bluuebunny/crossref_metadata_2025_split huggingface dataset:
Corpus cavernosal relaxation in impotent men
Authors: PICKARD R.S. , KING P. , ZAR M.A. , POWELL P.H. 
Published: November 2008

ObjectiveTo investigate smooth muscle responsiveness in isolated preparations of corpus cavernosum from men with vasculogenic impotence.Patients and methodsBiopsies of corpus cavernosum were obtained from 63 men undergoing penile surgery. These included a control group of eight men (mean age 59 years, range 38–82) undergoing penile amputation for carcinoma, 47 men with vasculogenic impotence (mean age 58, range 36–72) who were further sub‐divided into arterial (n = 9), venous (n = 24) or mixed arterial/venous (n = 14) impotence according to the results of pre‐operative haemo‐dynamic investigation, and eight men with non‐vasculogenic impotence (mean age 49 years, range 34–66). Smooth muscle contractile responses to a‐adrenoceptor activation and relaxant responses to stimulation of intrinsic nerves and exposure to papaverine and sodium nitroprusside were recorded in tissue strips prepared from the biopsies. Morphology was assessed histologically using haematoxylin and eosin staining of tissue sections together with immuno‐cytochemical labelling of intrinsic nerves.ResultsNerve‐evoked relaxation was markedly impaired in tissue from men with venous or mixed arterial/ venous impotence. A lesser degree of impairment was found in tissue from men with arterial impotence alone. Tissue from men with all types of vasculogenic impotence also showed a decreased contractile response to a‐adrenoceptor stimulation. The magnitude of relaxant responses to papaverine and sodium nitroprusside in the vasculogenic group was similar to that of the control. There were no differences in smooth muscle content or nerve density between the vasculogenic group and the control. In the non‐vasculogenic group responses to relaxant nerve stimulation, a‐adrenoceptor activation and relaxant drugs were similar to those of the control. Nerve density in this group was similar to the control but smooth muscle content was reduced.ConclusionsThe results of this study demonstrate a functional impairment of smooth muscle contractility and neurogenic relaxation in corpus cavernosum from impotent men with abnormal penile haemodynamics. Altered smooth muscle responsiveness is likely to be a factor in the aetiology of impotence in such men and may contribute to the relatively poor results of vascular surgery for impotence.
Peyronie's disease and congenital penile curvature: long‐term results of operative treatment with the plication procedure
Authors: NOOTER R.I. , BOSCH J.L.H.R. , SCHRODER F.H. 
Published: November 2008

Objective To evaluate the results of plication of the tunica albuginea in patients with a curved penis.Patients and methods Twenty‐two men with congenital penile curvatures and 33 men with acquired penile curvatures were treated by the plication technique. Their files were studied and all patients underwent a follow‐up interview and were physically examined. The mean age of the patients with congenital penile curvatures was 25.7 (range 17–58) and that of the men with acquired penile curvatures was 54.4 (range 28–67). The mean length of follow‐up was 42 months.Results The mean angle of deviation in relation to the longitudinal axis was 48.2d̀ in the congenital curvatures and 63.3d̀ in the acquired curvatures. AU congenital curvatures were corrected successfully, i.e. the penis was straight and satisfactory intercourse was possible. Slight shortening of the penile shaft was noticed by eight patients, but none was concerned about this finding. Pre‐operatively, 12 of 33 patients with acquired curvature were unable to have intercourse because of the combination of decreased rigidity and abnormal curvature. Of these patients, three were able to have satisfactory intercourse post‐operatively. Most of the nine patients with a poor result were known pre‐operatively to have adverse factors affecting erectile function. Of the 21 patients who were only able to have intercourse with difficulty pre‐operatively, intercourse was easier and more satisfactory in 18 and more difficult in three post‐operatively. Pre‐operative pain with erection improved in all patients. Complications were mild. Shortening concerned only two patients with recurrent Peyronie's disease after re‐operation.Conclusion Plication of the curved penis is a relatively simple, save and effective procedure.
Adenylate and guanylate cyclase activity in the penis and aorta of the diabetic rat: an in vitro study
Authors: MILLER M.A.W. , MORGAN R.J. , THOMPSON C.S. , MIKHAILIDIS D.P. , JEREMY J.Y. 
Published: November 2008

Objective To investigate the role of adenylate and guanylate cyclases in the mediation of erection in diabetic rats.Materials and methods Hyperglycaemic diabetes mellitus was induced in 3 5 rats using streptozotocin. Two months later the penises and aortae of these rats were excised and cut into rings or segments before being treated with varying concentrations of acetylcholine (Ach). sodium nitroprusside (NaNP), prostaglandin E1 (PGE1) and adrenaline (AD). The levels of adenosine 3'5′‐cyclic monophosphate (cAMP) and guanosine 3'5′‐cyclic monophosphate (cGMP) so generated were measured by radioimmunoassay and the results com‐ pared with those from seven age‐matched control rats that had not been given streptozotocin.Results Ach‐stimulated cGMP synthesis was impaired in the aortae in diabetic rats. Ach‐stimulated cGMP synthesis was undetectable in the penis. NaNP‐stimulated cGMP and PGE,‐stimulated cAMP synthesis was enhanced in both the penises and aortae in diabetic rats compared with controls. AD‐stimulated cAMP synthesis was enhanced in the aorta in diabetic rats compared with controls, but AD had no effect on CAMP synthesis in the penis.Conclusion Ach‐stimulated nitric oxide (NO) synthesis is impaired in the vasculature of diabetic rats and an Ach‐NO axis may not be present in the penis of the rat. The enhanced capacity of the penis and vasculat‐ ure to generate cAMP and cGMP may constitute an adaptive response to counteract the reduction in recep‐ tor‐linked NO release. Impaired adenylate or guanylate cyclase activity does not contribute to erectile dysfunc‐ tion in diabetic rats.
Laparoscopic procedure for varicocelectomy
Authors: MISCHINGER H.J. , COLOMBO T. , RAUCHENWALD M. , ALTZIEBLER S. , STEINER H. , VILITS P. , HUBMER G. 
Published: November 2008

Objective To report the results of laparoscopic varicocelectomy, a new surgical technique which presents minimal risks and provides an effective management of clinical varicoceles.Patients and methods Between July 199 1 and November 1992, 45 laparoscopic varicocelectomies were performed in 44 patients whose ages ranged from 11 to 41 years. Endoscopic ligation, carried out according to the technique described by Palomo [1], was performed in 14 patients. In the remaining 30 patients ligation of 31 spermatic veins was performed according to Bernardi's procedure [2].Results On post‐operative follow‐up symptoms disappeared in all the patients treated. Two of the patients showed persistent venous reflux on colour Doppler ultrasound examination.Conclusions The excellent identification of the anatomical structures, the minimal surgical trauma, the decrease in post‐operative morbidity and the quick convalescence of the patients have made this new technique a viable alternative to routine open high ligation.
The nutcracker syndrome: new methods of diagnosis and treatment
Authors: SHOKEIR A. A. , EL‐DIASTY T. A. , GHONEIM M. A. 
Published: November 2008

Objective To study the pathophysiology of the nutcracker syndrome and to describe a new method of treatment.Subjects and methods Computerized tomography (CT) was used to compare the anatomical relations of the left renal vein with the aorta and the superior mesenteric artery in three patients with the nutcracker syndrome and in a control group of 12 healthy kidney donors.Results Abnormal branching of the superior mesenteric artery from the arota was identified as the cause of the nutcraker syndrome. Two patients were treated by autotransplantation of the left kidney, while the third refused surgery. In the treated patients haematuria ceased 4 and 6 weeks after surgery. Postoperative excretory urography and repeated isotopic studies revealed perfect configuration and function of the autotransplanted kidneys. The patients remain asymptomatic 6 and 12 months after surgery.Conclusion In patients with haematuria from the left kidney, angiographic CT must be considered before phlebography and pressure measurement of the left renal vein. If the diagnosis of the nutcracker syndrome is established, autotransplantation of the left kidney is a treatment alternative.
A comparison between digitally‐guided fine needle aspiration and ultrasound‐guided transperineal core needle biopsy of the prostate for the detection of prostate cancer
Authors: ENGELSTEIN D. , MUKAMEL E. , CYTRON S. , KONICHEZKY M. , SUTZKI S. , VADIO C. SER 
Published: November 2008

Objective To prospectively examine the accuracy of fine needle aspiration (FNA) for the detection of prostate cancer. Ultrasound‐guided core needle biopsy of the prostate was used as the standard to which the FNA results were compared.Patients and methods One‐hundred patients who had been referred for urological evaluation were suspected of having prostate cancer on the basis of digital rectal examination (DRE) and/or transrectal ultrasound (TRUS). All were further evaluated by digitally guided transrectal FNA and by TRUS‐guided transperineal core needle biopsy.Results Prostate cancer was identified in 54 patients by core needle biopsy and in 45 by FNA. The sensitivity of FNA was 81% and both specificity and positive predictive value were 98%.Conclusion FNA is easily performed, has negligible morbidity and offers prompt results. These data suggest that FNA is a reasonable initial diagnostic procedure for the detection of prostate cancer. Core needle biopsy may be reserved for patients with negative cytology who are clinically suspected of having prostate cancer. In selected patients, FNA may be used as an alternative to core needle biopsy for diagnosis, treatment planning and follow‐up.
Laparoscopy in 100 consecutive patients with 128 impalpable testes
Authors: Cortes D. , Thorup J.M. , Lenz K. , Beck B.L. , Nielsen O.H. 
Published: November 2008

Objective To investigate the value of laparoscopy in boys with impalpable testes, to carry out a histological examination of testicular biopsies or orchidectomy specimens, and to present a clinical description of boys with impalpable testes. Patients and methods One hundred consecutive patients underwent laparoscopy for 128 impalpable testes. They ranged in age from 2.7 to 19.3 years (median 10.8). Histological examination was performed on 39 testicular biopsies, nine primarily orchidectomized testes and 13 tissue samples from the end of blind‐ending vessels and vasa deferentia. Any additional diagnoses to that of impalpable testes were recorded. Results There were no complications associated with laparoscopy and the procedure clarified the situation in all patients. In 50% of patients either blind‐ending cord structures above the internal inguinal ring or intra‐abdominal testes were identified; in the remainder, cord structures could be seen passing through the ring, indicating an intracanalicular testis. The impalpable testis was absent in 77% of patients with a contralateral scrotal testis. A seminoma was found in one 18.6‐year‐old patient with bilateral cryptorchid‐ism. No intratubular germ cell neoplasia (carcinoma in situ) was found. Germ cell hypoplasia or aplasia was demonstrated in 95% of patients with testicular parenchyma. Additional diagnoses were made in 49% of patients with bilaterally undescended testes (one or both of which were impalpable). Conclusion We recommend laparoscopy as a safe procedure which leads to a diagnosis in patients with impalpable testes; the advent of laparoscopic procedures makes definitive treatment possible in about 50% of such patients. Open procedures will be indicated only to ascertain the quality and treatment of intracanalicular testes.
A comparative optical analysis of laser side‐firing devices: a guide to treatment
Authors: Anson K. , Buonaccorsi G. , Eddowes M. , MaCrobert A. , Mills T. , Watson G. 
Published: November 2008

Objective To compare the optical characteristics of five different laser side‐firing fibres used to perform deep laser coagulation of the prostate. Materials and methods The intensity profile, angle of exit and beam divergence from the launch fibre were measured underwater (to simulate endoscopic conditions) for each fibre using both the Helium Neon(633 nm) and Nd:YAG(1064 nm) lasers. Results The intensity profiles and spot sizes varied among fibres but broadly fell within two groups characterized by large and small footprints (low and high power density). There was a maximum 5.5 fold difference in average power densities between the fibres. Conclusions Not all side‐firing devices are the same. Variations in the power density profiles among the fibres suggest that the choice of fibre is of critical importance in determining the type of laser tissue interaction (i.e. coagulation or vaporization) that will follow the use of that fibre.
Post‐operative risk factors associated with artificial urinary sphincter infection‐erosion
Authors: Martins F.E. , Boyd S.D. 
Published: November 2008

Objective To determine the incidence of infection‐erosion associated with the implantation of artificial urinary sphincters (AMS 800) in a high‐risk group of patients (post‐major pelvic surgery/radio therapy), and to emphasize the commonly neglected risk factors associated with this complication. Patients and methods One‐hundred‐and forty‐five male patients aged 55–79 years (mean 71) who had had an AMS 800 artificial sphincter implanted between January 1987 and November 1993 were reviewed. All patients had undergone meticulous surgical technique, intra‐operative shave and rigorous scrub, and were given peri‐operative antibiotics. The mean follow‐up was 34.3 months (range 1–83). Results Infection‐erosion occurred in 13 patients (9%), of whom 10 are currently available for follow‐up. One atient died of his underlying disease (bladder cancer) and two were lost to follow‐up. AH 13 patients had undergone radical pelvic surgery (radical retropubic prostatectomy, radical cystectomy and abdomino‐perineal resection); seven patients had also received radiation therapy. Cultures of the infected AMS 800 devices revealed a pleomorphic group of organisms, specifically enteric, Gram‐positive and anaerobic organisms. The risk of infection‐erosion was found to be increased in the presence of two main factors, improper urethral catheterization and urethral endo‐scopic manipulation with an activated AMS 800 artificial sphincter in place and exposure to radiation. At the time of revision, nine of the 13 patients were found to have positive urine cultures. Conclusion Despite all the precautions taken, there remains a group of patients who are still at a higher risk of infection‐erosion due to adverse circumstances that distort the anatomy of the perineal area, impair the host defence mechanisms, and ultimately enable the establishment of the infection‐erosion complex. Radiotherapy is known to increase the likelihood of non‐mechanical complications, specifically infection‐erosion. Extreme care must be taken so that avoidable iatrogenic factors such as improper urethral catheterization and endoscopic manipulation with an activated AMS 800 device in situ are not the cause of ‘failure’.
Periurethral implantation of glutaraldehyde cross‐linked collagen (contigen®) in women with type I or III stress incontinence: quantitative outcome measures
Authors: Moore K.N. , Chetner‐ M.P. , Metcalfe J.B. , Griffiths D.J. 
Published: November 2008

Objective To evaluate the effectiveness of periurethral collagen (Contigen®) implantation as a treatment for stress incontinence, using quantitative measures of urine loss and the patients' subjective response. Patients and methods Twelve women, age range 46–87 years, had video urodynamic testing—confirming Type I or m stress urinary incontinence and were eligible for periurethral collagen implant. Eleven had had at least one anti‐incontinence operation. One woman was withdrawn from the study because of a severe subcutaneous skin reaction 21 days after the skin‐test and one patient declined follow‐up. Ten patients had up to two implants each, introduced 3–5 months apart under local anaesthetic (5 mL collagen per implant). All patients underwent 10 h pad tests (with 2‐hourly pad changes) at baseline and 8 weeks after collagen implant. The following quantitative measures of incontinence severity and voiding function were studied: urine loss during the 10 h test, number of wet pads, weight of urine in the wettest pad, maximum voided volume, residual volume on ultrasound, maximum flow rate and urinary flow curve pattern. Blind to the quantitative results, patients were asked to categorize their outcome as cured, improved and failed. Results There was a significant decrease in urine loss (P= 0.007), number of wet pads (P= 0.05) and weight of the wettest pad (g) (P= 0.03) from baseline to 8 weeks after the second collagen implant. There was no significant difference at any point in maximum voided volume, maximum urinary flow rate and residual volume after voiding measured on ultrasound. Objectively, two women appeared cured (< 5 g urine loss on 10 h pad test); subjectively, both reported themselves as improved (not cured); one subject stated she was cured and on pad test had 11 g urine loss; two women stated there was no change yet urine loss decreased markedly by > 60% from 434 g to 123 g and 533 g to 199 g. The remaining six stated they were improved although, objectively, their urine loss after the collagen implant remained high (mean 132 g, range 87–185). Conclusion These Results show a significant reduction in urine loss at 8 weeks after the second collagen implant and an Objective cure rate of 18%. There was little relationship between the Objective measure of success and the self‐report. Of interest is the fact that no obstructive changes occurred in the voided amount, the flow curve and the residual volume after voiding.
Experience with ureteroscopy in children
Authors: Shroff S. , Watson G.M. 
Published: November 2008

Objective To present our experience of ureteroscopic procedures in children using miniaturized instrumentation. Patients and methods Fourteen children aged between 13 months and 14 years underwent 20 ureteroscopic procedures. Semi‐rigid 7.2 F and flexible 9.5 F uretero‐scopes were used in a retrograde and an antegrade fashion. Eighteen ureteroscopies were performed retro‐gradely and two antegradely. Of the 20 ureteroscopic procedures, 18 were for stone disease, one for haema‐turia of unknown origin and one for removal of a migrated stent. The average size of the stone was 12.9 × 6.6 mm. Results Access using miniaturized ureteroscopes was successful in all patients. Dilatation was required only in 1 of 20 procedures. The management of stone disease in 10 of 13 children was straightforward and a single ureteroscopy was required to clear the ureters. In three of 13 children with stone disease the problems were more complex and nine ureteroscopies were undertaken to render the ureters stone free. Complications were stricture at the site of stone impac‐tion (one patient), retention of urine due to a stone fragment in the urethra (one patient), haematuria (one patient) and migrated stent requiring ureteroscopy (one patient). Conclusion In the hands of an experienced surgeon ureteroscopy can be used with equal success in children as in adults to treat calculus disease.
Helping Smokers Quit: Understanding the Barriers to Utilization of Smoking Cessation Services
Authors: GOLLUST SARAH E. , SCHROEDER STEVEN A. , WARNER KENNETH E. 
Published: November 2008

Context:Counseling smokers to quit smoking and providing them with pharmaceutical cessation aides are among the most beneficial and cost‐effective interventions that clinicians can offer patients. Yet assistance with quitting is not universally covered by health plans or offered by all clinicians. Analysis of stakeholders' perspectives and interests can identify the barriers to more widespread provision of cessation services and suggest strategies for the public policy agenda to advance smoking cessation.Methods:Review of literature and discussions with representatives of stakeholders.Findings:All stakeholders—health plans, employers, clinicians, smokers, and the government—face barriers to broader smoking cessation activities. These range from health plans' perceiving that covering counseling and pharmacotherapy will increase costs without producing commensurate health care savings, to clinicians' feeling unprepared and uncompensated for counseling. Like other preventive measures aimed at behavior, efforts directed at smoking cessation have marginal status among health care interventions. State governments can help correct this status by increasing Medicaid coverage of treatment and expanding coverage for state employees. The federal government can promote the adoption of six initiatives recommended by a government subcommittee on cessation: set up a national quit line, develop a media campaign to encourage cessation, include cessation benefits in all federally funded insurance plans, create a research infrastructure to improve cessation rates, develop a clinician training agenda, and create a fund to increase cessation activities through a new $2 per pack cigarette excise tax. Both the federal and state governments can increase cessation by adopting policies such as the higher cigarette tax and laws prohibiting smoking in workplaces and public places.Conclusions:Public policy efforts should assume greater social responsibility for smoking cessation, including more aggressive leadership at the state and federal levels, as well as through advocacy, public health, and clinician organizations.
Characterization of natural gases in Japan based on molecular and carbon isotope compositions
Authors: WASEDA A. , IWANO H. 
Published: November 2008

AbstractIn this paper, the origin, maturity, migration, biodegradation and mixing of natural hydrocarbon gases in Japan have been interpreted using molecular and carbon isotope compositions. No indications of abiogenic gases have been found, the gases being classified as microbial, thermogenic or mixed microbial/thermogenic. However, secondary alteration (mixing, biodegradation, fractionation in migration processes) has had a major but variable impact on the composition of natural gases. Biodegradation, especially, has altered both molecular and isotopic signatures. Thus, the prime control of isotopic and molecular characteristics in gases is due to genetic phenomena, but secondary effects must be taken into account when attempting to understand the origin and distribution of gas. Where the extent of secondary alteration is small, carbon isotope compositions of thermogenic hydrocarbons are controlled largely by maturity. An isotope model developed by Berner and Faber was applied successfully to natural gases in northeast Japan. Besides maturity estimation, the application of the model enables detection of biodegradation, mixing between microbial and thermogenic gases, and mixing among gases with different maturities. The carbon isotope compositions of carbon dioxide also provide information for their genetic origins.