bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of initiation of therapy with once‐daily combination of a thiazolidinedione and a biguanide at an early stage of type 2 diabetes
Authors: Bell D. S. H. , Ovalle F. 
Published: August 2004

Context:  Utilization of the biguanide metformin and a thiazolidinedione (TZD) with new onset diabetes has the benefit of lowering A1cs into the normal range without the problem of severe hypoglycaemia.Objective:  To assess the effectiveness of once‐daily combined metformin and TZD therapy compared with other therapeutic regimens typically utilized at later stages of type 2 diabetes.Methods:  A random chart review of 300 type 2 diabetic patients and extraction of data for body mass index (BMI), duration of diabetes and C‐peptide and A1c was performed. In the 210 type 2 diabetic subjects in whom this information was currently available, the data were analysed.Results:  Eighty‐six patients on once‐daily metformin and rosiglitazone had an average A1c of 6.2% (group A), and 58 subjects on triple therapy (metformin, rosiglitazone and glimepiride) (group B) had an average haemoglobin A1c (HbA1c) of 6.9%. The 22 subjects on one injection of insulin per day in addition to triple therapy (group C) had an average HbA1c of 7.6%, and the 44 subjects on more than one insulin injection per day plus metformin and/or rosiglitazone (group D) had an average HbA1c of 8.3%. HbA1cs below 7.0% were found in 91.9% of group A, 21.7% of group B, 36.4% of group C and 56.8% of group D. HbA1cs below 6.5% were found in 78.2% in group A, 15.5% in group B, 22.7% in group C and 31.8% in group D. HbA1cs below 6.0% were found in 41.9% in group A, 6.9% in group B, 9.1% in group C and 13.6% in group D. On univariate analyses, the HbA1c was positively associated with the duration of diabetes and the BMI and negatively associated with random C‐peptide levels. Alternatively, on multiple regression analysis, there was no statistical correlation between the duration of diabetes or BMI with the HbA1c. However, there was a strong statistical correlation between the random C‐peptide level and the HbA1c (p = 0.002).Conclusion:  Early initiation of therapy for type 2 diabetes with a once‐daily combination of metformin and rosiglitazone provides the greatest opportunity to achieve A1cs within the normal range. The level of achieved glycaemic control is not dependent on the number or potency of the therapies utilized but is dependent on the level of endogenous insulin production. The use of a TZD as part of initial therapy of type 2 diabetes with its documented ability to preserve or improve β‐cell function has the potential to achieve prolonged normoglycaemia in the type 2 diabetic patient.
Atrial fibrillation and its association with type 2 diabetes and hypertension in a Swedish community
Authors: Östgren C. J. , Merlo J. , Råstam L. , Lindblad U. ,   for Skaraborg Hypertension and Diabetes Project
Published: August 2004

Aim:  To explore the prevalence of atrial fibrillation in patients with hypertension and type 2 diabetes and to identify possible mechanisms for the development of atrial fibrillation.Methods:  A community‐based, cross‐sectional observational study was conducted in the primary health care in Skara, Sweden, and 1739 subjects (798 men, 941 women) were surveyed. Patients were categorized as those with hypertension only (n = 597); those with both hypertension and type 2 diabetes (n = 171), and those with type 2 diabetes only (n = 147). In the reference population, 824 normotensive subjects without diabetes were identified and used as controls. Participants were examined for cardiovascular risk factors including fasting blood glucose, serum insulin, blood pressure, lipids and anthropometric measures. Resting electrocardiogram (ECG) was recorded and Minnesota‐coded. Insulin resistance was measured by the homeostasis model assessment (HOMA).Results:  Age‐adjusted prevalence of atrial fibrillation was 2% in patients with hypertension only, 6% in patients with both hypertension and type 2 diabetes, 4% in patients with type 2 diabetes only and 2% in controls, respectively. Age and sex adjusted odds ratios (OR) (95% CI) were; hypertension 0.7 (0.30–1.5), combined hypertension and type 2 diabetes 3.3 (1.6–6.7), and type 2 diabetes 2.0 (0.9–4.7). The association with combined hypertension and type 2 diabetes remained significant when adjusted for cardiovascular disease (CVD) risk factors and body mass index (BMI), was attenuated with adjustment for ischemic ECG; 2.4 (1.1–5.0) and lost significance with adjustment for insulin resistance; 1.3 (0.5–3.1).Conclusions:  Atrial fibrillation is associated with the combined occurrence of type 2 diabetes and hypertension. Insulin resistance may be a common underlying mechanism.
Acarbose lowers serum triglyceride and postprandial chylomicron levels in type 2 diabetes
Authors: Ogawa S. , Takeuchi K. , Ito S. 
Published: August 2004

Aim:  This study was designed to examine the therapeutic effect of acarbose on serum triglyceride (TG), free fatty acid (FFA), very low‐density lipoprotein (VLDL) and chylomicron (CM) in the meal tolerance test (MTT) before and after acarbose treatment in type 2 diabetes mellitus (DM2).Methods:  Effects of acarbose on postprandial lipid metabolism were examined in DM2 patients. The subjects with normotriglyceridaemia (TG ≥ 1.7 mmol/l, n = 60) were divided to three groups (A, B and C), and DM2 patients with hypertriglyceridaemia (TG > 1.7 mmol/l, n = 20) were designated group D. Group A was a control, and group B was designed to examine the one‐dose effect of acarbose (100 mg) on lipid levels in MTT using the balanced food of 400 kcal. In groups C and D, acarbose 300 mg/day was administered for 8 weeks, and MTT with the one‐dose acarbose administration was performed. We determined the levels of fasting and postprandial levels of glucose, insulin, FFA and TG‐rich lipoproteins such as CM and VLDL.Results:  Acarbose treatment lowered plasma glucose levels and insulin secretion. In comparison among study groups A, B and C, acarbose significantly lowered serum TG levels in postprandial state. In group D, after the 8‐week acarbose administration, fasting or postprandial FFA, TG and VLDL levels were also lowered. Interestingly, postprandial increase in CM was suppressed by acarbose administration in group B, C or D.Conclusions:  Acarbose lowers postprandial TG and CM levels in DM2 with either normotriglyceridaemia or hypertriglyceridaemia. Improvement of insulin resistance with acarbose may also reduce fasting TG levels in DM2 with hypertriglyceridaemia. Acarbose is a beneficial therapeutic agent to reduce TG levels in DM2 patients, thereby leading to suppression of cardiovascular events.
Anterior urethral valves and diverticula in children: a result of ruptured Cowper's duct cyst?
Authors: McLellan Dawn L. , Gaston Michael V. , Diamond David A. , Lebowitz Robert L. , Mandell James , Atala Anthony , Bauer Stuart B. 
Published: August 2004

The experience from Boston in anterior urethral valves and diverticula over a 40‐year period is described. Other articles describe experience with both ignoring and treating VUR, and ballooning of the foreskin and physiological phimosis.OBJECTIVETo review a series of children with anterior urethral valves and diverticula, to elucidate the pathophysiology and optimal management of this entity.PATIENTS AND METHODSNine cases (all boys; 1963 to 2003) were reviewed retrospectively.RESULTSSeven of nine boys had bulbar diverticula. Continuity between Cowper's duct and the diverticulum was noted endoscopically in two and confirmed radiographically in one. Initially, open surgery was curative but more recently endoscopic management has been the procedure of choice.CONCLUSIONThis series indicates that the distal lip of a ruptured syringocele may function as a flap‐valve, leading to anterior urethral obstruction. Advances in imaging and endoscopic instruments have altered the mode of presentation and management of this entity.
The association between patient age and prostate cancer stage and grade at diagnosis
Authors: Alibhai Shabbir M.H. , Krahn Murray D. , Fleshner Neil E. , Cohen Marsha M. , Tomlinson George A. , Naglie Gary 
Published: August 2004

OBJECTIVESTo investigate the association of age with prostate cancer stage and grade, as the latter factors at the time of diagnosis influence management and prognosis, with some studies suggesting that they may change as a function of patient age.PATIENTS AND METHODSThe charts were reviewed of an age‐stratified (<60, 60–69, 70–79 and ≥ 80 years) random sample of men with newly diagnosed, histologically confirmed prostate cancer in 1995/96 from three geographical areas in Ontario, Canada. Patients were identified using a comprehensive cancer registry, and the chi‐square analysis used to examine the relationship between age and stage, logistic regression for the effect of age on clinically localized disease, and linear regression to assess the age and grade relationships.RESULTSIn all, 347 charts were reviewed; more men in the oldest group had T1 and metastatic disease than had younger men (P = 0.034). The proportion of patients with clinically localized disease (T1 and T2) did not change with age (P > 0.10). Tumour grade, as assessed by Gleason score, increased slightly with age (R2 = 0.017, P = 0.011). Excluding those patients diagnosed by transurethral prostatectomy did not influence either the age/stage or age/grade relationship. Adjusting for prostate‐specific antigen level attenuated the age/grade relationship.CONCLUSIONThe stage and grade of prostate cancer at diagnosis changes only slightly with age, probably because of a lower intensity of screening and later diagnosis in older men, rather than any change in prostate cancer biology with age.
Dendritic cell immunotherapy for urological cancers using cryopreserved allogeneic tumour lysate‐pulsed cells: a phase I/II study
Authors: Pandha Hardev S. , John Robert J. , Hutchinson James , James Nick , Whelan Mike , Corbishley Catherine , Dalgleish Angus G. 
Published: August 2004

OBJECTIVETo assess the feasibility, toxicity and immunogenicity of dendritic cell (DC)‐based immunotherapy in patients with advanced urological cancers.PATIENTS AND METHODSPatients with hormone‐refractory prostate cancer (11) and metastatic renal cell carcinoma (five) received 1–3 × 106intradermal allogeneic tumour lystate‐pulsed DCs fortnightly for six vaccinations then monthly until disease progression. Intradermal keyhole limpet haemocyanin was injected near the DCs as the adjuvant. DC vaccine was prepared from buffy coats, then lysate‐pulsed, cryopreserved in aliquots, and tested for phenotypic expression and activity in an allogeneic mixed lymphocyte reaction before clinical use.RESULTSThere was no evidence of significant toxicity from vaccine or adjuvant. Delayed‐type hypersensitivity skin testing and biopsy revealed a cellular infiltrate to intradermal re‐challenge to tumour lysate and adjuvant in almost all patients. In addition, there was increased expression of T helper type 1 cytokines, interferon‐γ‐expressing T cell by ELISPOT analysis, but also interleukin‐10 in a few patients. Vaccination resulted in a reduction in the level of prostate‐specific antigen (PSA) in one patient, a reduction in PSA velocity in a further man and an increased PSA doubling time in six. Two of five patients with renal cell carcinoma had stabilization of disease.CONCLUSIONThe cryopreservation and repeated administration of DC vaccine was feasible and not toxic. There was evidence of induction of both humoral and cellular immunity to vaccine and adjuvant in most patients. The use of sequential aliquots of identical cryopreserved vaccine will ensure quality control and greatly facilitate future clinical studies in terms of consistency of vaccine administered and the provision of primed DCs forin vitroassessment of response.
Laparoscopic cytoreductive nephrectomy for metastatic renal cell carcinoma
Authors: Finelli Antonio , Kaouk Jihad H. , Fergany Amr F. , Abreu Sidney C. , Novick Andrew C. , Gill Inderbir S. 
Published: August 2004

The theme of laparoscopy, which has been strongly stated in the mini‐review section, continues here with a paper from the Cleveland Clinic on a series of patients who had a laparoscopic nephrectomy as part of a cytoreductive strategy before immunotherapy for metatastic renal cancer. They found it safe and helpful in patients with tumours of <15 cm which do not have local invasion or caval thrombus.Prostate cancer continues to occupy much time and interest. Papers this month from Canada, USA, Malaysia and Scotland assess the variation in PSA doubling time in untreated prostate cancer, the role of bone scintigraphy in patients with biochemical recurrence, the association between age and stage or grade, and the much‐vexed question of biopsy technique.There are also three papers on superficial bladder cancer, evaluating the difference between tumours in young and elderly patients, intravesical epirubicin to prevent recurrence, and the use of the holmium laser to treat recurrent tumours.OBJECTIVETo critically analyse the results of laparoscopic cytoreductive surgery for renal cell carcinoma (RCC), as phase III evidence supports cytoreductive nephrectomy before immunotherapy, and there is an overall shift towards minimally invasive renal surgery for this disease.PATIENTS AND METHODSSince October 2000, 22 patients were treated by laparoscopic cytoreductive nephrectomy for metastatic RCC (group 1). All patients had radiological evidence of metastatic disease, with biopsy confirmation in 10. To put the results into perspective, 25 consecutive contemporary patients with large organ‐confined nonmetastatic RCC (>7 cm, clinical stage T2) undergoing laparoscopic radical nephrectomy (group 2) were compared retrospectively. The baseline demographics were comparable between the groups.RESULTSThe mean tumour size was 8 cm in group 1 and 9.6 cm in group 2 (P = 0.07). Variables during and after surgery were comparable between the groups, with a mean operative duration of 3.1 vs 3.2 h (P = 0.82), blood loss of 285 vs 308 mL (P = 0.79), complications in two vs eight (P = 0.08), morphine sulphate equivalent requirements of 51.7 vs 44.1 mg (P = 0.1) and a median length of hospital stay of 1.7 vs 1.6 days (P = 0.68). In group 1 the median (range) time to immunotherapy was 35 (13–136) days.CONCLUSIONSLaparoscopic cytoreductive nephrectomy is safe and effective in selected patients. Currently the procedure is offered to candidates eligible for immunotherapy and with tumours of ≤ 15 cm, and no evidence of adjacent organ invasion or inferior vena caval thrombus. Significant perihilar adenopathy and numerous parasitic vessels can increase the complexity of the surgery. Adequate laparoscopic experience is necessary.
Radionuclide bone scintigraphy in patients with biochemical recurrence after radical prostatectomy: when is it indicated?
Authors: Gomez Pablo , Manoharan Marugesan , Kim Sandy S. , Soloway Mark S. 
Published: August 2004

OBJECTIVETo evaluate the use of radionuclide bone scintigraphy following biochemical recurrence after radical retropubic prostatectomy (RRP) for localized prostate cancer.PATIENTS AND METHODSOf 1197 patients undergoing RRP we identified those with biochemical recurrence and who had also had a bone scan. Biochemical recurrence was defined as a prostate specific antigen (PSA) level of ≥ 0.4 ng/mL. Patients with indeterminate bone scan findings and those in whom the interval between the PSA test and the bone scan was >3 months were excluded. Patient age, PSA level and other relevant pathological details were recorded. Clinical symptoms at the time of bone scan, androgen deprivation after RRP, bone scintigram details and time to recurrence were documented.RESULTSOf the 1197 patients, 153 (12.8%) had a biochemical recurrence and 35 (23%) of these had a total of 44 bone scans taken over a mean (sd) follow‐up of 70.4 (35.6) months; 34 (77%) bone scans were negative (group 1) and 10 (33%) positive (group 2). In group 1 the mean PSA at the bone scan was 5.2 ng/mL; 76% of the patients had a PSA of <7 ng/mL. In group 2 the mean PSA at the bone scan was 30.7 ng/mL and all patients had a PSA of >7 ng/mL. The only significant difference between the groups was the PSA at the time of the bone scan (P < 0.001).CONCLUSIONBone scintigraphy is a sensitive diagnostic tool for detecting prostate cancer metastases to bone. A bone scan in patients with a serum PSA of <7 ng/mL on biochemical recurrence after RRP is unlikely to be positive, whereas a PSA of ≥ 20 ng/mL is. The presence of skeletal symptoms or a PSA level of >7 ng/mL should prompt the clinician to obtain a bone scintigram.
Increasing prostate biopsy cores based on volume vs the sextant biopsy: a prospective randomized controlled clinical study on cancer detection rates and morbidity
Authors: Mariappan Paramananthan , Chong Wooi Loong , Sundram Murali , Mohamed Sahabudin R. 
Published: August 2004

OBJECTIVETo determine if a volume‐adjusted increase in the number of biopsy cores could detect more prostate cancers than the standard sextant biopsy alone, without increasing morbidity, and to determine its applicability in Malaysian patients, as a standard sextant biopsy misses 20–25% of prostate malignancies.PATIENTS AND METHODSIn a prospective randomized study of patients undergoing transrectal ultrasonography (TRUS)‐guided biopsy for a prostate‐specific antigen (PSA) level of 4–20 ng/mL without abnormal digital rectal examination (DRE), the men were divided into five main groups (A–E) with prostate volumes of <20, 20–40,  40–60, 60–80 and >80 mL, respectively. Patients in groups B–E were randomized into sextant (B1 to E1) and increased biopsy‐core subgroups, i.e. B2 (eight cores), C2 (10 cores), D2 (12 cores) and E2 (14 cores). The morbidity profile was also evaluated during and after TRUS biopsy, assessing a pain score, rectal bleeding, haematuria, haemospermia and development of fever. In all, 132 patients were recruited (mean age 67.8 years; mean PSA 9.41 ng/mL).RESULTSThe overall cancer detection rate was 24% (32 men). Taking more cores detected 65.5% of cancers, and the sextant biopsy 34.5% (P = 0.0025), but did not increase the overall morbidity.CONCLUSIONSThe volume‐adjusted, increased‐core regimen significantly increased the positive biopsy rate of TRUS‐guided prostate biopsies with no added morbidity.
Superficial papillary urothelial carcinomas in young and elderly patients: a comparative study
Authors: Migaldi Mario , Rossi Giulio , Maiorana Antonio , Sartori Giuliana , Ferrari Paolo , De Gaetani Carmela , Cittadini Achille , Trentini Gian Paolo , Sgambato Alessandro 
Published: August 2004

OBJECTIVETo compare the clinicopathological and immunohistochemical findings of superficial papillary transitional cell carcinomas in ‘young’ and ‘elderly’ patients, as the natural history and prognosis of bladder tumours in young patients remains a matter of debate.PATIENTS AND METHODSTumours from 50 patients with superficial urothelial tumours of the bladder diagnosed before 45 years old (‘young’ group, follow‐up 25–119 months) were compared with 90 similar tumours developed in patients aged >55 years (‘elderly’, follow‐up 24–102 months). All the patients had a transurethral resection with curative intent, and none had received any therapy before surgery. After surgery only patients diagnosed with pT1 tumours were treated by intravesical bacille Calmette‐Guérin (BCG) instillations; all received intravesical BCG if there was a recurrence. The clinicopathological variables, recurrence and disease‐free interval to recurrence were assessed. Proliferative activity (MIB‐1) and expression of cell‐cycle regulation proteins cyclin D1, p53 and p27kip1 were detected by immunohistochemistry in the tumours of both groups.RESULTSThere were statistically significant differences in tumour grade, stage and occurrence between the ‘young’ and ‘elderly’ groups. The ‘young’ group had a longer disease‐free interval to recurrence. Among the immunohistochemical markers analysed, only MIB‐1 and cyclin D1 were associated with an increased risk of recurrence in the ‘young’ group (P < 0.04 and <0.01, respectively) in a univariate analysis.CONCLUSIONSSuperficial papillary urothelial tumours of the bladder in ‘young’ patients had a better prognosis than those in the ‘elderly’ group, showing a lower grade and stage at diagnosis, and a lower recurrence rate. Proliferative activity and cyclin D1 expression levels were of prognostic significance for the risk of recurrence in these patients.
Natural history of lower urinary tract symptoms: preliminary report from a community‐based Indian study
Authors: Ganpule Arvind P. , Desai Mahesh R. , Desai Mihir M. , Wani Kishor D. , Bapat Sharad D. 
Published: August 2004

OBJECTIVETo describe the results of an analysis of baseline data from subjects included in the community‐screening programme for lower urinary tract symptoms (LUTS) in the Anand and Kheda district in the Gujarat state of India.SUBJECTS AND METHODSIn all, 2406 men aged >40 years were screened in the community in 18 villages. All subjects were given an International Prostate Symptom Score (IPSS) to complete, had a detailed physical examination, uroflowmetry and urine analysis, and were assessed using transabdominal and transrectal ultrasonography. Spearman's correlation coefficient was used to assess the relationships between quality of life (QoL), age, IPSS, maximum flow rate (Qmax) and prostate volume (PV); stepwise multiple regression was also used.RESULTSThe mean (sd) age of the men was 62.1 (9.5) years. The PV (mean 21.6 mL, sd 10.63) increased linearly with age, while Qmax (mean 14.6 mL/s, sd 8.4) decreased linearly. The mean (sd) IPSS was 12.2 (8.6) and did not correlate with age but correlated strongly with QoL (coefficient 0.72). Nocturia was the commonest symptom but correlated least with the IPSS and QoL (0.56 and 0.44). The correlations between Qmax, IPSS and PV were weak to moderate. The subjects had a 56% higher risk of developing moderate to severe symptoms if their PV was >25 mL.CONCLUSIONThese Indian men had smaller prostates with higher symptom scores than reported in the West. The IPSS was the strongest predictor of QoL. Overall, the correlation between Qmax, IPSS and PV was weak to moderate.