bluuebunny/crossref_metadata_2025_split huggingface dataset:
Robotically assisted laparoscopic pyeloplasty: a transatlantic comparison of techniques and outcomes
Authors: Chammas Mario F. , Hubert Jacques , Patel Vipul R. 
Published: April 2007

OBJECTIVETo report a comparison of two techniques of robotically assisted laparoscopic dismembered pyeloplasty (RALDP), and their associated outcomes, for treating pelvi‐ureteric junction obstruction (PUJO), evaluating the potential differences in the initial 50 cases of two centres in North America and Europe.PATIENTS AND METHODSBetween November 2001 and August 2005, 100 patients had transperitoneal RALDP for PUJO in one centre in the USA (group 1) and one in France (group 2). Group 1 consisted of 50 patients (30 males and 20 females, mean age 31 years, range 16–62) and group 2 of 50 patients (17 males and 32 females, one bilateral PUJO; mean age 39 years, range 17–81). The right side was affected in 30 (60%) patients in group 1 and 32 (64%) in group 2. Differences in preoperative evaluation, surgical technique and follow‐up were evaluated.RESULTSIn group 1 all procedures were completed laparoscopically. One conversion was necessary in group 2 due to technical difficulties. The mean operative duration was 122 min (group 1) and 127 min (group 2); the estimated blood loss was negligible (<100 mL) in both groups. Surgical findings included 15 patients with crossing vessels in group 1 and 28 in group 2. There were no peri‐operative complications in either group. The mean hospital stay was 1.1 days in group 1 and 5.8 days in group 2, reflecting differences in practice patterns. All patients were asymptomatic at stent removal and in subsequent clinical evaluations in both groups.CONCLUSIONThe combination of results form both series provide information suggesting that the robotically assisted approach is a viable treatment option. The results reflect some differences in techniques, follow‐up and practice patterns, but the outcomes were equally effective on both continents. Further follow‐up will allow us to determine the long‐term efficacy.
Post‐stroke urinary incontinence with impaired awareness of the need to void: clinical and urodynamic features
Authors: Pettersen Renate , Stien Ragnar , Wyller Torgeir B. 
Published: April 2007

Authors from Oslo report the difficult problem of urinary incontinence after a stroke, with impaired awareness of the need to void. In this interesting paper they compared it to urge urinary incontinence, and felt that it probably reflects greater brain damage. They also found that there were various urodynamic patterns associated with the condition.OBJECTIVETo describe a clinical subtype of urinary incontinence (UI) after a stroke, i.e. with impaired awareness of the need to void (IA‐UI), and to compare it to urge UI after a stroke for the risk factors and medium‐term outcome.PATIENTS AND METHODSIn a consecutive sample of 315 hospitalized stroke patients who were clinically stable and able to communicate, 65 with UI were identified (27 urge UI, 38 IA‐UI). All had a comprehensive clinical assessment and cerebral computed tomography (CT). Cysto‐urethrometry was performed in seven patients with IA‐UI.RESULTSOf the 38 patients with IA‐UI, 16 were partially aware of leakage, but not of bladder fullness; the remaining 22 denied leakage. Patients with IA‐UI were more functionally impaired (P = 0.001), had more visible new CT lesions (24 of 38 vs 10 of 27, P = 0.04) and less frontal lobe involvement (seven of 24 vs seven of 10, P = 0.05) than those with urge UI. Ten of 12 patients with parietal lobe involvement denied leakage; no particular lesion pattern was found in those with partial awareness. Two patients had normal cysto‐urethrometry, four showed terminal detrusor overactivity, and one had an incompetent urethral closure mechanism. In all, bladder sensation was reduced or absent. Only two of the surviving patients had regained continence after 1 year, whereas half of those with urge UI had become continent.CONCLUSIONIA‐UI after a stroke differs from urge UI in clinical and prognostic respects, and probably reflects greater brain damage. It might explain the prognostic importance of stroke‐related UI. There are various urodynamic patterns. Patients with better preserved insight might benefit from early awareness training and even from additional medical treatment if bladder overactivity is present; this needs further investigation.
Prognostic accuracy of an artificial neural network in patients undergoing radical cystectomy for bladder cancer: a comparison with logistic regression analysis
Authors: Bassi PierFrancesco , Sacco Emilio , De Marco Vincenzo , Aragona Maurizio , Volpe Andrea 
Published: April 2007

OBJECTIVETo compare the prognostic performance of an artificial neural network (ANN) with that of standard logistic regression (LR), in patients undergoing radical cystectomy for bladder cancer.PATIENTS AND METHODSFrom February 1982 to February 1994, 369 evaluable patients with non‐metastatic bladder cancer had pelvic lymph node dissection and radical cystectomy for either stage Ta‐T1 (any grade) tumour not responding to intravesical therapy, with or with no carcinoma in situ, or stage T2–T4 tumour. LR analysis based on 12 variables was used to identify predictors of overall 5‐year survival, and the ANN model was developed to predict the same outcome. The LR analysis, based on statistically significant predictors, and the ANN model were the compared for their accuracy in predicting survival.RESULTSThe median age of the patients was 63 years, and overall 201 of them died. The tumour stage and nodal involvement (both P < 0.001) were the only statistically independent predictors of overall 5‐year survival on LR analysis. Based on these variables, LR had a sensitivity and specificity for predicting survival of 68.4% and 82.8%, respectively; corresponding values for the ANN were 62.7% and 86.1%. For LR and ANN, the positive predictive values were 78.6% and 76.2%, and the negative predictive values were 73.9% and 76.5%, respectively. The index of diagnostic accuracy was 75.9% for LR and 76.4% for ANN.CONCLUSIONSThe ANN accurately predicted the survival of patients undergoing radical cystectomy for bladder cancer and had a prognostic performance comparable with that of LR. As ANNs are based on easy‐to‐use software that can identify nonlinear interactions between variables, they might become the preferred tool for predicting outcome.
Robotic radical prostatectomy: outcomes of 500 cases
Authors: Patel Vipul R. , Thaly Rahul , Shah Ketul 
Published: April 2007

OBJECTIVETo report the outcomes of 500 robotically assisted laparoscopic radical prostatectomies (RALPs), a minimally invasive alternative for treating prostate cancer.PATIENTS AND METHODSIn all, 500 patients had RALP over a 30‐month period. A transperitoneal six‐port approach was used in each case, with the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA). Prospective data collection included quality‐of‐life questionnaires, basic demographics (height, weight and body mass index), prostate specific antigen (PSA) levels, clinical stage and Gleason grade. Variables assessed during RALP were operative duration, estimated blood loss (EBL) and complications, and after RALP were hospital stay, catheter time, pathology, PSA level, return of continence and potency.RESULTSThe mean (range) duration of RALP was 130 (51–330) min; all procedures were successful, with no intraoperative transfusions or deaths. The mean EBL was 10–300 mL; 97% of patients were discharged home on the first day after RALP with a mean haematocrit of 36%. The mean duration of catheterization was 6.9 (5–21) days. The positive margin rate was 9.4% for all patients; i.e. 2.5% for T2 tumours, 23% for T3a and 53% for T4. The overall biochemical recurrence free (PSA level <0.1 ng/mL) survival was 95% at mean follow‐up of 9.7 months. There was complete continence at 3 and 6 months in 89% and 95% of patients, respectively. At 1 year 78% of patients were potent (with or without the use of oral medications), 15% were not yet able to sustain erections capable of intercourse, and another 7% still required injection therapy.CONCLUSIONRALP is a safe, feasible and minimally invasive alternative for treating prostate cancer. Our initial experience with the procedure shows promising short‐term outcomes.
Reliability of preoperative diagnostics and location of lymph node metastases in presumed unilateral prostate cancer
Authors: Weckermann Dorothea , Holl Gabriele , Dorn Robert , Wagner Theodor , Harzmann Rolf 
Published: April 2007

OBJECTIVETo investigate the reliability of preoperative diagnostics in predicting the true histopathological stage and grade of prostate cancer, and to examine whether lymph node (LN) metastases in unilateral prostate cancer are located unilaterally and therefore whether it is justified to dissect only the ipsilateral LNs in presumed unilateral disease.PATIENTS AND METHODSLN metastases in clinically localized prostate cancer are often located near the internal iliac vessels. They will be detected by extended or sentinel pelvic LN dissection (PLND). Both techniques might be time‐consuming and require extensive surgical experience. In all, 564 men with impalpable or unilateral palpable prostate cancer and positive biopsy cores only in one prostate lobe had a radical prostatectomy (RP) combined with radio‐guided PLND and in some cases an extended PLND.RESULTSA median of six sentinel LNs (mean, seven) and six non‐sentinel LNs (mean, seven) were dissected per patient; 52 of 564 men (9.2%) had positive LNs. Most men with unilateral disease had LN metastases on the same side of the pelvis. Comparing the clinical stage and grade with the tumour stage and grade of the RP specimen, there was a high percentage of upstaging and upgrading even in men with only one positive biopsy core.CONCLUSIONUnilateral prostate cancer preferentially metastasizes to the ipsilateral pelvic LNs. Because there are a few cases of bilateral LN metastases even in unilateral disease, and as it is not possible to reliably predict unilateral disease on the basis of biopsy features, PLND only on the tumour‐bearing side has a high risk of understaging, and would possibly leave LN metastases behind.
Upper urinary tract tumour after radical cystectomy for transitional cell carcinoma of the bladder: an update on the risk factors, surveillance regimens and treatments
Authors: Sanderson Kristin M. , Rouprêt Morgan 
Published: April 2007

The mini reviews this month cover two somewhat unusual topics, but I feel certain that they will be of interest to the readership. Metachronous TCC in the upper urinary tract after radical cystectomy has been an important topic in relation to the follow‐up, and this paper throws considerable light on the subject. The second paper is an excellent review of the literature on emphysematous cystitis.Urothelial carcinoma is characterized by multiple, multifocal recurrences throughout the genitourinary tract; ≈ 3% of patients treated by radical cystectomy (RC) for invasive transitional cell carcinoma (TCC) of the bladder will subsequently develop a subsequent TCC in the upper urinary tract (UUT) urothelium. Metachronous upper UUT tumours (mUUT‐TCC) typically occur as a late oncological event (>3 years after RC). The vast majority of mUUT‐TCCs are detected only after the progression to tumour‐related symptoms, e.g. haematuria, flank pain or pyelonephritis, despite strict adherence to surveillance protocols. Failure of imaging and cytology to detect most asymptomatic tumours has led to questions about the need for routine UUT surveillance. Some authors have advocated a more tailored approach to surveillance after RC, targeting high‐risk patients and with limiting imaging in those patients at lowest risk of developing a subsequent UUT‐TCC. mUUT‐TCCs are most common in patients with TCC in the ureter or urethra, and with organ‐confined bladder cancer. Although the prognosis is generally poor, long‐term survival can be achieved in a subset of patients after radical nephroureterectomy (NU). Minimally invasive techniques, e.g. ureteroscopic and percutaneous resection, have been proposed as renal‐sparing alternatives to radical surgery for patients with low‐stage and ‐grade de novo UUT‐TCC. However, oncological control of renal‐sparing therapies in those with high‐risk mUUT‐TCC remains largely unconfirmed. Until oncological outcomes equivalent to the standard, radical NU, are reported in patients after RC, conservative treatment strategies should be avoided.
Bone resorption and renal calcium reabsorption in renal cell carcinoma‐bearing mice: the effects of bisphosphonate
Authors: Weissglas Max , Löwik Clemens , Schamhart Denis , Theuns Harry , Kurth Karl‐Heinz , Papapoulos Socrates 
Published: April 2007

OBJECTIVETo examine the contribution of the skeleton and the kidney to the development of humoral hypercalcaemia of malignancy (HHM) in a mouse model of HHM treated with a potent bisphosphonate.MATERIALS AND METHODSMice bearing the human RCC cell line RC‐9 were treated with bisphosphonate (subcutaneous, 0.25 mg/kg body weight olpadronate) or saline solution. Treatment was initiated at a tumour volume (TV) of ≈100 mm3 and 500 mm3, and the mice were monitored for ≈4 weeks. Serum calcium and phosphate concentrations and trabecular bone volume (TBV) were assessed during and/or after treatment.RESULTSAthymic mice implanted with the RCC RC‐9, developed severe hypercalcaemia and bone resorption. During tumour growth the mean (sd) serum calcium concentration increased to 4.1 (0.3) mmol/L, and phosphate decreased to 1.6 (0.3) mmol/L, vs 2.3 (0.1) and 2.9 (0.4) mmol/L in controls, respectively. TBV decreased from 8.7 (1.8)% in mice with no tumour, to 5.3 (2.7)% in RC‐9‐bearing mice. Olpadronate initiated at a Tv of 100 mm3 prevented the loss of bone induced by RCC RC‐9 cells, with a TBV of 12.8 (2.1)%, but the development of hypercalcaemia was unaffected. Olpadronate treatment at a TV of 500 mm3 did not influence the development of hypercalcaemia and did not protect against bone resorption. Kinetic monitoring showed an identical rate of tumour growth in the presence or absence of bisphosphonate, while under both conditions there was a tumour load‐dependent increase in calcium concentration.CONCLUSIONSBisphosphonate can prevent parathyroid hormone‐related peptide (PTHrP)‐mediated bone resorption when administered during the early phase of renal tumour growth, but has no effect on the tumour‐induced development of hypercalcaemia, indicating a primary role for renal tubular reabsorption of calcium in the kidney by PTHrP in HHM.
Characteristics and response to antiretroviral therapy of HIV‐1‐infected patients born in Africa and living in France
Authors: Breton G , Lewden C , Spire B , Salmon D , Brun‐Vézinet F , Duong M , Allavena C , Leport C , Salamon R ,   the APROCO COPILOTE ANRS CO8 Study Group
Published: April 2007

BackgroundThe world‐wide AIDS epidemic is reflected in Western Europe in an increasing number of HIV‐infected persons who originate from Africa. We describe the characteristics and response to antiretroviral therapy (ART) of HIV‐infected patients born in Africa and living in France.MethodsAnalysis of data from the (Anti PROtéase COhorte APROCO) cohort study of HIV‐infected patients initiating ART was carried out. Included in the study were 90 patients born in sub‐Saharan Africa, 53 in North Africa and 771 in metropolitan France.ResultsAt baseline, there was a higher proportion of women and of the heterosexual transmission route of infection among patients born in sub‐Saharan Africa, a higher proportion of injecting drug users among patients born in North Africa and a higher frequency of unemployment and of unstable housing conditions among patients born in both sub‐Saharan and North Africa as compared with patients born in France. The median CD4 cell count was lower in patients born in both sub‐Saharan and North Africa (sub‐Saharan Africa: 197 cells/μL; North Africa: 222 cells/μL) than in patients born in France (307 cells/μL). Median HIV‐1 viral loads were similar. After a median follow‐up time of 36 months (2506 patient‐years), the Kaplan–Meier estimations of probability of survival without new AIDS‐defining events were not different. After 36 months of ART, in multivariate analysis, median CD4 cell count, CD4/CD8 ratio and viral load were not statistically different according to birthplace, but the median CD4 percentage was lower in patients born in both sub‐Saharan and North Africa. The adherence profiles were similar.ConclusionsAlthough clinical response and adherence to ART did not appear to differ in patients according to their birthplace, the reasons for the more advanced HIV infection observed at ART initiation among patients born in Africa should be further investigated.
National review of first treatment change after starting highly active antiretroviral therapy in antiretroviral‐naïve patients
Authors: Hart E , Curtis H , Wilkins E , Johnson M 
Published: April 2007

ObjectivesThe aim of the study was to explore the factors surrounding modification of the first antiretroviral (ARV) regimen where drug switch occurred 3 months or more after initiation. Reference was made to the British HIV Association (BHIVA) guidelines on HIV management.MethodsA case note and questionnaire‐based audit was carried out.ResultsToxicity was the single most important reason for ARV change and was the only, or a contributory, cause in over half the patients. Virological failure, adherence issues, requirement for treatment simplification, and patient request were other significant reasons cited. In one‐third of those with virological failure, six or more months had elapsed between first detection and the time of switching to a new ARV regimen.ConclusionsThis audit demonstrated broad adherence to the BHIVA guidelines, although the long time before switching ARVs in the setting of virological failure was of some concern, particularly given the continuing and significant occurrence of primary ARV resistance in the UK.
Cognitive function, mood and health‐related quality of life in hepatitis C virus (HCV)‐monoinfected and HIV/HCV‐coinfected individuals commencing HCV treatment*
Authors: Thein HH , Maruff P , Krahn M , Kaldor JM , Koorey DJ , Brew BJ , Dore GJ 
Published: April 2007

ObjectivesThe aim of the study was to examine cognitive function, mood and health‐related quality of life (HRQOL), and their interrelationships, among hepatitis C virus (HCV)‐monoinfected and HIV/HCV‐coinfected individuals.MethodsBaseline neuropsychological and HRQOL measures of HCV‐monoinfected and HIV/HCV‐coinfected individuals commencing HCV treatment were examined from a prospective cohort study conducted between April 2003 and August 2005 in Sydney, Australia. Participants' neuropsychological performance and HRQOL were measured using computer‐based battery, Trail Making Tests (TMT), Depression Anxiety Stress Scales (DASS), the Hepatitis Quality of Life Questionnaire (HQLQ), and the Visual Analogue Scale (VAS). Neuropsychological measures of HCV‐infected patient groups were compared with those of two control groups consisting of HIV‐monoinfected and uninfected individuals.ResultsSimilar cognitive function, mood and HRQOL were found in HCV‐monoinfected (n=19) and HIV/HCV‐coinfected (n=15) individuals. When compared with the HIV‐monoinfected (n=30) and uninfected control (n=30) groups, subtle cognitive impairment in attention was found in the HIV/HCV‐coinfected group (P<0.05). Twenty‐one percent of the HCV‐monoinfected group were classified as having cognitive impairment compared with 10% or less in the other groups. Sociodemographic characteristics, mood, HRQOL and HCV indices did not correlate with cognitive function.ConclusionsOur findings indicate no statistically significant difference in neuropsychological and HRQOL impairments between HIV/HCV‐coinfected individuals with nonadvanced HIV disease and HCV‐monoinfected individuals. This lack of significant difference may relate to the relatively small study population.
Multivitamin supplementation in HIV‐positive pregnant women: impact on depression and quality of life in a resource‐poor setting
Authors: Smith Fawzi MC , Kaaya SF , Mbwambo J , Msamanga GI , Antelman G , Wei R , Hunter DJ , Fawzi WW 
Published: April 2007

ObjectivesThe primary objective of this study was to examine the effect of vitamin supplementation on health‐related quality of life and the risk of elevated depressive symptoms comparable to major depressive disorder (MDD) in HIV‐positive pregnant women in Dar es Salaam, Tanzania.MethodsFrom April 1995 to July 1997, 1078 HIV‐positive pregnant women were enrolled in a randomized controlled trial. We examined the effects of vitamin supplementation on quality of life and the risk of elevated depressive symptoms, assessed longitudinally every 6–12 months.ResultsA substantial prevalence of elevated depressive symptoms (42%) was observed in HIV‐positive pregnant women. Multivitamin supplementation (B‐complex, C and E) demonstrated a protective effect on depression [relative risk (RR)=0.78; P=0.005] and quality of life [RR=0.72 for social functioning (P=0.001) and vitality (P=0.0001); RR=0.70 for role‐physical (P=0.002)]; however, vitamin A showed no effect on these outcomes.ConclusionsMultivitamin supplementation (B‐complex, C and E) resulted in a reduction in risk of elevated depressive symptoms comparable to MDD and improvement in quality of life in HIV‐positive pregnant women in Tanzania.