bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prostate‐specific antigen velocity (PSAV): a practical role for PSA?
Authors: Thanigasalam Ruban , Mancuso Pascal , Tsao Kim , Rashid Prem 
Published: October 2009

AbstractBackground:  Prostate cancer is a leading cause of morbidity and mortality in Australian men. Early detection and treatment are critical to patient outcome, but detection is often difficult because of the limited accuracy of available tests. This paper assesses whether the use of prostate specific antigen kinetics has a practical use in the contemporary urological setting.Methods:  A Medline literature review was performed examining related articles on the commonly available tests for prostate cancer, what they mean, their limited accuracy in cancer detection, and how this accuracy can be improved.Discussion:  Detection of significant organ‐confined prostate cancer should be the goal of general practitioners and urologists alike. Prostate‐specific antigen and digital rectal examination are commonly used but lack specificity and sensitivity, especially for small organ‐confined cancers. The additional use of prostate‐specific antigen velocity may enhance the specificity and sensitivity of detection.
Elective gastrostomy, nutritional status and quality of life in advanced head and neck cancer patients receiving chemoradiotherapy
Authors: Morton Randall P. , Crowder Victoria L. , Mawdsley Robert , Ong Esther , Izzard Mark 
Published: October 2009

AbstractBackground:  Chemoradiotherapy for treatment of advanced head and neck cancer (HNC) is used to achieve organ preservation without compromising survival. Because chemoradiotherapy usually impacts adversely on nutritional and functional status, feeding by percutaneous endoscopic gastrostomy (PEG) is often part of the management regimen for these patients, but the presence of a PEG tube can also be associated with reduced quality of life (QOL). This study aimed to examine the factors associated with PEG insertion and the effects of PEG use on QOL and functional outcomes in HNC patients receiving chemoradiotherapy.Method:  Survey of 36 consecutive patients treated by primary chemoradiotherapy for HNC. Patient weight, age, tumour type, details of PEG insertion, feeding regimens and treatment were noted. The survey comprised the Performance Status Scale, the Functional Measure for Swallowing, Nutritional Mode and a self‐assessment of QOL.Results:  PEG insertion within 1 month of treatment was associated with smaller fall in body mass index at 12 months than PEG insertion 1 month or more after the start of the treatment (P < 0.05). Body mass index change was inversely correlated with health‐related quality of life and significantly related to lower speech and swallowing function scores. Longer PEG duration correlated with poorer performance status and swallowing function (P < 0.01). Longer PEG duration also predicted poorer overall QOL (P < 0.01) and poorer swallowing (P < 0.01) and speech (P < 0.05). Nutritional mode was related to overall QOL (P < 0.01).Conclusions:  Nutritional support for HNC patients undergoing chemoradiotherapy is an essential component of patient care. Early PEG insertion and shorter PEG duration are associated with more favourable QOL‐related outcomes.
Outcome following surgery for squamous cell carcinoma of the oesophagus
Authors: Yong En Loon C. , Han Xing Peng , Watson David I. , Devitt Peter G. , Jamieson Glyn G. , Thompson Sarah K. 
Published: October 2009

AbstractIntroduction:  This study was undertaken to determine the outcomes of patients treated for squamous cell carcinoma (SCC) of the oesophagus.Methods:  The study group consisted of 61 patients (median age: 64 years) with invasive SCC of the oesophagus who underwent resection between 1987 and 2007 in Adelaide, South Australia. Thirty‐two (52%) were female. Survival data were available for all patients. The log rank test was performed to identify prognostic factors for survival.Results:  The 5‐year overall survival rate was 33% (median: 24 months). Of 61 patients, 42 (69%) received neoadjuvant therapy prior to surgery. The overall resection rate was 95%. Significant post‐operative morbidity occurred in 47%, and the in‐hospital mortality was 5% (30‐day mortality: 3%). No overall survival benefit was seen in patients undergoing neoadjuvant therapy prior to surgical resection. However, patients who had a complete pathological response to neoadjuvant therapy had a better 5‐year survival than patients who did not receive neoadjuvant therapy: 47% versus 30%, respectively.Conclusions:  Oesophagectomy following neoadjuvant therapy for SCC of the oesophagus can be performed with low perioperative mortality. A complete response to neoadjuvant therapy was followed by an improved survival outcome.
Bilateral thoracoscopy, mediastinoscopy and laparoscopy, in addition to CT, MRI and PET imaging, are essential to correctly stage and treat patients with mesothelioma prior to trimodality therapy*
Authors: Alvarez John M. , Hasani Arman , Segal Amanda , Sterret Greg , Millward Michael , Nowak Ana , Musk William , Bydder Sean 
Published: October 2009

AbstractBackground:  Trimodality therapy (TMT; extrapleural pneumonectomy (EPP), chemotherapy and radiation therapy) offers the potential of optimal survival in selected patients with Brigham stage I–II epitheliod mesothelioma based on CT, MRI and PET scanning. We hypothesized that these scanning modalities were inadequate to accurately stage these patients.Methods:  Patients suitable for TMT, in addition to CT, MRI and PET scanning, prior to EPP, underwent bilateral thoracoscopy, mediastinoscopy and laparoscopy (surgical staging). Follow‐up CT scans were performed, six monthly, quality of life assessments yearly.Results:  From 1 June 2004 to 28 February 2007, 34 patients were referred; mean age was 66 years (range: 44–69). Surgical staging was performed in 30 patients; 24 patients were confirmed as Brigham Stage I–II. However, six were upstaged, five as stage IV disease (one contralateral chest, two contralateral chest and abdomen, two abdomen) and one as mediastinal node positive; two further patients were reclassified histologically (one sarcomatoid, one biphasic). These eight patients fared poorly, 50% dying within 1 year from mesothelioma. Following surgical staging, 3 patients declined further surgery; thus, 19 patients proceeded to surgery, 3 were unresectable and 16 received EPP. Follow‐up of all 34 patients is complete.Conclusion:  Surgical staging identified 26% of patients who would have received no benefit from TMT.
Mandibular ameloblastoma: clinical experience and literature review
Authors: Sham Eric , Leong James , Maher Rory , Schenberg Michael , Leung Michael , Mansour Alan K. 
Published: October 2009

AbstractBackground:  Ameloblastoma is a locally aggressive odontogenic tumour of the mandible and maxilla that, if neglected, can cause severe facial disfigurement and functional impairment. A thorough understanding of its clinicopathological behaviour is essential to avoid recurrence associated with inadequately treated disease. Currently, wide resection and immediate reconstruction is the treatment of choice in most cases of mandibular ameloblastoma. We present our experience in the management of this disease and review the current status of the literature.Method:  Retrospective review of all patients between 1996 and 2006 with histologically confirmed ameloblastoma. A literature review on the current understanding of this disease and its management is then presented.Results:  Six patients were identified, ranging between 23 and 54 years old. All were females. Two tumours involved the angle and posterior body of the mandible, one the angle and ramus, one the body and two the anterior mandibular. Four patients underwent mandibular reconstruction with free tissue transfer and two by non‐vascularized bone grafts. All procedures were successful. One patient developed deep vein thrombosis requiring anticoagulation. Another developed a collection at the mandibular surgical site requiring drainage. Satisfactory union was achieved in all cases with no evidence of recurrence. All patients had adequate cosmesis, masticatory efforts and speech.Conclusion:  Management of ameloblastoma remains a challenge and requires a thorough understanding of the behaviour of its different clinicopathological variants. We have found segmental mandibulectomy and immediate reconstruction to be an excellent treatment option in our series of patients.
The rise of research on futures in ecology: rebalancing scenarios and predictions
Authors: Coreau Audrey , Pinay Gilles , Thompson John D. , Cheptou Pierre‐Olivier , Mermet Laurent 
Published: October 2009

Ecology Letters (2009) 12: 1277–1286AbstractConcern about the ecological consequences of global change has increasingly stimulated ecologists to examine the futures of ecological systems. Studying futures is not only a crucial element of the interaction between science, management and decision making, but also a critical research challenge per se, especially because futures cannot be observed or experimented on. In addition, researchers can encounter methodological and theoretical difficulties, which make interpretations and predictions problematic. In the literature which deals with futures of ecological systems two main lines of research can be distinguished: a predictive approach, which dominates the literature, can be contrasted with a rarer number of studies that elaborate potential scenarios for ecological systems. Scenario approaches currently concern mainly contacts with stakeholders or decision makers, or the use of climate scenarios to derive projections about ecological futures. We argue that a new direction for ecological futures research could be explored by using ecological scenarios in combination with predictive models to further fundamental ecological research, in addition to enhancing its applied value.
The costs and benefits of fast living
Authors: Rose Karen E. , Atkinson Rebecca L. , Turnbull Lindsay A. , Rees Mark 
Published: October 2009

Ecology Letters(2009) 12: 1379–1384AbstractGrowth rates play a fundamental role in many areas of biology (Q. Rev. Biol., 67, 1992, 283; Life History Invariants. Some Explorations of Symmetry in Evolutionary Biology, 1993; Philos. Trans. R. Soc. Lond. B Biol. Sci., 351, 1996, 1341; Plant Strategies, Vegetation Processes, and Ecosystem Properties, 2002; Trends Ecol. Evol., 18, 2003, 471; Q. Rev. Biol., 78, 2003, 23; J. Ecol., 95, 2007, 926.) but the cost and benefits of different growth rates are notoriously difficult to quantify (Q. Rev. Biol., 72, 1997, 149; Funct. Ecol., 17, 2003, 328). This is because (1) growth rate typically declines with size and yet the most widely used growth measure – relative growth rate or RGR (conventionally measured as the log of the ratio of successive sizes divided by the time interval) – is not size‐corrected and so confounds growth and size, (2) organisms have access to different amounts of resource and (3) it is essential to allow for the long‐term benefits of larger size. Here we experimentally demonstrate delayed costs and benefits of rapid growth in seven plant species using a novel method to calculate size‐corrected RGR. In control treatments, fast‐growing plants benefited from increased reproduction the following year; however, fast‐growing plants subjected to an experimental stress treatment (defoliation) showed strongly reduced survival and reproduction the following year. Importantly, when growth was estimated using the classical RGR measure, no costs or benefits were found. These results support the idea that life‐history trade‐offs have a dominant role in life‐history and ecological theory and that the widespread failure to detect them is partly due to methodological shortcomings.
Dorsal onlay lingual mucosal graft urethroplasty for urethral strictures in women
Authors: Sharma Girish K. , Pandey Ashwani , Bansal Harbans , Swain Sameer , Das Suren K. , Trivedi Sameer , Dwivedi Udai S. , Singh Pratap B. 
Published: October 2009

Study Type – Therapy (case series) Level of Evidence 4OBJECTIVETo describe the technique and results of dorsal onlay lingual mucosal graft (LMG) urethroplasty for the definitive management of urethral strictures in women.PATIENTS AND METHODSIn all, 15 women (mean age 42 years) with a history suggestive of urethral stricture who had undergone multiple urethral dilatations and/or urethrotomy were selected for dorsal onlay LMG urethroplasty after thorough evaluation, from October 2006 to March 2008. After a suprameatal inverted‐U incision, the dorsal aspect of the urethra was dissected and urethrotomy was done at the 12 o’clock position across the strictured segment. Tailored LMG harvested from the ventrolateral aspect of the tongue was then sutured to the urethrotomy wound over an 18 F silicone catheter.RESULTSThe preoperative mean maximum urinary flow rate of 7.2 mL/s increased to 29.87 mL/s, 26.95 mL/s and 26.86 mL/s with a ‘normal’ flow rate curve at 3, 6 and 12 months follow‐up, respectively. One patient at the 3‐month follow‐up had submeatal stenosis and required urethral dilatation thrice at monthly intervals. At the 1‐year follow‐up, none of the present patients had any neurosensory complications, urinary incontinence, or long‐term functional/aesthetic complication at the donor site.CONCLUSIONLMG urethroplasty using the dorsal onlay technique should be offered for correction of persistent female urethral stricture as it provides a simple, safe and effective approach with durable results.
Treatment of long ureteric strictures with buccal mucosal grafts
Authors: Kroepfl Darko , Loewen Heinrich , Klevecka Virgilijus , Musch Michael 
Published: October 2009

Study Type – Therapy (case series) Level of Evidence 4OBJECTIVETo describe the reconstruction of long ureteric strictures using buccal mucosal patch grafts and to report the intermediate‐term functional outcome.PATIENTS AND METHODSBetween November 2000 and October 2006 reconstruction of seven long ureteric strictures using buccal mucosal patch grafts and omental wrapping was performed in five women (one with bilateral strictures) and one man. The surgical steps of stricture reconstruction and wrapping with omentum are described in detail. Stricture recurrence was defined as persistent impaired ureteric drainage as displayed by imaging techniques or the necessity to prolong JJ stenting. Patency rates and stricture recurrence‐free survival rates are provided.RESULTSWith a median follow up of 18 months five of the seven strictures were recurrence‐free. Graft take was good in all patients. In one asymptomatic patient, there was impaired ureteric drainage on the reconstructed side, and in one patient with reconstruction of both ureters prolonged JJ stenting of one side was necessary. In both patients, the impaired drainage was caused by persistent stricture below the reconstructed ureteric segments.CONCLUSIONSAt intermediate‐term follow‐up in a small group of patients with long ureteric strictures, treatment with buccal mucosal patch grafts and omental wrapping showed good functional outcome.
The effect of the approach to radical prostatectomy on the profitability of hospitals and surgeons
Authors: Lotan Yair , Bolenz Christian , Gupta Amit , Hotze Timothy , Ho Richard , Cadeddu Jeffrey A. , Roehrborn Claus G. 
Published: October 2009

Study Type – Therapy (economics analysis) Level of Evidence 2bOBJECTIVETo evaluate the profit margins for radical retropubic prostatectomy (RRP), laparoscopic radical prostatectomy (LRP) and robot‐assisted laparoscopic prostatectomy (RALP), and the effect on the reimbursement to the urologist, as there has been a dramatic increase in use of RALP, with the cost of the robot borne by hospitals.METHODSData on costs and payments to hospital and surgeon from 2003 to 2008 for RRP, LRP and RALP were obtained from the hospital and urology department. We determined the profit based on the difference between payments received and total cost.RESULTSBetween 2000 and 2008, 1279 RPs were performed at our private hospital. The introduction of RALP increased total number of RPs and replaced most RRPs. RRP represents the only procedure where payments exceed total costs. For RRP there was a significantly higher profit for patients with comorbidities. The type of payer had a large effect on profit. Medicare provides a small profit for RRP but a significant loss of >US$4000 for RALP. While all insurance companies resulted in losses for LRP and RALP, there was variability of almost $600/case for LRP and >$1400/case for RALP. RALP provided the highest reimbursement for the surgeon due to additional reimbursement for the S2900 code (use of robot).CONCLUSIONSThe introduction of RALP has increased the case volume at our hospital and improved profits for the surgeon. The hospital loses money on each LRP and RALP case compared with RRP, which provides a small profit.
Open renal biopsy: comorbidities and complications in a contemporary series
Authors: Stec Andrew A. , Stratton Kelly L. , Kaufman Melissa R. , Chang Sam S. , Milam Douglas F. , Herrell S. Duke , Dmochowski Roger R. , Smith Jr Joseph A. , Clark Peter E. , Cookson Michael S. 
Published: October 2009

Study Type – Therapy (case series) Level of Evidence 4OBJECTIVETo report the indications and outcomes of a contemporary series of patients with contraindications to percutaneous renal biopsies (PRBs) who had an operative RB (ORB), as although ORB is a relatively infrequent procedure, it remains an important and underreported operation.PATIENTS AND METHODSIn a retrospective review of patients who had an ORB we examined comorbidities, indications, and 30‐day morbidity and mortality. Preoperative comorbidities were stratified according to the Charlson comorbidity index.RESULTSIn all, 115 patients had ORB between 1991 and 2006 (mean age 48 years, range 18–83); 60% of the patients were American Society of Anesthesiologists class ≥3. The median Charlson comorbidity index score was 3, with a score of 0 in 20.9%, 1–2 in 27.8%, 3–4 in 30.4% and ≥5 in 20.9% of patients. Indications for an ORB included morbid obesity, failed PRB, coagulopathy, and solitary kidney. In all, 47.8% of patients had a serum creatinine level of <3.0 mg/dL, 34.8% of >3.0 mg/dL and 17.4% were dialysis‐dependent. There were 43 complications in 36 patients. The mortality rate after surgery was 0.8%. There were eight major complications in seven patients (6.1%) including cardiac arrest, stroke, sepsis, reoperation and re‐intubation. There were minor complications 34 times in 31 patients (27%), the most common being wound infection, pneumonia, intraoperative transfusion of >2 units, arrhythmia, postoperative retroperitoneal bleed, and seep vein thrombosis.CONCLUSIONSThis study shows that there are significant comorbidities in patients referred to urologists for an ORB. With a mortality rate of 0.8% and major and minor complication rates of 6.1% and 27%, respectively, the ORB, while infrequent, carries a significant risk in this population that should be included in preoperative decision making and used for patient counselling.
Real‐time polymerase chain‐reaction detection of pathogens is feasible to supplement the diagnostic sequence for urinary tract infections
Authors: Lehmann Lutz E. , Hauser Stefan , Malinka Thomas , Klaschik Sven , Stüber Frank , Book Malte 
Published: October 2009

OBJECTIVETo evaluate, in a prospective pilot study, the feasibility of identifying pathogens in urine using real‐time polymerase chain reaction (PCR), and to compare the results with the conventional urine culture‐based procedures.PATIENTS AND METHODSSevere urinary tract infections (UTIs) are frequent in critically ill patients in the intensive‐care unit (ICU) and in outpatients, and thus the reliable and fast identification of the bacteria is mandatory, but routine urine culture is time‐consuming and the therapeutic regimen is often calculated and not culture‐based. The study included 301 prospectively collected urine samples from 189 patients with suspected UTI, based in a university hospital in 2005, and included outpatients and those in the ICU. Urine culture with Cled‐, MacConkey‐ and malt extract agar of all samples was followed by microbiological identification of the pathogens in 98 samples with visible growth. In parallel, all samples were assessed using qualitative real‐time PCR‐based DNA detection and identification by labelled hybridization probes.RESULTSIn all, 15 dipstick culture‐negative samples showed positive pathogen DNA identification by PCR. By contrast, 17 PCR‐negative samples showed detectable pathogens by culture, of which 10 were not detectable on PCR because the identified pathogens were not represented in the probe panel. The sensitivity and specificity for detecting contaminated samples was 0.90 and 0.87, respectively. Overall, 95% of the mono‐infection pathogens and 57% of the multiple‐infection pathogens were detected concordantly with both methods.CONCLUSIONIn this prospective pilot study PCR‐based identification of pathogens was feasible for supplementing conventional culture methods for the diagnosis of UTI. The main advantage is the time saved in identifying the pathogens. The limited pathogen detection in multiple‐infection‐samples by PCR might be explained by competitive PCR amplification conditions.
Critical appraisal of technical problems with robotic urological surgery
Authors: Nayyar Rishi , Gupta Narmada P. 
Published: October 2009

Study Type – Therapy (case series) Level of Evidence 4OBJECTIVETo record the technical problems and complications associated with the use of da Vinci S robotic system (Intuitive Surgical, Sunnyvale, CA, USA) and to review previous reports.METHODSWe analysed our records for all machine‐ or instrument‐related errors during the course of 340 consecutive robot‐assisted urological operations at our centre from July 2006 to March 2009, using one robotic machine. The cause of the error (machine or human), troubleshooting methods and consequences of the errors were evaluated.RESULTSThe overall device failure rate was 10.9% (37/340). The most frequent technical problems were related to robotic instruments (23/37). Other failures included colour/hue changes in the console image, intermittent double vision, fused illuminator bulb and problems with the master tool‐manipulator device (hand‐piece unit), patient cart circuitry, patient‐side manipulator arm, closed‐circuit camera unit or camera cable. Of 37 problems, 28 (76%) were surmountable during the course of surgery. The overall conversions to standard open/laparoscopic procedure attributable to mechanical failures of the robot were 0.6% (2/340). There were no complications or direct harm to the patient in any case. Most faults could be corrected or bypassed with some addition to operating room time.CONCLUSIONSDespite an association of various types of new technical problems with robotic surgery, it provides a safe mode of minimally invasive surgery with very low conversion rates attributable to it, and no direct patient injury.