bluuebunny/crossref_metadata_2025_split huggingface dataset:
Renal transplantation or bladder augmentation first? A comparison of complications and outcomes in children
Authors: Taghizadeh Arash K. , Desai Divyesh , Ledermann Sarah E. , Shroff Rukshana , Marks Stephen D. , Koffman Geoff , Duffy Patrick G. , Cuckow Peter M. 
Published: October 2007

Paediatric urology can uncover the most complicated cases that require careful attention to management details. Authors from the UK present a retrospective review of their experience of children who had undergone both renal transplantation and bladder augmentation. They recommend that the bladder be reconstructed before renal transplantation, as it might protect the transplanted kidney, and specifically the transplanted ureter.OBJECTIVETo identify whether the order of performing transplant and bladder reconstruction operations in children who need both operations affects outcome of either operation.PATIENTS AND METHODSA retrospective case note review was performed of children identified from our database, who had undergone both renal transplantation and bladder augmentation between 1990 and 2005.RESULTSIn all, 18 renal transplants (eight live‐related) were performed in 16 children with 10 transplants done after bladder augmentation and eight transplants done before augmentation. The median age at transplantation was 7.5 years and at augmentation was 7.0 years. The median interval between the operations was 33.5 months and the median follow‐up was 58.4 months after transplantation. Outcomes were compared between the two groups of patients: those who received their transplantation before bladder augmentation, and those who were transplanted after bladder augmentation. There was no difference between these groups in: the pre‐ transplant estimated glomerular filtration rate, inpatient stay after transplantation or after augmentation, and incidence of urinary tract infection in the 3 months after renal transplantation or after bladder augmentation. There was no statistical difference in renal allograft loss with one graft failure in the group who were augmented first, and four graft failures in the group who were transplanted first. However, it is of note that the single graft failure in the patient augmented first was due to renal artery thrombosis on the first day related to a double arterial anastomosis, whilst in the other group, three of the graft failures were in transplants that had initially been drained by ureterostomy. Three patients in the group transplanted first developed significant ureteric pathology, of which one developed graft failure.CONCLUSIONBladder reconstruction can be performed safely before transplantation; it does not increase complications and might better protect the renal graft and specifically the transplant ureter.
Protective effects of heme oxygenase‐1 against cyclophosphamide‐induced haemorrhagic cystitis in rats
Authors: Matsuoka Yoh , Masuda Hitoshi , Yokoyama Minato , Kihara Kazunori 
Published: October 2007

OBJECTIVETo investigate the expression profiles and protective roles of the inducible isoform of heme oxygenase‐1 (HO‐1) in cyclophosphamide (CYP)‐induced cystitis, as the HO system is involved in heme degradation and plays an important role in cellular homeostasis but its characterization is still unknown in urinary tract diseases.MATERIALS AND METHODSIn female Sprague‐Dawley rats CYP was administed intraperitoneally and the bladders excised at various time points. In separate experiments, hemin, an inducer of HO, was administered before CYP treatment, and bladders were harvested 24 h after CYP injection. The expressions of HO‐1 and HO‐2 were investigated by reverse‐transcription polymerase chain reaction and immunohistochemistry. The effects of CYP with/without hemin pretreatment were evaluated by microscopic features, bladder wet weight, myeloperoxidase activity, nitric oxide (NO)‐metabolite production, and expression levels of inflammation‐related genes.RESULTSCYP injection resulted in severe cystitis with time‐dependent increases both in bladder wet weight and HO‐1 mRNA expression. Pretreatment with hemin enhanced the CYP‐induced expression of HO‐1 mRNA and protein further, but significantly ameliorated inflammatory changes and reduced the increases in bladder oedema and myeloperoxidase activity. NO‐metabolite production and inducible NO synthase (iNOS) expression, induced by CYP, were down‐regulated significantly by hemin pretreatment. By contrast, HO‐2 was constitutively present in the urothelium and its expression was not influenced by CYP or by CYP plus hemin.CONCLUSIONHO‐1 expression is up‐regulated in bladders with CYP‐induced haemorrhagic cystitis, and this inducible enzyme plays cytoprotective roles in association with down‐regulation of NO production and iNOS expression. Our results suggest that HO‐1 induction might have therapeutic potential against inflammatory insults such as CYP‐induced cystitis.
Clinicians are poor raters of life‐expectancy before radical prostatectomy or definitive radiotherapy for localized prostate cancer
Authors: Walz Jochen , Gallina Andrea , Perrotte Paul , Jeldres Claudio , Trinh Quoc‐Dien , Hutterer Georg C. , Traumann Miriam , Ramirez Alvaro , Shariat Shahrokh F. , McCormack Michael , Perreault Jean‐Paul , Bénard Francois , Valiquette Luc , Saad Fred , Karakiewicz Pierre I. 
Published: October 2007

OBJECTIVETo test the accuracy of predicting life‐expectancy (LE) among 19 raters, as the accurate prediction of LE in candidates for definitive therapy for localized prostate cancer is crucial, and little is known of the ability of clinicians to predict LE.SUBJECTS AND METHODSWe randomly selected the case‐vignettes of 50 patients treated with either radical prostatectomy (RP, 25) or external beam radiotherapy (EBRT, 25) for prostate cancer, and who either survived for > 10 years or died earlier with no evidence of disease relapse. The median age at treatment was 67 years and the median Charlson Comorbidity Index (CCI) was 2. The raters consisted of urology staff (six), urology residents (10) and medical students (three). The case‐vignettes included patient age, comorbidities and CCI score, and raters were asked to predict the survival at 10 years (yes vs no), assuming no disease relapse.RESULTSOf the 50 cases, 20 (40%) did not survive for > 10 years; clinicians estimated a mean (range) of 23 (10–35) deaths before 10 years. The mean (95% confidence interval) overall predictive accuracy (0.5 = chance, 1.0 = perfect prediction) of LE predictions was 0.68 (0.64–0.71). Individual accuracy ranged from 0.52 (staff) to 0.78 (staff). There were no important differences among the rater groups (residents 0.69 vs staff 0.67 vs medical students 0.67).CONCLUSIONSClinicians are relatively poor at predicting LE; tools to predict LE might be able to improve clinicians’ performance in this important part of decision‐making about prostate cancer treatment. It remains to be determined whether this limitation exclusively applies to prostate cancer or also to other malignancies.
Severe bladder trabeculation obviates the need for bladder outlet procedures during augmentation cystoplasty in incontinent patients with neurogenic bladder
Authors: Khoury Antoine E. , Dave Sumit , Peralta‐Del Valle Maria Helena , Braga Luis H.P. , Lorenzo Armando J. , Bägli Darius 
Published: October 2007

OBJECTIVETo evaluate whether the degree of preoperative bladder trabeculation in neurogenic bladder (NB) patients is a marker of significant outlet resistance. If so, severe trabeculation may obviate the need for concomitant bladder outlet procedure (BOP) during augmentation cystoplasty (AC).PATIENTS AND METHODSWe retrospectively reviewed 48 incontinent patients with NB who had surgery. The patients were divided into two groups: group 1 (23 patients) had AC alone; group 2 (10) had AC with BOP. Children who had a BOP alone (15) were excluded from the study. Success was defined as a dry period of ≥4 h. Preoperative bladder trabeculation was classified as mild or severe. Data collected included continence status, imaging and urodynamic findings.RESULTSIn group 1 patients before surgery, there was severe bladder trabeculation in 14 (61%), hydronephrosis in 13 (57%) and associated vesico‐ureteric reflux (VUR) in 16 (70%). The mean detrusor leak‐point pressure (DLPP) was 49.7 cmH2O and the bladder neck was open in nine (39%). Dryness with AC alone was achieved in 91% of group 1 patients. In group 2 patients (10 patients), there was severe bladder trabeculation in five, hydronephrosis in three, and VUR in two. The mean DLPP was 42.8 cmH2O and the bladder neck was open in eight. After surgery, eight of 10 patients achieved a dry period of 4 h. There was no significant difference between group 1 and 2 patients for age at surgery, gender, ambulatory status, hydronephrosis, degree of trabeculation, detrusor overactivity, DLPP and eventual outcome. The incidence of VUR was higher in group 1 patients (P = 0.009) and more patients in group 2 had an open bladder neck (P = 0.031).CONCLUSIONSevere bladder trabeculation in incontinent patients with NB might predict an element of intrinsic outlet resistance. In this subset of patients, dryness was achieved by AC alone without further BOP. The degree of bladder trabeculation should be considered in the surgical decision‐making process for incontinent children with NB.
The morphology of extracted testicular sperm correlates with fertilization but not pregnancy rates
Authors: Schiff Jonathan D. , Luna Martha , Barritt Jason , Duke Marlena , Copperman Alan , Bar‐Chama Natan 
Published: October 2007

OBJECTIVETo investigate sperm morphology on the day of fresh testicular sperm extraction (TESE) with intracytoplasmic sperm injection (ICSI), and its effect on fertilization and pregnancy rates, as TESE in conjunction with ICSI results in high fertilization and pregnancy rates in most patients, but to our knowledge only one small study has assessed the morphology of retrieved sperm and found no correlation with the success of fertilization.PATIENTS AND METHODSIn a retrospective database analysis in a large academic centre, 68 men had 75 cycles of TESE combined with ICSI from January 2004 until April 2006. Sperm obtained by TESE was morphologically analysed at high (×400–600) magnification and used for ICSI on the day of tissue retrieval. Sperm were classified as being either normal, having an amorphous head, having a mid‐piece defect or having multiple defects. The calculated percentage of abnormal sperm injected was compared with the normal fertilization rate using Pearson’s correlation coefficient, and pregnancy rates between groups were compared using chi‐square analysis.RESULTSFifteen cycles had all morphologically normal sperm; 21 cycles had 50–99% normal forms and 39 cycles had <50% normal sperm. There was a highly significant correlation between the percentage of normal sperm used for ICSI and fertilization rates (P = 0.007). Overall, 43 clinical pregnancies resulted in this series, i.e. three among the group with all normal sperm injected, 12 in the group with 50–99% normal sperm and 28 in the group with <50% normal forms. There were also 11 pregnancies in cycles that used no normal forms. Pregnancy rates did not differ significantly among the groups (P = 0.08).CONCLUSIONSTESE with ICSI frequently results in successful pregnancy; normal morphology was highly and significantly associated with successful fertilization, but importantly there were still 10 clinical pregnancies in cycles where only abnormal sperm were used. Sperm morphology after TESE should be assessed at the time of the procedure, and whenever possible, morphologically normal sperm chosen for injection. However, it is reassuring that acceptable fertilization and pregnancy rates are still achievable in cases with no morphologically normal sperm available.
Increased postvoid residual volume after measuring the isovolumetric bladder pressure using the noninvasive condom catheter method
Authors: De Zeeuw Sandra , Van Mastrigt Ron 
Published: October 2007

The papers in this section cover a variety of topics, from urodynamics using a noninvasive method, the morbidity associated with long‐term urinary catheters and attempts being made to lower this, the use of botulinum toxin in refractory idiopathic detrusor overactivity, and finally, a study into the effect of chronic prostatitis‐like symptoms on the quality of life in a relatively large patient sample.OBJECTIVETo test, in an ongoing noninvasive longitudinal study in healthy men, whether the condom catheter method (a noninvasive urodynamic test to assess bladder function and bladder outlet obstruction) inhibits bladder function and whether this affects the reliability of the measured isovolumetric bladder pressure (Pves.iso).SUBJECTS AND METHODSSubjects (754, aged 40–79 years) voided three times, i.e. one free void and two condom measurements. The postvoid residual volume (PVR) was measured after each void using transabdominal ultrasonography. The statistical significance of differences was tested using Wilcoxon rank test and the Mann–Whitney U‐test.RESULTSAfter free voiding the median (interquartile range) PVR was 18 (37) mL, and independent of the amount of fluid intake. In a subgroup of volunteers, when the free void was done last, the PVR was no different (P = 0.25), suggesting that the bladder did not become exhausted during the protocol. The PVR after two subsequent condom measurements was significantly higher than after free voiding, at 45 (78) and 57 (88) (both P < 0.05), independent of the number of interruptions in voiding. After supplementary fluid intake before the condom measurements, the PVR was double that with a normal fluid intake (P = 0.03). The median Pves.iso was 3 cmH2O higher in the second condom measurement than in the first (P < 0.05), although this small difference was not clinically relevant.CONCLUSIONSThe condom measurement is associated with a significantly higher PVR, partly caused by supplementary fluid intake. This effect was only temporary and did not affect the measured Pves.iso.
The ‘ventral urethral elevation plus’ sling: a novel approach to treating stress urinary incontinence in men
Authors: Comiter Craig V. , Rhee Eugene Y. 
Published: October 2007

OBJECTIVETo evaluate the urodynamic changes after placing a novel ‘ventral urethral elevation plus’ (VUE+) sling (LeveraTM, Caldera Medical, Agoura Hills, CA, USA) in a cadaveric study, and in our initial experience in two patients.PATIENTS, MATERIALS AND METHODSIn two male cadavers (A and B) the maximum urethral closure pressure (MUCP) and retrograde leak‐point pressure (RLPP) were measured before and after transperineal placement of the Levera sling. A 5.5 × 7 cm sling, with two 1.5 × 22.5 cm inferior extensions and two 1.5 × 25 cm superior extensions, was placed over the bulbar urethra. The inferior extensions were passed using the transobturator approach, and the superior extensions by a prepubic approach. This procedure was offered to two men (C and D) with severe neurogenic intrinsic sphincter deficiency.RESULTSThe mean baseline MUCP in specimen A was 55 cmH2O and the RLPP 35 cmH2O; after placing the sling the respective values increased to 75 and 70 cmH2O. In specimen B the respective mean values were 56 and 50 cmH2O, and after placing the sling were 82 and 75 cmH2O. In patient C, the RLPP increased from 17 cmH2O before surgery to 65 cmH2O afterward, and in patient D, from 20 to 70 cmH2O. At the 12‐month follow‐up, there was complete resolution of urinary incontinence in both patients.CONCLUSIONSThe VUE+ Levera sling provides urethral compression against the perineal membrane using a straightforward pre‐pubic approach, and ventral elevation and compression of the bulbous urethra using the transobturator approach, avoiding the risks associated with of bone screws and retropubic needle passage. In our initial two patients stress incontinence was cured at 1 year of follow‐up. A long‐ term follow‐up and a larger prospective study of the VUE+ sling is needed to objectively assess the efficacy of this novel procedure.
REVIEW ESSAY
Authors: MENZEL PAUL T. 
Published: October 2007

Rationing Health Care in America:Perceptions and Principles of Justice by Larry R. Churchill. American Health Care:Realities, Rights, and Reforms by Charles J. Dougherty. Should Medical Care Be Rationed by Age? edited by Timothy M. Smeeding, with Margaret P. Battin, Leslie P. Francis, and Bruce M. Landesman, Totowa, N.J., Rowman and Littlefield.
NEWBORN INFANTS WITH SEVERE DEFECTS: A SURVEY OF PAEDIATRIC ATTITUDES AND PRACTICES IN THE UNITED KINGDOM.
Authors: OUTTERSON CAROLE 
Published: October 2007

ABSTRACTThis article reports the first results of a survey, by mail questionnaire, of the attitudes and practices of paediatricians with respect to the nontreatment of newborn infants with severe defects. Questionnaires were sent to 500 paediatricians in senior positions throughout the United Kingdom. 263 questionnaires, (52.6%) were completed and returned. The survey was an attempt to identify areas of consensus amongst paediatric specialists, and to discover some of the factors which influence their practice. A preliminary analysis of the data has revealed variations in attitudes and practices in some areas, and a broad consensus in others. The following report is not an endorsement of any particular point of view.
TREATMENT LIMITATION DECISIONS UNDER UNCERTAINTY: THE VALUE OF SUBSEQUENT EUTHANASIA
Authors: SAVULESCU JULIAN 
Published: October 2007

ABSTRACTThis paper examines how decisions to limit treatment to critically ill patients under uncertainty can be made rationally. Expected utility theory offers one way of making rational decisions under uncertainty. One problem with using this approach is that we may not know the value of each option. One rational course open is to treat until further information becomes available. However, treatment can limit the range of options open. With treatment, a patient may recover such that he no longer requires life‐supporting treatment. However, his life may be not worth living. If active euthanasia of %on‐terminal’conditions is prohibited, the option of dying will no longer be available. Taking a rational‘wait and see’course may result in being trapped within an unbearable life. On the other hand, sometimes present practice‘lets nature takes its course'. Critically ill patients are allowed to die because it is believed that their lives will be not worth living. It is likely that some patients are allowed to die when there is some objective chance of worthwhile future life. This paper argues that a policy of treating critically ill patients until the nature of future options can be better evaluated, in company with an offer of subsequent euthanasia where appropriate, allows a more rational and humane approach to treatment limitation decisions under uncertainty.
DOES JUSTICE REQUIRE THAT WE BE AGEIST?
Authors: HARRIS JOHN 
Published: October 2007

ABSTRACTThis paper restates some of the principal arguments against an automatic preference for the young as advocated by Kappel and Sandøe, arguments many of which have been extant for over a decade but which Kappel and Sandøe largely ignore. It then goes on to demonstrate that Kappel and Sandøe's “indifference test” fails to do the work required of it because it can be met by unacceptable conceptions of justice. The paper develops a number of new arguments against what I have called “ageist” preferences for the young or for those with long life expectancy. Finally I show that Kappel and Sandøe must believe that murdering older people is less morally wrong than murdering the young and that people relying on arguments such as theirs will have to accept the moral respectability of killing the innocent in order to maximise units of lifetime.
THE IMPACT OF REPORTING CASES OF EUTHANASIA IN HOLLAND: A PATIENT AND FAMILY PERSPECTIVE
Authors: CIESIELSKI‐CARLUCCI CHRIS , KIMSMA GERRIT 
Published: October 2007

ABSTRACTIn 1991 the Dutch government released the results of the first national investigation into the nature and extent of decisions concerning end of life including euthanasia. A significant finding was that most cases of euthanasia were not reported. This prompted us to ask what effect, if any, not reporting caused. More specifically, we asked whether reporting has a positive or negative impact on the experiences of friends or relatives of patients who have received euthanasia. In cases of euthanasia, complications of both process and experience can deter from a minimally complicated death. These difficulties arise when either the family or physician does not perceive the freedom to disclose euthanasia openly. On the basis of interviews with family members and patients, we illustrate that they generally benefit from reporting. Our premise is that reporting fosters open discussion of euthanasia. We further suggest physicians and society benefit from a milieu of openness initiated by reporting cases of euthanasia.
GENETIC THERAPY, IDENTITY AND THE PERSON‐REGARDING REASONS
Authors: PERSSON INGMAR 
Published: October 2007

AbstractIt has been argued that there can be no person‐regarding reasons for practising genetic therapy, since it affects identity and causes to exist an individual who would not otherwise have existed. And there can be no such reasons for causing somebody to exist because existing cannot be better for an individual than never existing. In the present paper, both of these claims are denied. It is contended, first, that in practically all significant cases genetic therapy will not affect the identity of beings of our kind. This is so irrespective of whether, essentially, we are beings with minds or beings of a certain biological species, the human one. Second, it is contended that, even if genetic therapy were to affect our identity, there could be person‐regarding reasons for conducting it, for existence can be better than non‐existence for the individual.
SPERM HARVESTING AND POSTMORTEM FATHERHOOD
Authors: MURPHY TIMOTHY F. 
Published: October 2007

AbstractThe motives and consequences of harvesting sperm from brain dead males for the purpose of effecting post mortem fatherhood are examined. I argue that sperm harvesting and post mortem fatherhood raise no harms of a magnitude that would justify forbidding the practice outright. Dead men are not obviously harmed by the practice; children need not be harmed by this kind of birth; and the practice enlarges rather than diminishes the reproductive choices of surviving partners. Certain ethical and legal issues nevertheless require attention. As a matter of consistency with other harvesting protocols, there ought to be a mechanism for respecting the wishes of men who when alive do not wish to become fathers post mortem. Mechanisms governing entitlement to harvest and use sperm will also be required. I note that the law is unlikely to recognize the paternity of children born from harvested sperm, though there may be reasons to recognize that paternity in some instances.
PRINCIPLISM AND THE ETHICAL APPRAISAL OF CLINICAL TRIALS
Authors: MESLIN ERIC M. , SUTHERLAND HEATHER J. , LAVERY JAMES V. , TILL JAMES E. 
Published: October 2007

AbstractFor nearly two decades, the process of reviewing the ethical merit of research involving human subjects has been based on the application of principles initially described in the U.S. National Commission's Belmont Report, and later articulated more fully by Beauchamp and Childress in their Principles of Biomedical Ethics. Recently, the use of ethical principles for deliberating about moral problems in medicine and research, referred to in the pejorative sense as “principlism”, has come under scrutiny. In this paper we argue that these principles can provide a foundation for the source of ethical appraisal of human research, but are not themselves wholly adequate for this purpose. Therefore, we further propose that (1) principles should be understood as heuristics that can be “specified” as described by DeGrazia (1992), and (2) that the principle‐based approach should be supplemented by formally incorporating “sensitivity to context” into the evaluation of clinical trials