bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Hutson Hypothesis A Clinical Study
Authors: SCOTT J. E. S. 
Published: December 2008

Summary— The hypothesis that testicular descent may be governed by Müllerian inhibiting substance (MIS) was investigated by observing the position of the testes in 13 children with XY karyotype and persistent Müllerian duct syndrome (PMDS). It was found that there was a direct relationship between failure of testicular descent and the degree of development of the Müllerian system. Where the Müllerian system was complete, the testes were in an ovarian position but where only the vagina was present, the testes were sometimes found in the inguinal region.To discover whether excessive androgen activity in females might produce ovarian descent, the position of the ovaries in 15 children with severe adrenogenital syndrome was observed. Despite complete genital masculinisation in three children and almost complete in six, all but one ovary was in the normal position: that ovary had descended in an inguinal hernia sac.These findings suggest that MIS rather than androgens may be responsible for the first or abdominal phase of testicular descent. Even excessive androgen activity failed to cause ovarian descent.
Acute Ureteric Dilatation for Ureteroscopy An Experimental Study
Authors: BODDY SU‐ANNA M. , NIMMON C. C. , JONES S. , RAMSAY J. W. A. , BRITTON K. E. , LEVISON D. A. , WHITIFIELD H. N. 
Published: December 2008

Summary— The effects of three methods of acute ureteric dilatation (by graded Teflon dilators, low and high pressure balloon dilators) were evaluated radiologically, renographically and histologically in minipigs. The minipig ureter was dilated from its normal calibre of 4 F to 10 F.All three methods caused upper urinary tract dilatation and an obstructive nephropathy which had not resolved 96 h after dilatation. Histology at 24 h showed destruction of the transitional epithelium, with inflammation throughout the ureteric wall. Four weeks after dilatation the ureter was still dilated and urothelial nests were seen in the lamina propria and in the muscle coats. There was no evidence of ischaemic necrosis or ureteric stricture formation. The implications of these findings for clinical practice are discussed.
Urinary Undiversion in Young Adults
Authors: CUMMING J. , COX R. , WOODHOUSE C. R. J. 
Published: December 2008

Summary— Eighteen patients who underwent urinary diversion in childhood were undiverted. There were three main groups: the neurologically intact bladder, the neuropathic bladder and the “occult” neuropathic bladder. The simplest procedure of anastomosing the proximal ureters to the distal ureters was preferred. The neuropathic group required excision of the bladder remnant and substitution with detubularised bowel.In four patients the renal function was progressively deteriorating pre‐operatively and two have required transplants. Renal failure in one of these patients was accelerated by a post‐operative anastomotic stenosis and infection, although his early post‐operative course was uneventful.
Bulbocavernosus Reflex Latency in the Investigation of Diabetic Impotence
Authors: PARYS B. T. , EVANS C. M. , PARSONS K. F. 
Published: December 2008

Summary— Impotence in males is a well recognised complication of diabetes mellitus, commonly held to be due to an autonomic neuropathy. The aim of this study was to determine the incidence of periphero‐conus neuropathy in diabetic impotence.Nineteen diabetic males seeking treatment for loss of potency had bulbocavernosus reflex latency (BCRL) and sacral reflex latencies (SRLs) performed. The conduction studies indicated that impotence in these cases was associated with peripheral neuropathy in 21% of patients and that BCRL and SRLs are sensitive and useful diagnostic tests.
Long‐term treatment of benign prostatic hyperplasia with alfuzosin: a 24–30 month survey
Authors: JARDIN A. , BENSADOUN H. , DELAUCHE–CAVALLIER M. C. , STALLA–BOURDILLON A. , Group P. ATTALI BPHALF 
Published: December 2008

Objective To address the long‐term results of alfuzosin. an α1‐antagonist, in patients with benign prostatic hyperplasia (BPH).Patients and methods A 6‐month, placebo‐controlled study involving 518 patients was followed by two successive one‐year, open extensions. Only centres who wished to continue the trial participated in the extensions: 131 patients entered the first extension, with 50 continuing into the second year extension. The results of the second year follow‐up are presented here.Results Depending on their initial randomization to either the placebo or alfuzosin arm, patients were treated with alfuzosin for 24 (n=50) or 30 months (n=22). The data collected on those 50 patients in comparison to baseline confirmed that the clinical efficacy observed in short/medium‐term studies was maintained. A clinically significant improvement in urinary symptoms was observed: the Boyarsky score decreased from 8.7 (± 0.3) at baseline to 5.2 (±0.3) at 24 months, with no deterioration in the objective parameters. In patients treated for 30 months (n=22). symptomatic assessment and urodynamic parameters remained stable, indicating the sustained effectiveness of therapy. No serious or unexpected sideeffect related to long‐term exposure to alfuzosin was observed. No complications associated with BPH occurred. Two patients (4%) reported dizziness, neither of whom withdrew from the study. In this population, where 40% of patients were receiving concomitant cardiovascular therapy, no clinically significant change in standing systolic blood pressure, diastolic blood pressure or heart rate was apparent between baseline data and those at 24 months.Conclusion These data demonstrate the usefulness of long‐term treatment with alfuzosin in patients with uncomplicated, moderate BPH.
Alpha1‐adrenoceptor subtypes in the human prostate
Authors: CHAPPLE C.R. , BURT R.P. , ANDERSSON P.O. , GREENGRASS P. , WYLLIE M. , MARSHALL I. 
Published: December 2008

Objective To determine the subset of α1‐adrenoceptors mediating the functional abstraction of the prostate to noradrenaline.Materials and methods Radioligand experiments were performed with membranes prepared from rat 1 fibroblasts trasfected with rat α1a, hamster α1b or bovine α1c adrenoceptor cDNA. Human prostatic tissue obtained from transurethral resection of the prostate with full informed consent was submitted to functional in vitro muscle strip experiments.Results The binding experiments defined the potential subtype selectivity of various antagonists. Using this information, it was possible to define the functionally important α1‐adrenoceptor subtype in the human prostate.Conclusion This work reports the results of the first functional characterization of the α1c‐adrenoceptor subtype. The most functionally important α1‐ceptor type in the human prostate appears to be the α1c subtype. This finding may aid the development of prostate‐selective adrenoceptor pharmacotherapy.
The diagnostic value of colour Doppler flow in the peripheral zone of the prostate, with histological correlation
Authors: PATEL U. , RICKARDS D. 
Published: December 2008

Objective To study the discriminative value of the amount of colour flow on Doppler ultrasound within the peripheral zone of the prostate.One‐hundred and twenty three men were studied using a 7 MHz transrectal probe, and 274 guided biopsies were undertaken. With each biopsy histological outcome was correlated with the grade of colour flow on ultrasound hard copy images. Biopsies with inflammatory cell infiltration, but without carcinoma, were subgraded according to the degree of inflammatory cell infiltration: and these grades were correlated with the corresponding colour flow grade.Results Normal clour flow was seen with both normal and abnormal prostate biopsy. With increases; the highest grade of colour flow the likelihood of abnormal tissue increases: the highest grade of colour flow was seen with either carcinoma or prostatis (grade 0, 1, 2 and 3 colour flow=23%, 65%, 74% and 100% respectively of biopsies that were abnormal). In biopsies with inflammatory cell infilitation there was no linear relationship between the grades of colour flow and cellular infilitration (r=0.52, P>0.05, Kendall rank correlation). The mean grade of cellular infiltration was significantly greater in samples with grade 3 colour flow compared with grades 0–2.Conclusion Grading of the amount of colour flow with Doppler ultrasound is of limited diagnostic discrimination, although with the greatest colour flow specificity for the diagnosis of abnormal prostate (either cancer or prostatitis) is very high. With Prostatitits, markedly increased colour flow reflects the severity of inflammatory cellular reaction.
Transrectal ultrasound versus magnetic resonance imaging in the estimation of prostatoc volume
Authors: AL‐RIMAWI M. , GRIFFITHS D.J. , BOAKE R.C. , BOAKE D.R. , JOHSON M.A. 
Published: December 2008

Objective To establish which method of determining prostatic volume (transrectal ultrasound[TRUS] or magnetic resonance imaging [MRI] and which calculation formula give the most exact and least variable results: to determine the size and the source of the variability: and to establish which method is the more sensitive to drug‐induced changes in prostate volume.Patients and methods Prostatic size was estimated by TRUS and MRI in 21 patients treated medically (either active treatment or placebo) for benign prostatic hyperlasia. Each patient was examined at baseline and after 3 months and 6 months of treatment. Prostatic volume was calculated at every visit using different formulae proposed in the literature.Results With some of these formulae, including the classical ellipsoid formula there was a strong correlation (r>0.8) between TRUS and MRI volume estimates. For others the correlation was much weaker, suggesting unreliability. MRI gave a significantly larger volume than TRUS because of larger values for the cephalocaudal and anteroposterior diameters. For patients on placebo the visit‐to‐visit variability of the prostate volume was 10–12% of the mean volume. whether calculated by TRUS or MRI. Part of this variability was apparently due to natural variation of prostate size.Conclusion The classical ellipsoid formula is adequate for determining prostate volume, MRI and TRUS give different volumes. Visit‐to‐visit variability is similar for both methods and is partly due to real, natural variation. MRI is better able than TRUS to detect drug‐induced changes in prostate volume.
Three‐dimensional imaging of the prostatic urethra—an exciting new tool
Authors: NG K.J. , Gardener J.E. , RICKARDS D. , LEES W.R , MILORY E.J.G. 
Published: December 2008

Objeactive To evalute the technique of three‐dimensional (3‐D) ultrasound imaging of the urethra and its application in both research and clinical practice.Patients and techniques The study involved 23 patients: 10 with benign prostatic hyperplasia, four with urethral strictures, three post‐insertion of prostatoc stents, one with bladder neck dyssuyner, three post‐transurethral resection of the prostate, and two with non‐urological conditions. A transrectal ultrasound scan was initially performed to acquire a series of images of the urethra. These images were then reconstruicted into a 3‐D format.Results The 3‐D image of the urethra could be rotated on screen and viewed from any angle. The image could also be sliced at any plane to reveal the sectional view.Conclusion This new tool represents a major advance in imaging techniques and promises to provide new knowledge in understanding the hydrodynamics of knowledge in understanding the hydrodynamics of the lower urinary tract. The precise geometry of the 3‐D urethra will also help in the design of new stents.
Perineal versus retropubic radical prostatectomy for T1, T2 prostate cancer
Authors: HAAB F. , BOCCON‐GIBOD LAURENT , DELMAS V. , BOCCON‐GIBOD LILIANNE , TOUBLANC M. 
Published: December 2008

Objective To compare retrospectively the efficacy of radical perineal and retropubic prostatectomy in patients with T1, T2 cancer of the prostate.Patients and methods From January 1991 to January 1993, 71 patients with T1, T2 carcinoma of the prostate aged 52–74 years underwent radical retropubic prostatectomy (36) or radical perineal prostatectomy (35); this was preceded by endosurgical lymphadenectomy. The two groups were identical with regard to age (64 vs 66 years), clinical stage (Tla 17% vs 25%, T2 82% vs 74%), mean and median pre‐operative prostate‐specific antigen (PSA) (20 vs 26, 11 vs 15 using the YANG polyclonal assay n<2.5 ng/ml). Radical retropubic prostatectomy and radical perineal prostatectomy were performed using standard procedures. Specimens were inked and analysed: operative time, volume of blood transfusions, duration of hospital stay, peri‐operative complications, sexual function, urinary continence and quality of the specimens were assessed retrospectively.Results Both groups were identical as far as operation time, hospital stay, complications (one rectal injury in each group), specimen weight and pathology were concerned. The proportions of organ‐confined (54% in radical perineal prostatectomy group vs 55% in radical retropubic prostatectomy group) and margin‐positive cancers (37% in radical perineal prostatectomy group vs 39% in radical retropubic prostatectomy group) were identical. The volume of blood transfusion was significantly less in the radical perineal prostatectomy group: 54% required transfusion compared with 100% in the radical retropubic prostatectomy group), 7% of radical perineal prostatectomy patients received homologous transfusion vs 38% of the radical retropubic prostatectomy patients: 11 and 3% of the patients were potent 3–6 months after surgery. Two anastomotic strictures developed after radical retropubic prostatectomy and none after the radical perineal prostatectomy. Continence was achieved at 3 months in 71% of the radical perineal prostatectomy group and in 82% of the radical retropubic prostatectomy group; by 6 months 88% of the patients were dry in both groups.Conclusion When nodal status has been assessed by lymph node dissection (open or endosurgical), radical perineal prostatectomy is a reasonable, minimally invasive alternative to radical retropubic prostatectomy provided that impotence and a slower return to full continence are accepted.
Conservative management with symptomatic treatment and delayed hormonal manipulation is justified in men with locally advanced carninoma of the prostate
Authors: RANA A. , CHISHOLM G. D. , KHAN M. , RASHWAN H. M. , ELTON R. A. 
Published: December 2008

Objective To examine the clinical course following surveillance and symptomatic treatment, and compare the outcomes of immediate and delayed hormonal treatment in men with locally advanced prostatic cancer.Patients and methods Of a consecutive series of 199 men (mean age 74 years) with T2‐T4 Nx MO prostatic cancer, 110 (55%) were followed until death and the rest had a mean follow‐up of 4.2 years. Fifty‐one men received immediate orchidectomy, 88 had this treatment delayed until metastatic progression, and 60 had the treatment in the intervening period. The actuarial survival was compared with the expected survival for an age‐matched healthy population in Scotland. The adjusted effect of the timing for hormonal manipulation was assessed by including it with age, Gleason score and clinical stage in a multiple Cox regression.Results The actuarial survival for the whole group was 17% less at 5 years and 15% less at 10 years when compared with the expected survival for an age‐matched population in Scotland. This was despite the fact that their nodal status was unknown and also those with occult metastasis (elevated serum prostatic acid phosphatase, M1a) at presentation were not excluded. In terms of metastatic progression, overall survival and cause‐specific survival, there was no significant difference between immediate and delayed hormonal treatment.Conclusion A conservative approach with surveillance and symptomatic treatment for locally advanced prostatic cancer is justified by the present evidence on disease progression and survival, which do not differ from alternative methods of treatment as reported in contemporary literature. This study has the limitations relative to the ideal of a prospective randomized trial on immediate versus delayed hormonal treatment, but the lack of significant differences in outcome even after adjustment for other established prognostic factors does suggest that there may be little to be gained from an immediate orchidectomy.
The management of bilateral ureteric obstruction and renal failure in advanced prostate cancer
Authors: PAUL A. B. , LOVE C. , CHISHOLM G. D. 
Published: December 2008

Objectives To investigate the effect of upper tract decompression on the prognosis of uraemia secondary to bilateral ureteric obstruction in prostate cancer, with particular reference to the hormone dependency of the tumour.Patients and methods Prospectively collected data, over the period 1978–1993, were selected from the departmental database and from hospital case code data. Inclusion criteria were: blood urea ≥15 mM, radiological evidence of bilateral ureteric obstruction, a histological diagnosis of prostate cancer, and the exclusion of out‐flow tract obstruction. Of the 820 patients recorded in the departmental database, 27 (3.3%) fulfilled the criteria. Thirty‐six patients were identified in total. Statistical analysis was by the Mann‐Whitney non‐parametric test.Results Of the 36 patients with bilateral ureteric obstruction and renal failure, in those in whom androgen depletion had been undertaken after ureteric obstruction (i.e. androgen depletion was a treatment option), the mean survival was 646 days (n=12, SD=786). Among these patients upper tract decompression improved survival and reduced the amount of time patients spent in hospital. In those in whom androgen depletion had been carried out before obstruction (i.e. the tumour had escaped from hormonal control), survival was significantly worse (80 days, n=24, SD=86.8, P<0.01.) In this group the use of decompression improved survival little. Percutaneous nephrostomy was the commonest means of decompression (nephrostomy, 9: stent, 5: ureteroneocystostomy, 2).Discussion In patients for whom hormonal therapy remains an option, upper tract decompression offers a worthwhile improvement in terms of increased survival and reduced in‐patient time. However, if ureteric obstruction is diagnosed after hormone manipulation has been used, upper tract decompression has little effect on survival and should only be used in exceptional circumstances.
Walk‐in, walk‐out day case genito‐scrotal surgery with sedation reversal. A survey of patient attitudes and morbidity
Authors: BIRCH B. R. P. , MILLER R. A. 
Published: December 2008

Objective To survey patient attitudes and assess the extent of patient morbidity in the first 24 h follwoing walk‐in, walk‐out day case genito‐scrotal surgery with sedation reversal.Patients and methods One hundred patients who were undergoing genito‐scrota1 surgery were eligible for inclusion in the study. All patients walked into theatre, positioned themselves on the operating table and were sedated with intravenous (i.v.) midazolam (Hypnovel, Roche Products Ltd, Welwyn, UK) following which the appropriate local anaesthetic block was performed. One minute before the end of surgery sedation was reversed with an i.v. injection of 0.5 mg flumazenil (Anexate, Roche Products Ltd). When conscious and alert (approx. 2 min), patients were allowed to get themselves up off the operating table and walk from theatre. All patients were given a questionnaire to complete and were reviewed 2 weeks after surgery.Results Eighty‐six of 100 patients returned questionnaires. Fifty‐five patients were asymptomatic and no patient experienced nausea or vomiting in the first 24 h post‐operatively. Other symptoms such as headache (2%), drowsiness (20%) and dizziness (11%) were uncommon and significantly less frequent than seen with general anaesthetic procedures. Seventeen patients described minor wound complications and one patient with a scrotal haematoma was readmitted for overnight observation. Nearly all patients (98%) expressed their satisfaction with the technique.Conclusion Walk‐in, walk‐out day case surgery as described is a well‐tolerated technique with a low morbidity and towards which patients have a positive attitude.
THE MORAL OBLIGATION TO CREATE CHILDREN WITH THE BEST CHANCE OF THE BEST LIFE
Authors: SAVULESCU JULIAN , KAHANE GUY 
Published: December 2008

ABSTRACTAccording to what we call the Principle of Procreative Beneficence (PB), couples who decide to have a child have a significant moral reason to select the child who, given his or her genetic endowment, can be expected to enjoy the most well‐being. In the first part of this paper, we introduce PB, explain its content, grounds, and implications, and defend it against various objections. In the second part, we argue that PB is superior to competing principles of procreative selection such as that of procreative autonomy. In the third part of the paper, we consider the relation between PB and disability. We develop a revisionary account of disability, in which disability is a species of instrumental badness that is context‐ and person‐relative. Although PB instructs us to aim to reduce disability in future children whenever possible, it does not privilege the normal. What matters is not whether future children meet certain biological or statistical norms, but what level of well‐being they can be expected to have.
ETHICAL DEBATE OVER ORGAN DONATION IN THE CONTEXT OF BRAIN DEATH
Authors: BRESNAHAN MARY JIANG , MAHLER KEVIN 
Published: December 2008

ABSTRACTThis study investigated what information about brain death was available from Google searches for five major religions. A substantial body of supporting research examining online behaviors shows that information seekers use Google as their preferred search engine and usually limit their search to entries on the first page. For each of the five religions in this study, Google listings reveal ethical controversy about organ donation in the context of brain death. These results suggest that family members who go online to find information about organ donation in the context of brain death would find information about ethical controversy in the first page of Google listings. Organ procurement agencies claim that all major world religions approve of organ donation and do not address the ethical controversy about organ donation in the context of brain death that is readily available online.
ARE MORAL PHILOSOPHERS MORAL EXPERTS?
Authors: GESANG BERNWARD 
Published: December 2008

ABSTRACTIn this paper I examine the question of whether ethicists are moral experts. I call people moral experts if their moral judgments are correct with high probability and for the right reasons. I defend three theses, while developing a version of the coherence theory of moral justification based on the differences between moral and nonmoral experience:The answer to the question of whether there are moral experts depends on the answer to the question of how to justify moral judgments. Deductivism and the coherence theory both provide some support for the opinion that moral experts exist in some way. I maintain – within the framework of a certain kind of coherence theory – that moral philosophers are ‘semi‐experts’.