeks after surgery. Compliance in providing semen for analysis was poor.

Conclusions The routine adoption of distal vasal lavage during vasectomy for contraception cannot be recommended. As compliance in providing semen for analysis was poor, the clinician has a responsibility to remind the patient of the consequences of such action.
Immunohistochemical detection of the 150‐kDa oxygen‐regulated protein in bladder cancer
Authors: Asahi H. , Koshida K. , Hori O. , Ogawa S. , Namiki M.
Published: March 2003

Objective To investigate the relationship between the expression of the 150‐kDa oxygen‐regulated protein (ORP150, which functions as a molecular chaperone in the endoplasmic reticulum for the folding and trafficking of newly synthesized proteins) and the aggressiveness of bladder cancer, and the expression of vascular endothelial growth factor (VEGF) and matrix metalloproteinases (MMPs), as the former is a secreting protein through the endoplasmic reticulum and the latter are closely involved in tumour invasion.

Materials and methods Thirty‐nine cystectomy specimens, comprising 12 superficial (pT1) and 27 invasive (pT2–pT4) tumours, were immunohistochemically analysed using antibodies against ORP150, VEGF, MMP‐1, MMP‐2 and MMP‐9. Staining was scored from 0 to 3, according to the ratio of positively staining cells.

Results Staining was positive (score 1–3) for ORP150 in 10 of 12 superficial and 25 (93%) of the invasive tumours, with a significantly higher staining score for stage T4 than stage T1 tumours. The trend was the same for the staining score of MMP‐2, and there was a significant correlation between ORP150 and MMP‐2 expression.

Conclusions The expression of ORP150 was common in bladder cancer, with a tendency for greater expression in higher stages. The significant correlation between ORP150 and MMP‐2 expression suggests that ORP150 acts as a molecular chaperone for MMP‐2 secretion and thus tumour invasion.
Orchidectomy after chemotherapy for patients with metastatic testicular germ cell cancer
Authors: Geldart T.R. , Simmonds P.D. , Mead G.M.
Published: March 2003

Objective To evaluate the contribution of routine orchidectomy in the management of patients who present with advanced, metastatic, testicular germ cell cancer and who are treated with initial chemotherapy.

Patients and methods Sixty consecutive patients presenting with metastatic testicular germ cell cancer and treated with initial chemotherapy followed by orchidectomy were identified. The results from a clinical and pathological review of these patients are presented. The pathological findings at orchidectomy were compared with the pathological findings from metastatic masses resected after chemotherapy, and are reviewed with the clinical outcome.

Results Of the 60 orchidectomy specimens after chemotherapy, 24 (40%) contained significant histological abnormalities comprising residual invasive germ cell cancer, intratubular germ cell neoplasia and/or mature teratoma. The remaining 36 (60%) orchidectomy specimens contained fibrous scarring with or with no necrosis. Six (10%) orchidectomy specimens contained residual invasive germ cell cancer, three nonseminomatous germ cell cancer (NSGCT) and three seminoma. The patients with residual invasive NSGCT present within the testis had evidence of residual invasive NSGCT within extragonadal masses resected after chemotherapy; all three have relapsed and died from chemorefractory progressive disease.

Conclusion Orchidectomy after chemotherapy is recommended in all patients undergoing primary chemotherapy, as a significant proportion (40%) are left with histological abnormalities that predispose to subsequent relapse. Persistence of invasive NSGCT at the site of the primary tumour after chemotherapy is associated with persistence of invasive disease at other metastatic sites and is a poor prognostic finding.
Altered cognitive function in men treated for prostate cancer with luteinizing hormone‐releasing hormone analogues and cyproterone acetate: a randomized controlled trial
Authors: Green H.J. , Pakenham K.I. , Headley B.C. , Yaxley J. , Nicol D.L. , Mactaggart P.N. , Swanson C. , Watson R.B. , Gardiner R.A.
Published: March 2003

Objective  To report the first systematic investigation of the cognitive effects of luteinizing hormone‐releasing hormone (LHRH) analogues in male patients, as LHRH analogues have been associated with memory impairments in women using these drugs for gynaecological conditions.

Patients and methods  Eighty‐two men with extraprostatic prostate cancer were randomly assigned to receive either continuous leuprorelin, goserelin (both LHRH analogues), cyproterone acetate (a steroidal antiandrogen) or close clinical monitoring. These patients underwent cognitive assessments at baseline and before starting treatment (77), and then 6 months later (65).

Results  Compared with the baseline assessments, men receiving androgen suppression monotherapy performed worse in two of 12 tests of attention and memory; 24 of 50 men randomized to active treatment and assessed 6 months later had a clinically significant decline in one or more cognitive tests but not one patient randomized to close monitoring showed a decline in any test performance.

Conclusion  Pharmacological androgen suppression monotherapy for prostate cancer may be associated with impaired memory, attention and executive functions.
Common skin disorders of the penis
Authors: Buechner S.A.
Published: March 2003

Diseases of the male genitalia range from infectious lesions to inflammatory and neoplastic conditions, including many genital manifestations of more general skin diseases. This review highlights the clinical features, diagnosis and treatment of the most common dermatoses of the male genitalia. Herpes genitalis and infections caused by human papillomavirus (HPV) are increasing, particularly in young sexually active people. Herpes simplex virus infection is the commonest infectious cause of genital ulceration, with evidence that many infections are asymptomatic. HPV infection may be latent, subclinical and clinical. The most common causal agents for condyloma acuminatum are low‐risk HPV 6 and 11; high‐risk HPV types 16 and 18 are associated with premalignant and malignant lesions. Treatment for genital warts remains unsatisfactory; recurrences are common. Imiquimod, a new topical immunotherapeutic agent, which induces interferon and other cytokines, has the potential to be a first‐line therapy for genital warts. Scabies and pediculosis are transmitted by skin‐to‐skin contact and sexual transmission is common, with the penis and scrotum favourite locations for scabious lesions. Oral ivermectin, a highly active antiparasitic drug, is likely to be the treatment of choice, but until approval is granted it should be reserved for special forms of scabies. Common skin diseases, e.g. psoriasis and lichen planus, may have an atypical appearance in the genital area. The typical psoriatic scale is usually not apparent because of moisture and maceration. Allergic contact dermatitis of the genital area may result from condoms, lubricants, feminine hygiene deodorant spray and spermicides. More often, contact dermatitis is irritant, resulting from persistent moisture and maceration. Lichen sclerosus is a chronic inflammatory disease that occurs as atrophic white patches on the glans penis and foreskin. The penile form is a common cause of phimosis in uncircumcised men; involvement of the urethral meatus may lead to progressive meatal stenosis. Plasma cell balanitis is a benign, idiopathic condition presenting as a solitary, smooth, shiny, red‐orange plaque of the glans and prepuce of a middle‐aged to older man. Squamous cell carcinoma (SCC) in situ, e.g. erythroplasia of Queyrat and Bowen's disease, cannot be excluded clinically; their apparent clinical benignity may lead to lengthy periods of misdiagnosis and biopsy is required to confirm the diagnosis. SCC is the most common malignancy of the penis and the role of oncogenic HPV‐types has been also established in SCC of the penis. Prevention of SCC of the penis presupposes an identification of risk factors, early detection of all pre‐cancerous lesions and treatment of phimosis.
Banking of fresh‐frozen prostate tissue: methods, validation and use
Authors: Riddick A.C.P. , Barker C. , Sheriffs I. , Bass R. , Ellis V. , Sethia K.K. , Edwards D.R. , Ball R.Y.
Published: March 2003

The question of banking of fresh frozen human prostatic tissue is addressed by a group of authors who have compared its value with what they call “pseudobanked” tissue. They then validate their methodology by a number of methods, including expression of hepsin, which they found to be significantly higher in malignant than in benign tissue. The theme of prostate cancer is continued by an English group looking at recent trends in the use of radical prostatectomy in England, and they make a number of interesting comments about this. Again in relation to prostate cancer, a group from Boston assess the use of steroids after prostate brachytherapy to reduce the risk of acute urinary retention.

Authors from McGill University, Montreal and Beth Israel in Boston, comment on the controversial areas of insulin‐like growth factor and prostatic intraepithelial neoplasia and their role in the genesis of prostate cancer.

Other interesting areas such as testicular sparing surgery in testis cancer, and a comparison of hand‐assisted laparoscopic versus open radical nephrectomy, are also described in this section.

OBJECTIVE

To describe the establishment, methods, validation and use of a bank of fresh‐frozen human prostate tissue.

MATERIALS AND METHODS

On obtaining informed patient consent, protocols were followed for banking prostate tissue from any type of prostatectomy or cystoprostatectomy. A pseudobanking procedure was devised to determine the accuracy of assessing the histopathological status of the banked tissue. RNA was extracted, its quality assessed and used for quantitative real‐time reverse transcription‐polymerase chain reaction for the serine protease hepsin.

RESULTS

To date prostate tissue from 112 patients has been banked, with pseudobanking in 58. The histopathological assessment showed pseudobanked tissue matched adjacent unbanked tissue in 98% of cases for benign vs malignant diagnoses, and in 92% of carcinomas for the Gleason score. Hepsin expression was significantly higher in malignant than in benign tissues (P < 0.0001).

CONCLUSION

We established a validated method for banking human fresh‐frozen prostate tissue and applied it successfully. Hepsin expression can be used to differentiate malignant and benign prostate tissue, and as an indicator of tissue heterogeneity.
Decisional regret and quality of life after participating in medical decision‐making for early‐stage prostate cancer
Authors: Davison B.J. , Goldenberg S.L.
Published: March 2003

OBJECTIVE

To determine the effect of men's reported levels of involvement in medical decision‐making and quality of life (QoL) on their levels of decisional regret after definitive treatment.

PATIENTS AND METHODS

Men referred to a hospital‐based resource centre completed QoL and decisional‐regret measures after definitive treatment for localized prostate cancer. Data from these questionnaires were linked with a previous study conducted to determine if providing individualized information to men newly diagnosed with prostate cancer would lower their levels of psychological distress and enable them to become more active participants in treatment decision‐making. The preferred role in medical decision‐making and QoL had previously been measured at the time of diagnosis and the assumed role at 4 months after the definitive treatment decision. This postal survey was conducted ≈ 18 months after diagnosis.

RESULTS

Of 74 men, 67 (91%) responded; the mean (sd) time since definitive treatment was 10.3 (4.7) months and the mean age of the men 62.5 (6.9) years. Radical prostatectomy was the most frequent treatment (72%). Most (94%) patients participated in medical decision‐making either actively or collaboratively and did not regret their treatment choice. The type of definitive treatment received had no effect on decisional regret; patients’ QoL scores were similar to the levels before treatment. Levels of sexual function were significantly lower after definitive treatment, but urinary incontinence was not significantly affected. Men who had neoadjuvant hormone therapy reported having significantly more treatment‐related symptoms.

CONCLUSIONS

There is no evidence that providing information to facilitate participation in medical decision‐making causes decisional regret or psychological distress within the first year after definitive treatment. A longitudinal follow‐up of these patients is required to adequately assess the long‐term effects of treatment on QoL and decisional regret.
Transurethral electrovaporization of the prostate: is it any better than conventional transurethral resection of the prostate?
Authors: McAllister W.J. , Karim O. , Plail R.O. , Samra D.R. , Steggall M.J. , Yang Q. , Fowler C.G.
Published: March 2003

OBJECTIVE

To evaluate transurethral electrovaporization of the prostate (TUVP), compared with transurethral resection of the prostate (TURP), as a treatment for men with symptomatic benign prostatic enlargement (BPE).

PATIENTS AND METHODS

In all, 235 men with symptomatic BPE in four hospitals in the South‐East of England were randomized to TUVP (115) and TURP (120). Patients were assessed using the International Prostate Symptom Score (IPSS), the Short Form‐36 (SF‐36), EuroQol and sexual function questionnaire, uroflowmetry, ultrasonographic measurement of residual urine volume, pressure‐flow urodynamics and transrectal ultrasonography.

RESULTS

There was no statistically significant difference in the objective and subjective outcome after TURP and TUVP. The latter was associated with a lower transfusion rate than TURP but this did not result in an overall reduction in complications. There was no difference in the length of hospital stay. Overall, the two operations produced equivalent results and equivalent complication rates.

CONCLUSION

TUVP is an effective treatment for symptomatic BPE, with results equivalent to TURP. TUVP has not led to the expected reduction in early postoperative morbidity or shorter hospital stays.
Testicular‐sparing surgery: a reasonable option in selected patients with testicular lesions
Authors: Passarella M. , Usta M.F. , Bivalacqua T.J. , Hellstrom W.J.G. , Davis R.
Published: March 2003

OBJECTIVE

To describe our experience of inguinal exploration in patients who had a reasonable chance of having a benign testicular lesion.

PATIENTS AND METHODS

From 1995 to 2002, 11 patients (mean age 43 years, range 27–63) with testicular masses that were suspected to be benign underwent inguinal exploration.

RESULTS

In nine of the 11 patients, frozen‐section analysis and the final pathological results were similar, and two underwent inguinal orchidectomy. In seven patients the testicle was spared. Finally, because of an uncertain pathological diagnosis and patient age, two patients underwent orchidectomy.

CONCLUSIONS

Inguinal exploration and testicular‐sparing surgery are reasonable options in patients with peripheral intratesticular lesions, on the basis of preoperative ultrasonographic characteristics, and if there is a possibility of the mass being benign because of age, race, physical examination and tumour markers.
The neuroanatomy of the human scrotum: surgical ramifications
Authors: Yucel S. , Baskin L.S.
Published: March 2003

The developmental neuroanotomy of the human scrotum may not have been evaluated up to now, but the authors from San Francisco report here on an outstanding study in foetuses of this important area of interest. They have helped to define clearly the neuroanotomy of this region, which will be useful in planning surgery to the scrotum and penis in children.

The group from the Hospital for Sick Children in Toronto have evaluated the safety and efficacy of toleterodine in children who have previously failed to tolerate oxybutinin. They found that toleterodine is well tolerated in children, and 77% of patients were able to continue this treatment without significant side effects in this subgroup who could not tolerate oxybutinin.

OBJECTIVE

To define the scrotal nerve origin and distribution with respect to surrounding structures in male human fetuses, by using neuronal‐specific markers and three‐dimensional (3D) imaging techniques, as the developmental neuroanatomy of the human scrotum has not been studied in detail and an explicit description of nerve derivation and distribution in the human scrotum is germane to genital reconstructive surgery.

MATERIALS AND METHODS

Sixteen normal human fetal penile specimens at 17.5–38 weeks of gestation were studied. Specimens were fixed in formalin, embedded in paraffin wax, serially sectioned at 6 µm and stained with the neuronal marker S‐100. All of the specimens contained the whole penis and scrotum from glans to anal verge. The gestational age of the fetuses was determined by fetal heel‐to‐toe length. 3D‐computer reconstruction of serial sections allowed a detailed analysis of the neuroanatomy of the fetal penis and scrotum.

RESULTS

The nerves innervating the ventral side of the proximal penis and scrotum originated mainly from the perineal nerves arising from pudendal nerves. The nerves travelling along the ventral side of penis coalesced at the penoscrotal area to be directed into the interscrotal septum. At the penoscrotal junction, nerves on both sides of the ventral penis shifted to the interscrotal septum in a triangular fashion. The interscrotal septum was densely occupied by nerve fibres. Nerves were distributed horizontally to both hemiscrotal walls through this interscrotal septum. Both hemiscrota seem primarily to be innervated separately.

CONCLUSION

The interscrotal septum has a dense innervation. Both hemiscrota were innervated mainly by horizontally distributed nerve fibres arising from the interscrotal septum. Any procedure violating the penoscrotal and interscrotal septal area may jeopardize scrotal innervation.
Efficacy and safety of acarbose in the treatment of Type 1 diabetes mellitus: a placebo‐controlled,double‐blind, multicentre study
Authors: Riccardi G. , Giacco R. , Parillo M. , Turco S. , Rivellese A. A. , Ventura M. R. , Contadini S. , Marra G. , Monteduro M. , Santeusanio F. , Brunetti P. , Librenti M. C. , Pontiroli A. E. , Vedani P. , Pozza G. , Bergamini L. , Bianchi C.
Published: March 2003

Aims The aim of the study was to evaluate the efficacy and safety of acarbose in patients with Type 1 diabetes mellitus (DM).

Methods A multicentre double‐blind, randomized, placebo‐controlled study was performed. After a 6‐week run‐in, 121 patients were randomized to acarbose or placebo and to high‐ or low‐fibre diet for 24 weeks. Acarbose dose was 50 mg t.d.s. for the first 2 weeks and 100 mg t.d.s. for the subsequent weeks.

Results At the end of 24 weeks of treatment the intention to treat analysis showed that acarbose compared with placebo decreased 2 h postprandial plasma glucose levels (12.23 ± 0.83 vs. 14.93 ± 0.87 mmol/l;F = 6.1, P < 0.02) (least square means ± sem). No significant effect of acarbose was recorded on HbA1c or on the number of hypoglycaemic episodes. The effect of acarbose on blood glucose control was not influenced by the amount of carbohydrate and/or fibre intake. The incidence of adverse events were 75% and 39% in acarbose and placebo groups, respectively; they were mild and confined to the gastrointestinal tract.

Conclusions The use of acarbose in combination with insulin reduces postprandial plasma glucose levels in Type 1 diabetic patients who are not satisfactorily controlled with insulin alone but without significant effect on HbA1c.

Diabet. Med. 16, 228–232 (1999)
Association of plasma fibrinogen level and blood pressure with diabetic retinopathy, and renal complications associated with proliferative diabetic retinopathy, in Type 2 diabetes mellitus
Authors: Fujisawa T. , Ikegami H. , Yamato E. , Kawaguchi Y. , Ueda H. , Shintani M. , Nojima K. , Kawabata Y. , Ono M. , Nishino T. , Noso S. , Yamada K. , Babaya N. , Okamoto N. , Ohguro N. , Fukuda M. , Ogihara T.
Published: March 2003

Aim To clarify the association of several clinical parameters, including plasma fibrinogen level, with diabetic retinopathy in patients with Type 2 diabetes mellitus (DM).

Methods A total of 294 Japanese patients with Type 2 DM were studied; 53 patients with no diabetic retinopathy (NDR), 90 with background diabetic retinopathy (BDR), and 151 with proliferative diabetic retinopathy (PDR). Multiple logistic regression analysis was performed to assess variables independently associated with diabetic retinopathy in two settings: presence of retinopathy of any severity and presence of advanced retinopathy.

Results The following parameters were identified as independent factors associated with the presence of diabetic retinopathy (NDR vs. BDR + PDR): type of therapy (P < 0.0005), log‐transformed plasma fibrinogen level (P < 0.05), mean blood pressure (P < 0.05), and duration of diabetes (P < 0.05). The independent variables associated with advanced retinopathy were type of therapy (P < 0.00005), age (P < 0.0005) and nephropathy (P < 0.05). Body mass index, smoking and hypertensive status, HbA1c and total cholesterol levels were not independently associated.

Conclusions These data suggest that in patients with Type 2 DM, an increased blood viscosity due to high fibrinogen level as well as an elevated intravessel pressure play a role in the development of diabetic retinopathy, and that the progression to PDR is influenced or accompanied by the deterioration of renal status.
Effectiveness of screening and monitoring tests for diabetic retinopathy – a systematic review
Authors: Hutchinson A. , McIntosh A. , Peters J. , O'keeffe C. , Khunti K. , Baker R. , Booth A.
Published: March 2003

SUMMARY

Aims  To determine which screening and monitoring tests for diabetic retinopathy are most effective and under what circumstances.

Methods  A systematic review of the English language literature, published from 1983 to April 1999.

Results  Available studies are generally limited in their ability to answer the important questions on the effectiveness of tests for early detection of diabetic retinopathy. No randomized controlled trials were identified although primary studies exist for two screening tests: ophthalmoscopy, either direct or indirect, and retinal photography, using either mydriasis or non‐mydriasis. Retinal photography under mydriasis appears to be the most effective test, with the majority reporting levels of sensitivity in excess of 80%. However effectiveness is compromised when photographs are ungradable. Ophthalmoscopy can also reach acceptable standards of sensitivity and specificity.

Conclusion  Based on an assessment of available cohort studies, the most effective strategy for testing is the use of mydriatic retinal photography with the additional use of ophthalmoscopy for cases where photographs are ungradable. This does not exclude the use of ophthalmoscopy alone for opportunistic case finding but there is evidence of considerable variation in effectiveness of this test.
A randomized, controlled trial comparing insulin lispro with human soluble insulin in patients with Type 1 diabetes on intensified insulin therapy
Authors: Group E. A. M. Gale for the U.K. Trial
Published: March 2003

Aims Despite considerable experience with insulin lispro, few blinded comparisons with soluble insulin are available. This study compared insulin lispro with human soluble insulin in patients with Type 1 diabetes mellitus on multiple injection therapy who inject shortly before meals.

Methods Glucose control, frequency of hypoglycaemia and patient preference were examined in the course of a prospective, randomized, double‐blind, crossover comparison, with a 6‐week run‐in period and 12 weeks on each therapy. Ninety‐three patients took part, all on multiple daily doses of insulin, with soluble insulin before meals and NPH (isophane) insulin at night. The main outcome measures were self‐monitored blood glucose profiles, glycated haemoglobin, frequency of hypoglycaemic episodes, patient satisfaction and well‐being and patient preference.

Results Blood glucose levels were significantly lower after breakfast and lunch, but higher before breakfast, lunch and supper, in patients taking insulin lispro. Levels of HbA1c were 7.4 ± 1.1% on Humulin S and 7.5 ± 1.1% on insulin lispro (P = 0.807). The overall frequency of symptomatic hypoglycaemia did not differ, but patients on insulin lispro were less likely to experience hypoglycaemia between midnight and 6 a.m., and more likely to experience episodes from 6 a.m. to midday. Questionnaires completed by 84/87 patients at the end of the study showed that 43 (51%) were able to identify each insulin correctly, nine (11%) were incorrect, and 32 (38%) were unable to tell the insulins apart. No significant preference emerged: 35 (42%) opted for insulin lispro, 24 (29%) opted for Humulin S, while the remainder had no clear preference.

Conclusions Substitution of insulin lispro for soluble insulin in a multiple injection regimen improved post‐prandial glucose control at the expense of an increase in fasting and pre‐prandial glucose levels. Patients who already injected shortly before meals expressed no clear preference for the fast‐acting analogue, and did not improve their overall control as a result of using it. Nocturnal hypoglycaemia was however, less frequent on insulin lispro, and may emerge as a robust indication for its use.
Autoantibodies to tissue transglutaminase are sensitive serological parameters for detecting silent coeliac disease in patients with Type 1 diabetes mellitus
Authors: Kordonouri O. , Dieterich W. , Schuppan D. , Weber G. , Müller C. , Sarioglu N. , Becker M. , Danne T.
Published: March 2003

Aims To investigate the clinical significance of the determination of IgA antibodies to tissue transglutaminase (tTG) for the detection of silent coeliac disease in patients with Type 1 diabetes mellitus.

Methods A total of 520 patients with diabetes (median age 14.2 years, range 1–27) were tested for IgA antibodies to tTG (IgA anti‐tTG, ELISA), endomysium (EmA, indirect immunofluoresence) and gliadin (IgA‐AGA, enzyme immunometric assay) after ruling out IgA deficiency.

Results The prevalence of IgA anti‐tTG among patients with diabetes was 4.4% (23 of 520), and that of EmA and IgA‐AGA 3.5% (18 of 520, respectively). The coefficient of agreement between IgA antitTG and EmA was high (Cohen's kappa = 0.87, P < 0.001). Thirteen of the 23 IgA anti‐tTG‐positive patients underwent duodenal biopsy. Coeliac disease was confirmed in nine of 13 patients. One of them was negative for EmA and AGA, but positive for IgA anti‐tTG. Retrospective annual determinations up to 8 years in six IgA anti‐tTG‐positive patients showed both permanent and transient elevations of the serological markers.

Conclusions These data show that a positive IgA antibody test to tTG is a more sensitive parameter than EmA for silent coeliac disease in patients with diabetes. Confirmatory small bowel biopsy, however, remains necessary for diagnosis as some patients with positive antibodies may be without histological changes.
Diabetes as a result of atypical anti‐psychotic drugs – a report of three cases
Authors: Rigalleau V. , Gatta B. , Bonnaud S. , Masson M. , Bourgeois M. L. , Vergnot V. , Gin H.
Published: March 2003

Aims  Atypical anti‐psychotic drugs (APDs) are widely used in psychotic disorders refractory to conventional neuroleptic agents.

Results  Three cases of new‐onset diabetes are reported in Caucasian men who were on clozapine (one) or olanzapine (two) for 3–6 months. They had a distinct presentation: weight loss, ketosis (one ketoacidosis), severe hyperglycaemia requiring insulin therapy, and relative insulin deficiency as reflected by glucagon stimulatory tests. In all cases, insulin was stopped within 1 month after the APD was discontinued.

Conclusions  Novel APDs not only induce diabetes as a result of weight gain in predisposed patients, but can also lead to a reversible state of insulin deficiency, and sometimes ketoacidosis.
Oral hypoglycaemic agents in 118 diabetic pregnancies
Authors: Hellmuth E. , Damm P. , Mølsted‐Pedersen L.
Published: March 2003

SUMMARY

Aims  To assess maternal and neonatal complications in pregnancies of diabetic women treated with oral hypoglycaemic agents during pregnancy.

Methods  A cohort study including all consecutively registered, orally treated pregnant diabetic patients set in a diabetic obstetrical service at a university hospital: 50 women treated with metformin, 68 women treated with sulphonylurea during pregnancy and a reference group of 42 diabetic women treated with insulin during pregnancy.

Results  The prevalence of pre‐eclampsia was significantly increased in the group of women treated with metformin compared to women treated with sulphonylurea or insulin (32 vs. 7 vs. 10%, P < 0.001). No difference in neonatal morbidity was observed between the orally treated and insulin‐treated group; no cases of severe hypoglycaemia or jaundice were seen in the orally treated groups. However, in the group of women treated with metformin in the third trimester, the perinatal mortality was significantly increased compared to women not treated with metformin (11.6 vs. 1.3%, P < 0.02).

Conclusion  Treatment with metformin during pregnancy was associated with increased prevalence of pre‐eclampsia and a high perinatal mortality.