bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mutual Mentoring in Laparoscopic Urology – A Natural Progression from Laparoscopic Fellowship
Authors: Jones A , Eden C , Sullivan ME 
Published: May 2007

INTRODUCTION The objective of this study is to report a novel system of ‘mutual mentoring’ that overcomes the limited availability of laparoscopic mentors and allows progression from laboratory and fellowship experience into independent clinical practice. PATIENTS AND METHODS A total of 88 laparoscopic cases were performed during the fellowship. In the first 2 years as consultants, we (AJ and MS) performed 151 cases with mutual mentoring (simple nephrectomy [n = 28], radical nephrectomy [n = 35], nephro-ureterectomy [n = 19], pyeloplasty [n = 31], pelvic LND [n = 21], others [n = 17]). RESULTS Mutual mentoring has resulted in the successful introduction of laparoscopic services to two hospitals, allowing an exposure to an average of two cases a week. Complication rates are acceptable and objective measures such as conversion rates, operative time and blood loss appear to be improving. CONCLUSIONS Mutual mentoring allows for a greater through-put of cases, a high level of assistance, advice with intra-operative decisions and the potential to ‘share’ cases, reducing fatigue and increasing experience. It provides significant moral support in the difficult early days of starting the service. Its disadvantages are that it is time consuming and is geographically restrictive. Mutual mentoring has allowed us to introduce a laparoscopic service at our respective hospitals with high case-load acceptable complication rates.
The Impact of Patient-Controlled Analgesia on Laparoscopic Cholecystectomy
Authors: Sinha S , Munikrishnan V , Montgomery J , Mitchell SJ 
Published: May 2007

INTRODUCTION Laparoscopic cholecystectomy has revolutionised the management of symptomatic gallstones and is increasingly performed as a day-case procedure. The aim of this study was to assess the impact of opioid patient-controlled analgesia (PCA) on elective laparoscopic cholecystectomy. PATIENTS AND METHODS In a prospective, non-randomised, observational study, 76 consecutive patients who underwent elective in-patient laparoscopic cholecystectomy were reviewed. Six patients with complicated gall stone disease and four patients who converted from laparoscopic to an open operation were excluded. RESULTS Of the 66 remaining in the study group, 25 patients received morphine-PCA and, of these, 9 were fit for discharge. In contrast, 41 patients did not receive PCA and, of these, 27 were fit for discharge (P < 0.05). Median Aldrete score in the PCA group was 16 and in the non-PCA group 18 (P < 0.05). Postoperative nausea and vomiting were more common in patients receiving a morphine-based PCA and with in those with higher anti-emetic requirement (10/25 in PCA and 7/41 non-PCA groups; P < 0.05). CONCLUSIONS Routine postoperative opioid PCA prolongs the recovery and in-patient stay following elective laparoscopic cholecystectomy. Its role in postoperative pain management in routine laparoscopic cholecystectomy should be questioned.
Out-Patient Flexible Cystoscopy Using a Disposable Slide-On™ Endosheath System
Authors: Kimuli Michael , Lloyd Stuart N 
Published: May 2007

INTRODUCTION The aim of this study was to investigate the feasibility of out-patient flexible cystoscopy. PATIENTS AND METHODS Twenty-seven patients awaiting diagnostic or check cystoscopy in Leeds, UK were invited to undergo out-patient flexible cystoscopy using a CST-2000 Flexible Cystoscope (Vision Sciences; Natick, MA, USA) using the sterile single-use slide-on™ disposable endosheath endoscope system (EndoSheath®; Vision Sciences). The performance of the cystoscope was evaluated, and the patients' experiences were documented using a questionnaire. RESULTS The out-patient setting proved to be ideal for flexible cystoscopy. The cystoscope was rated highly for image quality, ease of use and handling. All patients complimented us on the service and preferred out-patients to a day-ward or theatre attendance. CONCLUSIONS This study demonstrates that it is possible to perform out-patient flexible cystoscopy safely, economically and efficiently with the aid of a disposable endoscope system.
Ecstasy-Associated Pneumomediastinum
Authors: Marasco Silvana F , Lim H Kiat 
Published: May 2007

INTRODUCTION Ecstasy, also known as MDMA (3,4, methylenedioxymethamphetamine), is a popular illicit party drug amongst young adults. The drug induces a state of euphoria secondary to its stimulant activity in the central nervous system. PATIENTS AND METHODS A database review at two major inner city hospitals was undertaken to identify patients presenting with pneumomediastinum and their charts reviewed. A Medline review of all reported cases of pneumomediastinum associated with ecstasy abuse was undertaken. RESULTS A total of 56 patients presenting with pneumomediastinum were identified over a 5-year period. Review of the charts revealed a history of ecstasy use in the hours prior to presentation in six of these patients, representing the largest series reported to date. CONCLUSIONS Review of previously reported cases reveals the likely mechanism is due to Valsalva manoeuvre during periods of extreme physical exertion, and not a direct pharmacological effect of the drug.
A Comparison of the Views of Patients and Medical Staff in Relation to the Process of Informed Consent
Authors: Berry MG , Unwin Jennifer , Ross GL , Peacock Elizabeth , Juma A 
Published: May 2007

INTRODUCTION The quality and quantity of information required in the consent process is well documented, but there is little extant literature regarding timing of either information about the proposed procedure or the act of consent itself. With the recent introduction of a new NHS-wide consent form, we wished to determine the preferences of both patients and staff to ascertain whether any concordance of views existed. PATIENTS AND METHODS A 10-point questionnaire, developed in conjunction with the department of clinical psychology was completed by 242 patients selected for surgery over a 4-month period. Identical questionnaires were completed by local staff (n = 50) and national consultant plastic surgeons (n = 56). RESULTS The cumulative majority (61.8%) preferred information at the specialist out-patient appointment (OPA). There was a significant difference (P < 0.001) between patients and staff as to information provision by the specialist as compared to non-specialists; staff indicating it much more strongly. As to the timing of consent form signature, 40.2% preferred signature on admission with no statistically significant difference between subgroups. An additional pre-operative clinic, for consent form signing, was selected by 27.3%. Staff expressed this view more often than patients (P < 0.001). CONCLUSIONS Patients prefer information about a planned surgical procedure at their specialist OPA and final consent for surgery when admitted to the ward. Staff had quite definite views and felt an additional pre-operative out-patient appointment to be beneficial, more so than the patients themselves.
Avulsion Injuries of the Hamstring Origin – A Series of 12 Patients and Management Algorithm
Authors: Gidwani Sam , Bircher Martin D 
Published: May 2007

INTRODUCTION Injuries to the origin of the hamstring muscles usually occur in athletes and can result in an avulsion fracture of the ischium, an avulsion of the ischial apophysis, or a pure avulsion of the hamstring tendons themselves, depending on the patient' sage. These are rare injuries in the general population and are often initially misdiagnosed as a simple ‘hamstring pull’, leading to the development of chronic pain and disability. PATIENTS AND METHODS We present a retrospective case series of the 12 patients with such injuies who presented or were referred consecutively to the senior author between 1997 and 2006. RESULTS There was a significant delay (5 months to 12 years) in the diagnosis of the injury in 8 of the 12 patients. Five of these 8 patients required more extensive surgery than would otherwise have been required as a result of this delay, but all recovered well. The sporting career of one of the remaining three patients had already been brought to an end by her injury and the subsequent disability, and she elected not to have surgery. Of the four patients who were diagnosed acutely, three required surgery, and all four had an excellent result. CONCLUSIONS Injuries to the hamstring origin are rare and are often initially misdiagnosed as a simple ‘hamstring pull’, leading to the development of chronic pain and disability. Displaced injuries of the ischial apophysis and pure tendon avulsions are probably best treated surgically in the acute setting. As a result of our experience with these patients, we have produced a management algorithm.
Inter- and Intra-Observer Variation of the Schatzker and AO/OTA Classifications of Tibial Plateau Fractures and a Proposal of a New Classification System
Authors: Charalambous CP , Tryfonidis M , Alvi F , Moran M , Fang C , Samaraji R , Hirst P 
Published: May 2007

INTRODUCTION The aim of this study was to evaluate the intra- and inter-observer variation of the Schatzker and AO/OTA classifications in assessing tibial plateau fractures, using plain radiographs. PATIENTS AND METHODS Fifty tibial plateau fractures were classified independently by six observers as per the Schatzker and AO/OTA classifications, using antero-posterior and lateral plain radiographs. Assessment was done on two occasions, 8 weeks apart. RESULTS We found that both the Schatzker and AO/OTA classifications have a high intra-observer (κ = 0.57 and 0.53, respectively), and inter-observer (κ = 0.41 and 0.43, respectively) variation. Classification of tibial plateau fractures into unicondylar versus bicondylar and pure splits versus articular depression ± split conferred improved inter- and intra-observer variation. CONCLUSIONS The high inter-observer variation found for the Schatzker and AO/OTA classifications must be taken into consideration when these are used as a guidance of treatment and when used in evaluating patients' outcome. Simply classifying tibial plateau fractures into unicondylar versus bicondylar and pure splits versus articular depression ± split may be more reliable.
The Future (R)evolution of Preimplantation Genetic Diagnosis/Human Leukocyte Antigen Testing: Ethical Reflections
Authors: de Wert Guido , Liebaers Inge , Van de Velde Hilde 
Published: May 2007

Abstract
There has been increasing support for combining preimplantation genetic diagnosis (PGD) for specific diseases with a test for human leukocyte antigens (HLA) because the generation of HLA-matched umbilical cord blood cells may save the life of a diseased sibling. To date, this procedure has taken place in the context of conceiving another child—PGD/HLA testing type 1. However, it may well become possible to perform PGD/HLA testing outside this context, that is, to select matched embryos from which embryonic stem cells could be derived and used in cell therapy—PGD/HLA testing type 2. A proactive ethical analysis is needed and is presented in this article. Although PGD/HLA testing type 1 can be morally justified, the risks, pitfalls, and practical limitations of this procedure make it necessary to develop alternative strategies. PGD/HLA testing type 2 may provide an alternative strategy. From an ethical point of view, the controversial issue is that this procedure creates embryos purely for instrumental use. However, given the dominant view that the preimplantation embryo has only limited moral value, this alternative may be as morally justified as PGD/HLA testing type 1.
Disclosure of potential conflicts of interest is found at the end of this article.
Initiate Insulin by Aggressive Titration and Education (INITIATE)
Authors: Yki-Järvinen Hannele , Juurinen Leena , Alvarsson Michael , Bystedt Tord , Caldwell Ian , Davies Melanie , Lahdenperä Sanni , Nijpels Gil , Vähätalo Markku 
Published: May 2007

OBJECTIVE—Insulin is often postponed for years because initiation is time-consuming. We sought to compare initiation of insulin individually and in groups with respect to change in A1C and several other parameters in type 2 diabetic patients.
RESEARCH DESIGN AND METHODS—A randomized (1:1), multicenter, two-arm, parallel design study with a recruiting period of up to 14 weeks and a 24-week treatment period. Either in groups of 4–8 or individually, using the same personnel and education program, 121 insulin-naive type 2 diabetic patients with an A1C of 7.0–12.0% were randomized to initiate bedtime insulin glargine. The patients visited the treatment center before and at the time of insulin initiation and at 6, 12, and 24 weeks. Patients self-adjusted the insulin dose to achieve a fasting plasma glucose 4.0–5.5 mmol/l.
RESULTS—At 24 weeks, mean ± SE A1C had decreased from 8.7 ± 0.2 to 6.9 ± 0.1% in those treated individually and from 8.8 ± 0.2 to 6.8 ± 0.1% in those in groups (not significant [NS]). Insulin doses averaged 62 ± 5 IU and 56 ± 5 IU at 24 weeks (NS), respectively. The frequency of hypoglycemia was similar. The total time (visits and phone calls) spent in initiating insulin in the patients in groups (2.2 ± 0.1 h) was 48% less than in those treated individually (4.2 ± 0.2 h). Diabetes treatment satisfaction improved significantly in both sets of patients.
CONCLUSIONS—Similar glycemic control and treatment satisfaction can be achieved by initiating insulin in groups and individually. Starting insulin in groups takes one-half as much time as individual initiation.
Interindividual Variability and Intra-Individual Reproducibility of Glycemic Index Values for Commercial White Bread
Authors: Vega-López Sonia , Ausman Lynne M. , Griffith John L. , Lichtenstein Alice H. 
Published: May 2007

OBJECTIVE—We sought to assess the intra- and interindividual variability of glycemic index value determinations for white bread using glucose as the reference food.
RESEARCH DESIGN AND METHODS—A total of 23 healthy adults (aged 20–70 years) completed up to three sets of two visits per set. Each pair of visits assessed the glycemic response to 50 g available carbohydrates from commercial white bread and glucose, administered in random order. Glycemic index values were calculated by dividing the 2-h incremental area under the serum glucose response curve after each commercial white bread challenge by the mean area under the curve (AUC) for glucose.
RESULTS—The mean ± SE ratio of the AUC after white bread intake by the AUC after glucose intake for the first set of determinations was 78 ± 15 (n = 23; coefficient of variation [CV] 94%). When using glycemic index values calculated with the subset of participants who completed three sets of tests (n = 14), glycemic index values for each of the three sets of determinations were 78 ± 10, 60 ± 5, and 75 ± 10, respectively. CVs were 50, 28, and 50%, respectively. The mean glycemic index value of these three sets was 71 ± 6, with a CV of 30%. When an ANOVA approach was applied to these data, the interindividual CV was 17.8%, and the intra-individual variation was 42.8%.
CONCLUSIONS—These data suggest that in response to a challenge of white bread relative to glucose, within-individual variability is a greater contributor to overall variability than among-individual variability. Further understanding of all the sources of variability would be helpful in better defining the utility of glycemic index values.
Plasma Resistin, Associated With Single Nucleotide Polymorphism −420, Is Correlated With Insulin Resistance, Lower HDL Cholesterol, and High-Sensitivity C-Reactive Protein in the Japanese General Population
Authors: Osawa Haruhiko , Tabara Yasuharu , Kawamoto Ryuichi , Ohashi Jun , Ochi Masaaki , Onuma Hiroshi , Nishida Wataru , Yamada Kazuya , Nakura Jun , Kohara Katsuhiko , Miki Tetsuro , Makino Hideichi 
Published: May 2007

OBJECTIVE—Resistin, secreted from adipocytes, causes insulin resistance in rodents. We previously reported that the G/G genotype of a resistin gene promoter single nucleotide polymorphism (SNP) at −420 increases type 2 diabetes susceptibility by enhancing promoter activity. We report here on the relation between plasma resistin and either SNP −420 genotype or factors related to insulin resistance.
RESEARCH DESIGN AND METHODS—We cross-sectionally analyzed 2,078 community-dwelling Japanese subjects attending a yearly medical checkup. The SNP −420 genotype was determined by TaqMan analysis. Fasting plasma resistin was measured using an enzyme-linked immunosorbent assay kit.
RESULTS—Plasma resistin was associated with the SNP −420 genotype (P &lt; 0.0001), which was highest in G/G followed by C/G and C/C. Plasma resistin was higher in elderly individuals, female subjects, nondrinkers, and subjects with high blood pressure (P &lt; 0.001, 0.003, &lt;0.001, and 0.001, respectively). Simple regression analysis revealed that age, female sex, homeostasis model assessment of insulin resistance (HOMA-IR) index, systolic blood pressure, low HDL cholesterol, and high-sensitivity C-reactive protein (hs-CRP) were positively correlated with plasma resistin (P &lt; 0.001, 0.003, &lt;0.001, 0.004, &lt;0.001, and 0.003, respectively). Multiple regression analysis adjusted for age, sex, and BMI revealed that plasma resistin was an independent factor for HOMA-IR, low HDL cholesterol, and hs-CRP (P = 0.001, &lt;0.001, and 0.006, respectively).
CONCLUSIONS—Plasma resistin was associated with SNP −420 and was correlated with insulin resistance, low serum HDL cholesterol, and high hs-CRP in the Japanese general population.
The Underuse of Screening Services Among Elderly Women With Diabetes
Authors: McBean A. Marshall , Yu Xinhua 
Published: May 2007

OBJECTIVE—To determine whether the use of nondiabetes-related preventive services (mammography, colorectal cancer screening, and bone density testing) among elderly diabetic women is different from the use among nondiabetic women.
RESEARCH DESIGN AND METHODS—Using a representative sample of the U.S. elderly female population and the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare files, we identified women with or without diabetes who were ≥67 years of age on 1 January 1999. All women with a prior history of cancer were excluded. Bivariate and multivariate analyses were used to compare the rates of preventive service use and to understand the factors influencing their use in the next 2–4 years.
RESULTS—Women with diabetes were less likely to have a mammogram (odds ratio [OR] 0.83 [95% CI 0.78–0.88]), colorectal cancer screening (0.79 [0.70–0.88]), and bone density testing (0.63 [0.58–0.69]). Women with diabetes seen by endocrinologists had significantly higher rates of bone density testing than women seen by primary care physicians. Women seen by obstetrician/gynecologists had the highest rates of use of all three services.
CONCLUSIONS—Elderly women with diabetes are less likely to receive cancer and osteoporosis screening than women without diabetes. Physicians treating these patients need to assure that they receive all recommended preventive services appropriate for their age. Additional national guidelines, practice-based improvements, and patient education targeting those at greatest risk of not receiving these services may be needed to achieve parity.
Normalization of the IGF-IGFBP Axis by Sustained Nightly Insulinization in Type 1 Diabetes
Authors: Ekström Klas , Salemyr Jenny , Zachrisson Ingmar , Carlsson-Skwirut Christine , Örtqvist Eva , Bang Peter 
Published: May 2007

OBJECTIVE—We sought to test the hypothesis that start of insulin glargine with sustained nightly insulin action results in changes in circulating concentrations of IGF-I and IGF binding proteins (IGFBPs) in adolescents with type 1 diabetes—changes that may support improvement of A1C.RESEARCH DESIGN AND METHODS—Twelve pubertal adolescents with type 1 diabetes and initially on NPH insulin were studied during 12 weeks of intensified treatment with glargine.RESULTS—Subnormal IGF-I SD scores on NPH (−1.8 ± 0.4) rapidly increased and remained 54 ± 9% elevated (P &lt; 0.001) after 12 weeks on glargine. A1C decreased from 8.3 ± 0.6% to a nadir of 6.9 ± 0.3% (P = 0.002) at 6 weeks and correlated with changes in IGF-I (r = −0.64, P &lt; 0.05). The increase in IGF-I did not suppress the mean overnight growth hormone (GH) secretion at 6 weeks. The mean overnight IGFBP-1 levels decreased (P = 0.035), supporting the hypothesis that the nightly hepatic insulin action was increased. Circulating IGF-I increased in the absence of changes in both GH secretion and GH receptor numbers (assessed by growth hormone binding protein), indicating that postreceptor mechanisms are involved. IGFBP-3 proteolysis was decreased.CONCLUSIONS—Increased hepatic insulin action after start of glargine was evident from a decrease in night time IGFBP-1 concentrations. This may improve GH postreceptor signaling, resulting in increased circulating IGF-I. We suggest that even in the absence of changes in GH, increased IGF-I and decreased IGFBP-1 support the improvement of metabolic control.
Accelerated Loss of Skeletal Muscle Strength in Older Adults With Type 2 Diabetes
Authors: Park Seok Won , Goodpaster Bret H. , Strotmeyer Elsa S. , Kuller Lewis H. , Broudeau Robert , Kammerer Candace , de Rekeneire Nathalie , Harris Tamara B. , Schwartz Ann V. , Tylavsky Frances A. , Cho Yong-wook , Newman Anne B. ,   for the Health, Aging, and Body Composition Study
Published: May 2007

OBJECTIVE—It has been shown that adults with either long-standing type 1 or type 2 diabetes had lower skeletal muscle strength than nondiabetic adults in cross-sectional studies. The aim of the study was to investigate longitudinal changes of muscle mass and strength in community-dwelling older adults with and without type 2 diabetes.
RESEARCH DESIGN AND METHODS—We examined leg and arm muscle mass and strength at baseline and 3 years later in 1,840 older adults aged 70–79 years in the Health, Aging, and Body Composition Study. Regional muscle mass was measured by dual energy X-ray absorptiometry, and muscle strength was measured using isokinetic and isometric dynamometers.
RESULTS—Older adults with type 2 diabetes (n = 305) showed greater declines in the leg muscle mass (−0.29 ± 0.03 vs. −0.23 ± 0.01 kg, P &lt; 0.05) and strength (−16.5 ± 1.2 vs. −12.4 ± 0.5 Nm, P = 0.001) compared with older adults without diabetes. Leg muscle quality, expressed as maximal strength per unit of muscle mass (Newton meters per kilogram), also declined more rapidly in older adults with diabetes (−1.6 ± 0.2 vs. −1.2 ± 0.1 Nm/kg, P &lt; 0.05). Changes in arm muscle strength and quality were not different between those with and without diabetes. Rapid declines in leg muscle strength and quality were attenuated but remained significant after controlling for demographics, body composition, physical activity, combined chronic diseases, interleukin-6, and tumor necrosis factor-α.
CONCLUSIONS—In older adults, type 2 diabetes is associated with accelerated loss of leg muscle strength and quality.