bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retroperitoneoscopic pre‐transplant native kidney nephrectomy
Authors: GOEL RAJIV , MODI PRANJAL , DODIA SHARAD 
Published: May 2006

Aims:  Laparoscopic nephrectomy has become a standardized procedure for removal of benign non‐functioning kidneys. We present our experience of retroperitoneoscopic pre‐transplant native kidneys nephrectomy.Methods:  Comparison of 40 patients who underwent retroperitoneoscopy with 40 open simple pre‐transplant nephrectomy patients was done.Results:  Forty retroperitoneoscopic nephrectomies were done between June 2003 and April 2005. The mean operative time was similar in the two groups; however, the mean blood loss, postoperative analgesic requirement, complication rate, hospital stay and convalescence period were significantly less in the retroperitoneoscopic group.Conclusion:  Retroperitoneoscopic nephrectomy should be offered as the primary treatment modality to patients requiring pre‐transplant native kidney nephrectomy, except in patients where it is contraindicated.
Long‐term outcome of upper urinary tract carcinoma in situ: Effectiveness of nephroureterectomy versus bacillus Calmette‐Guérin therapy
Authors: KOJIMA YOSHIYUKI , TOZAWA KEIICHI , KAWAI NORIYASU , SASAKI SHOICHI , HAYASHI YUTARO , KOHRI KENJIRO 
Published: May 2006

Background:  We examined the long‐term outcome and compared the usefulness of nephroureterectomy with that of bacillus Calmette‐Guérin (BCG) therapy for the management of upper urinary tract carcinoma in situ (CIS).Methods:  We retrospectively reviewed the post‐treatment course of 17 patients with CIS of the upper urinary tract who had undergone either a nephroureterectomy (group A, n = 6) or BCG therapy (group B, n = 11) at our institute.Results:  Median follow up was 58.3 months (range 1–120 months). Four of the six patients in group A (67%) had no recurrence and remained cystoscopically, cytologically and radiographically free of disease. The cytology became negative after an 8‐week course in nine of the eleven patients in group B (82%; eight of ten units, 77%). Two of the nine patients showed recurrence after BCG therapy. One patient died of respiratory failure caused by a side‐effect of BCG, which was interstitial pneumonia. There was no significant difference in either the 5‐year recurrence‐free survival or the 5‐year cancer‐specific survival between groups A and B.Conclusions:  BCG therapy for CIS of the upper urinary tract is as effective as nephroureterectomy in long‐term outcome, although it has some dangerous aspects. Further experience with treatment of CIS of the upper urinary tract is required.
Early results of a new open surgical technique for treatment of uretero‐pelvic junction obstruction
Authors: SHAKERI SAEED , SALEHI‐POUR MEHDI , YARMOHAMMADI HOOMAN , PARVIZI ALI‐REZA 
Published: May 2006

Objective:  Here we report our initial experience with a new open surgical technique for treating uretero‐pelvic junction obstruction (UPJO).Methods:  One centimeter distal to the site of the uretero‐pelvic junction (UPJ) stenosis, a longitudinal incision of about 15 mm was made over the lateral side of the ureter. The renal pelvis was evacuated. Simultaneously, an oblique incision was made over the posterior and anterior walls of the renal pelvis. The most dependent point over the renal pelvis was sutured to the distal end of the ureterotomy incision. The anterior edge of the pyelotomy incision was anastomosed to the anterior edge of the ureterotomy incision and the posterior edge was anastomosed to the posterior edge of the ureterotomy incision. When the pyeloplasty was completed, the UPJ, accompanied by the proximal 1 cm of the ureter and excessive parts of the renal pelvis, was excised.Results:  In 21 (92%) out of 23 patients, the surgical technique was successful.Conclusions:  This technique results in predictably good outcomes and has the advantages of the dismembered method. It seems to be a valuable alternative treatment for UPJO.
Priming of indirect defences
Authors: Heil Martin , Kost Christian 
Published: May 2006

AbstractLeaf damage induces in many plant species the secretion of extrafloral nectar (EFN) and/or the release of specific odours (volatile organic compounds, VOCs). Both traits attract carnivorous arthropods and function as indirect plant defences by increasing the predation pressure on attacking herbivores. We have conducted field experiments in Mexico and found that plants that had been exposed to VOCs thereafter responded to subsequent leaf damage with an increased EFN secretion. VOCs ‘primed’ the plants to respond more efficiently once they were attacked themselves. Such priming effects are well known for induced resistance to pathogens, yet this is the first description of VOCs priming EFN secretion, a taxonomically widespread anti‐herbivore defence. Plants can use chemical signals in their environment to assess the risk of herbivory and make use of this information to adjust their own defensive strategy accordingly.
Convalescence after colonic surgery with fast‐track vs conventional care
Authors: Jakobsen D. H. , Sonne E. , Andreasen J. , Kehlet H. 
Published: May 2006

AbstractObjective  To compare convalescence after colonic surgery with a fast‐track rehabilitation programme vs conventional care.Background  Introduction of a multimodal rehabilitation programme (fast‐track) with focus on epidural anaesthesia, minimal invasive surgical techniques, optimal pain control, and early nutrition and mobilization together with detailed patient information have led to a shorter hospital stay after colonic surgery. There are not much data on convalescence after discharge.Methods  A prospective, controlled, non‐randomized interview‐based assessment in 160 patients undergoing an elective, uncomplicated, open colonic resection or the Hartmann reversal procedure with a fast‐track or a conventional care programme in two university hospitals. A structured interview‐based assessment was performed preoperatively, and day 14 and 30 postoperatively.Results  Patients undergoing colonic surgery with a fast‐track programme regained functional capabilities earlier with less fatigue and need for sleep compared with patients having conventional care. Despite early discharge of the fast‐track patients (mean 3.4 days vs 7.5 days), no differences were found according to the need for home care, social care and visit to general practitioners, although the fast‐track group had an increased number of visits at the outpatient clinic for wound care. More patients in the fast‐track group were re‐admitted, but the overall mean total hospital stay was 4.2 days vs 8.3 days in the conventional group.Conclusion  A fast‐track rehabillitation programme led to a shorter hospital stay, less fatigue and earlier resumption of normal activities, without the increased need for support after discharge compared with conventionally treated patients after uncomplicated colonic resection.
Reported symptoms, diagnostic delay and stage of colorectal cancer: a population‐based study in Denmark
Authors: Korsgaard M. , Pedersen L. , Sørensen H. T. , Laurberg S. 
Published: May 2006

AbstractObjective  The primary prognostic factor for colorectal cancer (CRC) is stage. Any association between symptoms, diagnostic delay and stage may have implications for the clinical course of the disease. We examined the association between symptoms and diagnostic delay and between symptoms and stage, and assessed whether the associations differed for colon cancer (CC) and rectal cancer (RC).Patients and methods  Population‐based prospective observational study based on 733 Danish CRC patients. Diagnostic delay and patients’ reported symptoms were determined through questionnaire–interviews. Dukes’ stage was obtained from medical records and pathology forms. Diagnostic delay was categorized into three delay groups: ≤ 60, 61–150 and > 150 days. Stage was classified into nonadvanced (Dukes’ A and B) or advanced (Dukes’ C and D) cancers. We calculated the frequency of the most frequently reported initial symptom or symptom complex for CC and RC patients, and evaluated the frequency of patients with different initial symptoms/symptom complexes in the three delay groups. For the most frequent initial symptoms/symptom complexes, we calculated the frequencies according to stage, and estimated the relative risk of having an advanced stage, with 95% confidence intervals.Results  The most frequent initial symptoms/symptom complexes were very vague symptoms for CC and rectal bleeding for RC. For both CC and RC, rectal bleeding was significantly associated with nonadvanced stage. The relative risk of having an advanced cancer was 0.6 for monosymptomatic rectal bleeding and 0.7 for rectal bleeding combined with other symptoms.Conclusions  Initial symptoms of CC were often very vague, making it difficult to identify a precise start date. The most frequent initial symptom/symptom complex for RC – rectal bleeding – was better defined. Rectal bleeding was significantly associated with nonadvanced CC and RC and a significantly decreased relative risk of having an advanced cancer.
Investigation of stimulus position in the production of the strength duration curve of the external anal sphincter muscle in women with anorectal dysfunction
Authors: Telford K. J. , Grey B. R. , MacKenzie N. , Hosker G. L. , Kiff E. S. 
Published: May 2006

AbstractObjective  The strength duration test (SDT) is a minimally invasive test of the innervation of a muscle and has been successfully adapted for use on the external anal sphincter (EAS). The SDT has previously been performed on the EAS placing a stimulating probe in the 3 o'clock position. The aim of this study was to determine whether there was any variation in the strength duration curves (SDC) produced at different positions around the EAS.Patients and methods  Thirty‐one patients with anorectal dysfunction attended our Institution for Anorectal Physiology Studies and were recruited to the study. After undergoing anal manometry, pudendal nerve terminal motor latency measurement and endoanal ultrasonography, the SDT was performed in four stimulus positions (3, 6, 9 and 12 o'clock). The sequence of positions was randomly selected.Results  Four SDCs were obtained successfully in 25 patients. There was no significant difference seen between the four positions at the longer current durations (1–100 ms). Significant differences occurred at the shortest current durations (0.3 and 0.1 ms) when comparing adjacent stimulus positions except between the 6 and 9 o'clock positions, which were comparable. When opposing positions were compared (3–9 and 6–12 o'clock) at these short durations no significant difference was found.Conclusion  There was no significant difference between the SDC produced at 3 and 9 o'clock. These positions closely correspond to where the pudendal nerves enter the EAS. It therefore appears acceptable to perform the SDT in either of these positions, though 3 o'clock remains our preferred position.
Diagnostic utility of brain‐natriuretic peptide for left ventricular diastolic dysfunction in asymptomatic type 2 diabetic patients
Authors: Shimabukuro M. , Higa N. , Oshiro Y. , Asahi T. , Takasu N. 
Published: May 2006

Aim:  Left ventricular (LV) diastolic dysfunction has been reported to be prevalent in diabetic subjects, but this recognition could often be missed. We evaluated prevalence of LV diastolic dysfunction and diagnostic utility of brain‐natriuretic peptide (BNP) in asymptomatic patients with type 2 diabetes mellitus.Research design and methods:  Plasma BNP levels and LV geometry and diastolic filling indices, including the ratio of peak early transmitral Doppler flow (E) over flow propagation velocity (Vp) measured by colour M‐mode Doppler echocardiography, were analysed in 98 consecutive asymptomatic patients with type 2 diabetes mellitus and 51 age‐matched controls.Results:  The LV mass index and relative wall thickness were higher in diabetic groups than controls without any differences in LV systolic function. The frequency of diastolic dysfunction defined as E/Vp ≥ 1.5 were 31% in diabetic groups and 15% in controls (χ2 = 4.364, p = 0.037). By receiver‐operating characteristic (ROC) curve analysis, a BNP cutoff value of 19.2 pg/ml in controls had a 53.1% positive predictive value (53.1%) and a high negative predictive value (94.4%) for E/Vp ≥ 1.5, whereas a BNP cutoff value of 18.1 pg/ml in diabetic groups had a 61.8% positive and 97.3% negative predictive values.Conclusions:  The frequency of E/Vp ≥ 1.5 was higher in asymptomatic diabetic patients, suggesting that LV diastolic dysfunction was prevalent. The plasma concentration of BNP could be used to depict LV diastolic dysfunction in such population.
Adiponectin receptors gene expression in lymphocytes of obese and anorexic patients
Authors: Alberti L. , Gilardini L. , Girola A. , Moro M. , Cavagnini F. , Invitti C. 
Published: May 2006

Aim:  Two adiponectin receptors (ADIPORs), ADIPOR1 and ADIPOR2, are widely expressed in tissues. Whether changes in the expression of ADIPORs are associated with obesity and insulin resistance in humans is still unclear. The aim of this study was to explore whether lymphocyte ADIPOR1 and ADIPOR2 mRNA expression is associated with obesity, insulin resistance, first‐phase insulin secretion and serum adiponectin levels.Methods:  Using reverse transcription‐polymerase chain reaction, we measured ADIPOR1 and ADIPOR2 mRNA levels in the lymphocytes of 59 obese patients, of whom 39 had normal glucose tolerance, 8 had impaired glucose tolerance or impaired fasting glucose, and 12 had type 2 diabetes, and of 21 women with restrictive anorexia nervosa.Results:  In all subjects, ADIPOR1 expression was 2.2‐fold higher than that of ADIPOR2 (p < 0.0001). The mRNA expression level of both receptors correlated with each other (p < 0.0001). After adjustment for age and sex, lymphocyte ADIPORs mRNA expression (ADIPOR1, p < 0.005; ADIPOR2, p < 0.05) and serum adiponectin (p < 0.0001) were significantly lower in obese patients than in anorexic subjects. In a multivariate analysis with ADIPOR1 as the dependent variable and body mass index (BMI), blood pressure and adiponectin as the independent variables, only serum adiponectin remained positively and independently correlated with ADIPOR1 (p < 0.05). Adiponectin was independently and negatively related to BMI and sex.Conclusions:  We have demonstrated in this study that lymphocytes express ADIPORs and that, similar to serum adiponectin, ADIPORs expression is markedly reduced in obese subjects. ADIPORs expression is not independently related to BMI, insulin resistance and β‐cell function.
Insulin detemir lowers the risk of hypoglycaemia and provides more consistent plasma glucose levels compared with NPH insulin in Type 1 diabetes
Authors: Kølendorf K. , Ross G. P. , Pavlic‐Renar I. , Perriello G. , Philotheou A. , Jendle J. , Gall M‐A. , Heller S. R. 
Published: May 2006

AbstractAims  Hypoglycaemia remains a major barrier preventing optimal glycaemic control in Type 1 diabetes due to the limitations of conventional insulin preparations. We investigated whether basal‐bolus therapy with insulin detemir (detemir), a new soluble basal insulin analogue, was more effective in reducing the risk of hypoglycaemia compared with NPH insulin (NPH).Methods  In this multinational, open‐label, cross‐over trial, 130 individuals with Type 1 diabetes received detemir and NPH twice daily in a randomized order in combination with premeal insulin aspart (IAsp) during two 16‐week treatment periods. Risk of hypoglycaemia was based on self‐measured plasma glucose (SMPG) and self‐reported episodes during the last 10 weeks of each period.Results  Risk of nocturnal and overall hypoglycaemia was, respectively, 50% and 18% lower with detemir than with NPH (P < 0.001). A total of 19 severe hypoglycaemic episodes occurred during treatment with detemir compared with 33 with NPH (NS). HbA1c decreased by 0.3% point with both treatments and was comparable at 7.6% (± sem 0.06%, 95% confidence interval −0.106, 0.108) after 16 weeks with similar doses of basal insulin. Within‐person variation in mean plasma glucose was lower with detemir than with NPH (sd 3.00 vs. 3.33, P < 0.001), as was prebreakfast SMPG (P < 0.0001).Conclusions  Detemir was associated with a significantly lower risk of hypoglycaemia compared with NPH at similar HbA1c when used in combination with mealtime IAsp. The more consistent plasma glucose levels observed with detemir may allow people to aim for tighter glycaemic control without an increased risk of hypoglycaemia.
Aldosterone synthase (CYP11B2) −344T/C polymorphism is not associated with the initiation and progression of diabetic nephropathy in Caucasian Type 1 diabetic patients
Authors: Lajer M. , Schjoedt K. J. , Jacobsen P. , Tarnow L. , Parving H.‐H. 
Published: May 2006

AbstractAims  Aldosterone is one of the main effectors of the renin–angiotensin–aldosterone system regulating blood pressure. Previous studies have shown that the aldosterone synthase promoter polymorphism −344T/C influences aldosterone levels and is associated with hypertension, a risk factor for the initiation and progression of diabetic nephropathy. Therefore, we investigated whether the −344T/C polymorphism is associated with the development and progression of diabetic nephropathy in Type 1 diabetes mellitus.Methods  The −344T/C polymorphism was determined using standard PCR techniques in 422 Type 1 diabetic patients with overt diabetic nephropathy [mean age 43 years (sd 11)], and in 479 patients with persistent normoalbuminuria and long‐standing Type 1 diabetes [age 47 years (sd 12), duration of diabetes 27 years (sd 10)]. Furthermore, we genotyped 163 Type 1 diabetic patients with overt diabetic nephropathy treated with angiotensis‐converting enzyme inhibitors (ACE‐I). These patients were followed for a median of 6 years (range 3–14), with nine measurements (range 3–29) of glomerular filtration rate (GFR), and had a decline in GFR of 3.1 (−3.2; 23.7) ml/min per year.Results  There was no significant difference between cases and controls in either genotype distributions (cases TT 0.33, TC 0.48, CC 0.19; controls TT 0.32, TC 0.48, CC 0.20) or allele frequencies (cases T/C 0.57/0.43; controls T/C 0.56/0.44). Furthermore, a genotype–phenotype interaction analysis in the normoalbuminuric patients revealed no differences in sex distribution, age, duration of diabetes, blood pressure, HbA1c, or urinary albumin excretion rate across genotypes. In the observational follow‐up study, the rate of decline in GFR did not differ between groups of patients with different −344T/C genotype (P = 0.41). However, the T‐allele made a statistically significant contribution to both systolic and diastolic pressure during follow‐up (P = 0.006 and 0.032, respectively).Conclusions  The −344T/C polymorphism of the aldosterone synthase gene is not associated with initiation or progression of diabetic nephropathy in Caucasian Type 1 diabetic patients, but modulates blood pressure variation.
Assessment of diabetes screening by general practitioners in France: the EPIDIA Study
Authors: Cogneau J. , Balkau B. , Weill A. , Liard F. , Simon D. 
Published: May 2006

AbstractAims  To audit Type 2 diabetes screening in general practice in France and to determine the frequency of undiagnosed diabetes in patients at high risk, after systematic screening and diagnosis.Methods  For this study, 288 general practitioners volunteered to include all consecutive non‐diabetic patients aged < 65 years who had at least two risk factors for diabetes, whatever the reason for consultation. If a plasma glucose had not been recorded in the previous 12 months, a fasting plasma glucose (FPG) was performed, with a second test if FPG ≥ 7.0 mmol/l.Results  There were 5950 patients included. The most frequent diabetes risk factors were: age ≥ 40 years, 92%; overweight [body mass index (BMI) ≥ 27 kg/m2], 59%; treated hypertension, 48%; treated dyslipidaemia, 37%; family history of diabetes, 24%. Of these subjects at high risk for diabetes, 88% had a FPG measurement in their medical record (75% measured during the preceding 12 months). In the 1499 patients in whom FPG was measured, diabetes was diagnosed in 40 patients (2.7% 95% CI 1.9–3.5) and 22% had impaired fasting glucose (IFG). Thus, the frequency of undiagnosed diabetes in the 5950 high‐risk patients was 0.67% (0.46–0.88).Conclusion  Screening for diabetes by general practitioners in France appears to be adequate and undiagnosed diabetes is rare in patients with risk factors for diabetes, at least in those consulting the general practitioners studied.
A randomized trial of adding insulin glargine vs. avoidance of insulin in people with Type 2 diabetes on either no oral glucose‐lowering agents or submaximal doses of metformin and/or sulphonylureas. The Canadian INSIGHT (Implementing New Strategies with Insulin Glargine for Hyperglycaemia Treatment) Study
Authors: Gerstein H. C. , Yale J.‐F. , Harris S. B. , Issa M. , Stewart J. A. , Dempsey E. 
Published: May 2006

AbstractAims  Insulin is generally withheld until people with Type 2 diabetes are unresponsive to other therapies. However, its potential advantages suggest that it could be added earlier to achieve glycaemic goals; this possibility was tested in a clinical trial.Methods  Consenting adults aged 18–80 years with Type 2 diabetes for at least 6 months, HbA1c of 7.5–11%, and on 0, 1 or 2 oral agents, were randomized to one of two therapeutic approaches for 24 weeks: evening insulin glargine plus self‐titration by 1 unit/day if the fasting plasma glucose (FPG) was > 5.5 mmol/l; or conventional therapy with physician adjustment of oral glucose‐lowering agents if capillary FPG levels were > 5.5 mmol/l. The primary outcome was the first achievement of two consecutive HbA1c levels ≤ 6.5%.Results  Two hundred and six participants were allocated to glargine and 199 to oral agents. Compared with control subjects, participants receiving glargine: (i) were 1.68 times more likely to achieve two consecutive HbA1c levels ≤ 6.5% (95% CI 1.00–2.83; P = 0.049); (ii) reduced their HbA1c by 1.55 vs. 1.25% (P = 0.005), achieving adjusted means of 7.0 vs. 7.2% (P = 0.0007); (iii) had lower FPG (P = 0.0001), non‐high‐density lipoprotein (HDL) cholesterol (P = 0.02) and triglycerides (P = 0.02); (iv) had greater increases in treatment satisfaction (P = 0.045); and (v) had a 1.9‐kg greater increase in weight (P < 0.0001). No differences in hypoglycaemia were noted.Conclusions  Adding insulin glargine is more likely to achieve a lower HbA1c level than conventional therapy with oral agents.