bluuebunny/crossref_metadata_2025_split huggingface dataset:
Con: pediatric anesthesia training in developing countries is best achieved by out of country scholarships
Authors: WALKER ISABEAU A. 
Published: November 2008

SummaryMedical migration is damaging health systems in developing countries and anesthesia delivery is critically affected, particularly in sub‐Saharan Africa. ‘Within country’ postgraduate anesthesia training needs to be supported to encourage more doctors into the specialty. Open‐ended training programs to countries that do not share the same spectrum of disease should be discouraged. Donor agencies have an important role to play in supporting sustainable postgraduate training programs.
Doppler‐guided haemorrhoidal artery ligation, rectoanal repair, sutured haemorrhoidopexy and minimal mucocutaneous excision for grades III–IV haemorrhoids: a multicenter prospective study of safety and efficacy
Authors: Theodoropoulos G. E. , Sevrisarianos N. , Papaconstantinou J. , Panoussopoulos S. G. , Dardamanis D. , Stamopoulos P. , Bramis K. , Spiliotis J. , Datsis A. , Leandros E. 
Published: November 2008

AbstractObjective The isolated use of Doppler‐guided haemorrhoidal artery ligation (DGHAL) may fail for advanced haemorrhoids (HR; grades III and IV). Suture haemorrhoidopexy (SHP) and mucopexy by rectoanal repair (RAR) result in haemorrhoidal lifting and fixation. A prospective evaluation was performed to evaluate the results of DGHAL combined with adjunctive procedures.Method The study included 147 patients with HR (male patients: 102; grade III: 95, grade IV: 52) presenting with bleeding (73%) and prolapse (62%).Results More ligations were required for grade IV than grade III HR (10.7 + 2.8vs8.6 + 2.2,P < 0.001). SHP (28 patients) and RAR (18 patients) at 1–4 positions were deemed necessary in 46 (31%) patients. Minimal (muco‐)cutaneous excision (MMCE) was added in 23 patients. SHP/RAR was applied more frequently in grade IV HR (60%vs16%,P < 0.001). In patients not having MMCE, SHP/RAR was added in 57% of grade IV cases (P < 0.001). Complications included residual prolapse (10; two second surgery), bleeding (15; two second DGHAL), thrombosis (four), fissure (three) and fistula (one). Analgesia was required not at all, up to 1–3 days, 4–7 days and >7 days by 30%, 31%, 16% and 14% of the patients, respectively. SHP/RAR was associated with greater discomfort (17%vs6%,P < 0.001). No differences were found between SHP and RAR. At an average follow‐up of 15 months, 96% of patients were asymptomatic and 95% were satisfied.Conclusions DGHAL with the selective application of SHP/RAR is a safe and effective technique for advanced grade HR.
Myocutaneous flap reconstruction of the pelvis after abdominoperineal excision
Authors: Nisar P. J. , Scott H. J. 
Published: November 2008

AbstractObjective  Perineal wound complications after abdominoperineal excision (APE) for anorectal cancer represent a considerable source of morbidity for patients. Strategies to improve wound healing include reconstruction with myocutaneous flaps. This is an evidence‐based review of reconstruction of pelvic defects after APE, using rectus abdominus (RAM), gracilis and gluteus maximus flaps.Method  A Pubmed search was performed using MESH headings.Results  Thirty‐six studies reported outcomes of interest. Five controlled studies reported improved outcomes after APE and chemoradiotherapy with RAM reconstruction and two controlled studies reported improved outcomes with gracilis reconstruction. There were seven patients with total flap loss after RAM reconstruction, in a combined 300 patients. There were eight patients with complete cutaneous necrosis after gracilis reconstruction in a combined 83 patients.Conclusion  Data from the controlled studies support the use of myocutaneous flaps for single‐stage reconstruction after APE in the presence of chemoradiotherapy. Ultimately, the choice of flap depends on the goals of reconstruction, size of the defect and the availability of donor tissue. The implications of an expanding role for radiotherapy in the treatment of low rectal cancer and radical dissection to achieve negative circumferential margins, necessitate close co‐operation between colorectal and reconstructive surgeons to achieve APE with reduced wound morbidity.
Urine Flow Rates in Male and Female Urodynamic Patients Compared with the Liverpool Nomograms
Authors: HAYLEN B. T. , PARYS B. T. , ANYAEGBUNAM W. I. , BY DEBORAH ASH , WEST C. R. 
Published: November 2008

Summary— The Liverpool male and female nomograms provide normal reference ranges for the maximum and average urine flow rates over a wide range of voided volumes. A known urine flow rate, in combination with the respective voided volume (and in men the age), can be converted into an equivalent centile ranking, using the equation for the relevant nomogram. Centile rankings allow the urine flow rates of specific male and female populations to be compared.The maximum and average urine flow rates of urodynamic patients (504 consecutive male and 168 consecutive female) were converted into centile rankings. These centile rankings were then compared with the respective urodynamic diagnoses.The median centile rankings for their maximum and average urine flow rates were 21 and 11 (male) respectively and 31 and 18 (female) (vs 50 for the normal populations). The low urine flow rates applied to all diagnostic groups, including those symptomatic men and women who were found to be urodynamically normal. Low urine flow rates may be one of a number of subtle manifestations of urological disease in these patients.Men with obstruction and women with voiding difficulties had the lowest urine flow rates. The 25th centile (men) and the 10th centile (women) appeared to be most appropriate lower limits of normality for both urine flow rates to identify those men more likely to be obstructed and those women at higher risk of voiding difficulties.Men and women with detrusor instability had the highest urine flow rates. Detrusor instability was present in 71% of men with centile rankings for the maximum urine flow rate over 50; 50% of women whose maximum urine flow rate centiles were over 90 had detrusor instability.
Urethral Pressure and Power Generation during Coughing and Voluntary Contraction of the Pelvic Floor in Healthy Females
Authors: LOSE G. , COLSTRUP H. 
Published: November 2008

Summary— A probe which permits continuous measurement of the related values of pressure and cross‐sectional area in the female urethra was used to provide a quantitative description of the adjunctive occlusive forces in terms of pressure and power (mWatt) generation. Measurements were carried out at the bladder neck, midurethrally and distally in the urethra in 30 healthy women during coughing and squeezing.Statistically significant variations were found in pressure and power generation between the 3 sites of measurement both during coughing and squeezing. Power generation and the pressure increase were significantly greater during coughing than during squeezing along the entire length of the urethra. The presence of a dynamic active closure mechanism was demonstrated at the bladder neck in addition to that located midurethrally. This bladder neck mechanism is thought to be due to the vagino‐levator sling system (the urethral supports).
Validation of a Non‐invasive Radioisotope Method of Imaging Ureteric Urine Transport
Authors: WEMYSS‐HOLDEN G. D. , HOSKER G. L. , ROSE MARJORIE R. , PAYNE S. R. , TESTA H. J. 
Published: November 2008

Summary— Measurement of ureteric function has hitherto involved the use of invasive techniques. A non‐invasive, radioisotope method of imaging and displaying individual ureteric boluses has been described, a refinement of which is used in this department. Each “spindle” displayed using this technique theoretically represents an individual ureteric bolus of urine, but the technique has never been validated in the normal ureter in either the experimental model or man.A porcine model was set up to allow simultaneous measurement of ureteric bolus transmission using the radioisotope (compressed image) method and by the accepted techniques of electromyography (EMG) and urine drop counting. The timing of each urinary bolus, as recorded by the different modalities, was then compared.The results from 11 studies showed a significant correlation between the radioisotope and EMG methods (mean r= 1.00, P=0.0003). There was a constant relationship between the part of the radioisotopic image representing the rear end of the bolus and the EMG complex (mean time difference = 5.32 ± 1.067s), thus defining that part of the image representing the peristaltic contraction wave. There was a variable relationship between the EMG and the part of the image representing the leading edge of the bolus (mean time difference = 13.36 ± 5.23s), emphasising that bolus length is variable, being dependent on bolus volume.The radioisotope “spindle” concurs with EMG activity in the porcine ureter. The compressed image technique is thus validated as a non‐invasive method of demonstrating ureteric urine transport.
Non‐invasive Investigation of Normal Individual Ureteric Activity in Man
Authors: WEMYSS‐HOLDEN G. D. , ROSE MARJORIE R. , PAYNE S. R. , TESTA H. J. 
Published: November 2008

Summary— This study was designed to investigate non‐invasively human ureteric function between individuals and with increasing diuresis, using the radioisotope compressed image technique.Five normal males underwent fast frame renography with ureteric spindle imaging in dehydrated and hydrated states, urine production being measured in each individual for each scan.Urine flow rates and renographic parameters demonstrated that each ureter carried more urine in the hydrated state. The velocity at which individual boluses passed down the ureter was constant for each ureter and did not change with diuresis.The ureteric peristaltic rate showed wide individual variation between ureters in the same subject, but fell within what is becoming accepted as the “normal range” of < 4 urine boluses per minute.Some ureters accommodated an increase in urine flow by an increased peristaltic frequency, some showed no change and others showed a decreased frequency. In those ureters in which there was no change, or a decrease in perstaltic frequency with diuresis, the increased urine flow must have been handled by increases in bolus volume. Thus increases in ureteric urine flow in man are accommodated by changes in both peristaltic frequency and bolus size.The results are discussed in relation to previous studies which used invasive techniques.
In vitro analysis of Urinary Calculi: Type Differentiation using Computed Tomography and Bone Densitometry
Authors: HERREMANS D. , VANDEURSEN H. , PITTOMVILS G. , BOVING R. , OYEN R. , GEUSENS P. , BAERT L. 
Published: November 2008

Summary Thirty‐six urinary stones were studied by computed tomography and bone densitometry in order to find a correlation between the chemical composition of the stones and the densitometric data.In vitro, the more common cases of lithiasis can be divided into 3 main groups: uric acid, cystine and the calcium salts, e.g. calcium oxalate monohydrate, calcium oxalate dihydrate and calcium phosphate. Struvite stones fall between the second and third groups. Computed tomography and bone densitometry can differentiate between the groups, provided that the value of the “stone mineral or calcium content” is correlated with the true calculated volume of the stone (resulting in the specific stone density) instead of the projection area (resulting in the area density). This is only possible in vitro. The in vivo application of these technologies in the treatment of stones of unknown composition could provide important information, but major restrictive factors pose difficulties. Further clinical studies are necessary, especially to define the role of bone densitometry.
Ultrastructural Features of Penile Tissue in Impotent Men
Authors: LIU LI‐CHANG , HUANG CHUN‐HSIUNG , HUANG YEONG‐LEI , CHIANG CHIN‐PEI , CHOU YII‐HER , LIU LO‐HUI , SHIEH SHENG‐RENN , LU PO‐SHING 
Published: November 2008

Summary Penile erection is related to the integrity of penile tissue. In order to study the ultrastructural histopathological changes in penile erectile tissue in impotent men, biopsies were taken from 29 impotent and 5 normal patients during surgical treatment.Light microscopy revealed insignificant histological changes and various degrees of fibrotic change in the corpora cavernosa of impotent men, and electron microscopy revealed severe myopathic, fibrotic changes in the penile tissue.These non‐specific changes could not be used to determine the aetiology of impotence, and the relationship between the ultrastructural apperances, the causes of impotence and the results of treatment was unclear. Further studies are required to establish the value of intracorporeal biopsy in selecting treatment for impotent patients.
Urodynamic and Clinical Aspects of Ileal Low Pressure Bladder Substitutes
Authors: CASANOVA G. A. , SPRINGER J. P. , GERBER E. , STUDER U. E. 
Published: November 2008

Summary Twenty‐three patients with an ileal bladder substitute formed after cystectomy for invasive bladder cancer were evaluated clinically and urodynamically between 3 and 38 months post‐operatively. The urodynamic measurements were compared with the clinical findings. After reeducation of the patients' voiding habits the mean voiding volumes of the bladder substitutes stabilised 6–9 months post‐operatively at 350 ml. The frequency of micturition was 3 to 5 times during the day and once or twice at night. The maximum functional capacity (maximum voiding volume) was about 490 ml. Ninety‐one per cent of the patients were continent during the day 18 months after the operation and 82% were continent during the night. Micturition was problem‐free with an average maximum flow of 25 ml/s and an average micturition time of 50 s.The mean voiding volume of ileal bladder substitutes was 50% of the measured cystometric capacity; the maximum functional capacity (= max. micturition volume) was 80% of the cystometric capacity. The average basal pressure was <20 cm H2O from the third post‐operative month onwards. Eleven of the 23 patients had contractions in the bladder substitute (average at 30 cm H2O) at 55–76% of the maximum cystometric capacity or at approximately 90% of the maximum functional capacity. Such spike waves had no clinical or radiological consequences.If the patients were shown how to increase the functional capacity of a reservoir made from only 40 cm of ileum, the clinical results were excellent.
Comparison of Laparoscopic and Open Ligation of the Testicular Vein
Authors: LYNCH W. J. , BADENOCH D. F. , McANENA O. J. 
Published: November 2008

Summary Scrotal varicoceles undoubtedly contribute to subfertility in an as yet undefined group of patients. The best method of treatment of varicoceles, however, remains controversial. Laparoscopic testicular vein ligation has recently been offered as a new option.We examined the feasibility of laparoscopic testicular vein ligation (n = 11) compared with standard high ligation (n = 11). The mean post‐operative stay in the open group was 25.6 h compared with 7.1 h in the laparoscopic group. Analgesic requirements were a mean of 4.73 Co‐proxamol tablets for the open group and 0.18 tablets for the laparoscopic group. All operations were successful. Laparoscopic ligation of the testicular vein is an effective treatment of varicocele with decreased post‐operative morbidity.
Posterior Urethral Valves. Does Prenatal Diagnosis Influence Prognosis?
Authors: JEE L. D. , RICKWOOD A. M. K. , TURNOCK R. R. 
Published: November 2008

Summary Forty‐eight boys with posterior urethral valves were reviewed to assess the impact on prognosis of prenatal ultrasonography, which had been the method of diagnosis in 17 of them; the remaining 31 presented postnatally. Renal function before treatment was mildly to moderately impaired in 59% of those presenting prenatally, 42% presenting before 3 months of age and 25% of those first presenting when older than 3 months. All but one of the infants diagnosed prenatally had clinical signs and/or elevated serum creatinine in the early neonatal period. Eight had associated maternal oligohydramnios, of whom 6 presented prenatally and 2 postnatally: this factor was associated with a poor prognosis, with renal impairment persisting in 6 of these patients after treatment. Renal function did not relate consistently to the presence or otherwise of vesicoureteric reflux (unilateral or bilateral).Twelve of the patients who presented postnatally had normal fetal ultrasonography late in pregnancy, of whom 11 had upper tract dilatation when investigated. Six of these patients who currently have impaired renal function did not have maternal oligohydramnios, and it is argued that antenatal detection of the condition would have been beneficial in less than 20% of patients presenting postnatally with posterior urethral valves.
Renal parenchyma‐sparing surgery as conservative treatment of renal cell carcinoma*
Authors: CIANCIO G. , POLITANO V.A. , FERRELL S. , BLOCK N.L. 
Published: November 2008

Objective To evaluate the role of parenchyma‐sparing surgery in patients with renal cell carcinoma (RCC).Patients and methods Between 1965 and 1990, 34 patients with RCC underwent renal parenchyma‐sparing surgery. There were 22 men and 12 women with a mean age of 62 years (range 40–89). Ten patients underwent enucleation (Group A), 15 partial nephrectomy (Group B), and nine a combination of procedures (Group C). Conservative surgery was performed in the presence of a normal contralateral unit in four patients (12%).Results Five patients developed local recurrence. Metastases appeared in six patients (18%) from 12 to 58 months post‐operatively. Adequate renal function was obtained in 32 of the 34 patients. The mean follow‐up for all patients was 64.6 months overall, 75.6 months for group A, 64.1 months for group B and 53.4 months for group C. The 3 and 5 year probabilities of survival for all patients were 77.8% and 69.5% respectively. The probabilities of 3 and 5 year survival were 80% for group A, 80% for group B and 71.4% and 57.1% for group C.Conclusion Enucleation and partial nephrectomy are both viable options in the management of solitary or bilateral RCC, as there is no decline in effective tumour control and prognosis. Larger groups and longer follow‐ups are needed to assess the role of renal parenchyma‐sparing surgery more definitively.
Immunological parameters in peripheral blood of patients with renal cell carcinoma before and after nephrectomy
Authors: DADIAN G. , RICHES P. G. , HENDERSON D. C. , TAYLOR A. , MOORE J. , ATKINSON H. , GORE M.E. 
Published: November 2008

Objective To determine the effects of nephrectomy on the immune response of patients with renal cell carcinoma (RCC).Patients and methods Five patients with RCC were monitored before and over a period of up to 3 months after nephrectomy. The aspects measured were the phenotypic expression of markers on circulating lymphocytes, circulating concentrations of cytokines, markers of inflammatory and immune responses, and natural killer (NK) cell and lymphokine‐activated killer (LAK) cell activity in peripheral blood mononuclear cells (PBMC). The suppressive activity of patients' plasma on NK activity and ability to generate interleukin‐2 (IL‐2) induced LAK cells in PBMC of normal volunteers was also investigated.Results The results indicated that high CD4/8 ratios were present pre‐nephrectomy with evidence of inflammatory responses and immune activation in some patients, particularly those with metastatic disease.Conclusion The effect of nephrectomy was to decrease the inflammatory response and increase immune activation. Various defects in NK cell activity and LAK cell generation were demonstrated pre‐surgery which slowly improved once the primary tumour had been removed and it is suggested that such defects could have contributed to tumour growth and development due to an ineffective immune response.
The clinical application of dorsal penile nerve cerebral‐evoked response recording in the investigation of impotence
Authors: PICKARD R.S. , POWELL P. H. , SCHOFIELD I.S. 
Published: November 2008

To determine whether recording of penile cerberal‐evoked response (CER) is useful in the assessment of men with impotence.Patients and mehtods A total of 280 impotent men underwent CER recording as part of an assessment for a complaint of importance. They were categorized from findings in the history and examination as having non‐neurogenic impotence (n=106), impotence related to existing neurological disturbance (n = 67), type I diabetes (n = 49) or type II diabetes (n = 58). Increased period of latency or absence of first positive peak (P1) on CER were used as the criteria for an abnormal response with reference to an age‐matched control group of potent men (n = 34).Results Overall, impotent men with diabetes or a history of neurological disturbance had significantly longer P1 latencies and lower response amplitudes compared with the control group. In contrast the CER recorded from men with non‐neurogenic impotence was similar to the control group. Individual results showed an increased period of latency or absence of P1 in 100 (36%) impotent men, 72 (72%) of whom were diabetic or had a history of neurological dysfunction. CER abnormalities were associated with neurological signs on physical or cystometrographic examination in 40 (40%) individuals.Conclusion Although technically satisfactory, the clinical usefulness of CER recording is limited by the poor discriminatory value of response latencies. Most abnormal results could be predicted by the presence of diabetes or pre‐existing neurological dysfunction, or by evidence of neurological deficit on physical examination. The test is not therefore suitable for routine clinical assessment of impotence but may be worthwhile if objective evidence of penile sensory dysfunction is required.
Experience with the second generation Urolume prostatic stent
Authors: Bajoria S. , Agarwal S.A. , White R. , Zafar F. , Williams G. 
Published: November 2008

Objective To assess the efficacy of the new, second generation UroLume (American Medical Systems) prostatic stent. Patients and methods Forty‐seven men with symptomatic and objective evidence of bladder outflow obstruction who were fit for a transurethral resection accepted, as an alternative, the insertion of a new prostatic stent which shortens less than its predecessor. Results It was possible to insert the stent into 44 of the 47 men. All patients voided spontaneously following stent insertion. Thirty‐three patients had their stent inserted either as a day case or with an overnight stay. Six patients were lost to follow‐up and two died. Of the remaining 36 patients 22 have now been followed for 2 years, with a mean obstructive score of 1.6 (range 0–12), a mean irritative score of 2.5 (range 0–10) and a mean peak flow of 16.8 mL/s (range 3–31). Fourteen stents had to be removed; in the majority of cases this was because of stent migration or the development of epithelial hyperplasia within the lumen of the stent. Conclusion Because of the development of epithelial hyperplasia and stent migration in approximately one‐third of men in this study, a third generation stent has now been developed. Before permanently implanted stents can be recommended for widespread use, the efficacy of new stents should be assessed in specialist units with large numbers of patients and adequate facilities for follow‐up.