bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical management of prostatic intraepithelial neoplasia as diagnosed by extended needle biopsies
Authors: San Francisco I.F. , Olumi A.F. , Kao J. , Rosen S. , DeWolf W.C. 
Published: March 2003

OBJECTIVETo examine the results of the clinical management of patients with high‐grade prostatic intraepithelial neoplasia (PIN), as diagnosed by extended needle biopsies.PATIENTS AND METHODSThe clinical data were reviewed from a cohort of 387 men who underwent ≥ 10 core prostate needle biopsies between 1 January 1996 and 31 December 1997 by one urologist (W.C.D.). Two study groups were identified; the first comprised 47 patients with only high‐grade PIN and the second was a control group of 137 patients with only benign findings on their biopsies. Those patients with cancer, atypia or a prostatic biopsy with fewer than 10 cores were excluded. The clinical and histological data were evaluated. The criteria for re‐biopsy were two successive increases in prostate specific antigen (PSA) level or any change in the findings on digital rectal examination (DRE). All patients were monitored at 6–12 month intervals.RESULTSOf the 387 patients, 46% had normal findings, 5.2% had atypia, 12.6% had PIN alone, 15 (3.9%) had PIN plus atypia, 6.7% had PIN plus cancer and 32.3% had cancer. There was no significant difference between the PIN and control groups in age, DRE, PSA level, prostate size (by ultrasonography), free testosterone level, number of the cores and time of follow‐up (median 34.8 and 36.6 months for the PIN and control groups, respectively). Of the PIN and control groups, 21 (45%) and 43 (31%) respectively had at least one re‐biopsy. Five patients (24%) in the PIN and one (2.3%) in the control group developed cancer (P = 0.0124). All these patients had organ‐confined disease and were found to have either Gleason scores 3 + 3 or 3 + 4 on surgical specimens. There was no correlation between the original location of PIN and the location of subsequent malignancy.CONCLUSIONSPatients with one set of extended needle biopsies with high‐grade PIN should be followed clinically every 6–12 months, and it may be safe to reserve repeat biopsy for those with changes in PSA level and/or in the DRE.
The use of tolterodine in children after oxybutynin failure
Authors: Bolduc S. , Upadhyay J. , Payton J. , Bägli D.J. , McLorie G.A. , Khoury A.E. , Farhat W. 
Published: March 2003

OBJECTIVETo assess the safety and efficacy of tolterodine tartrate prescribed to children who previously failed to tolerate oxybutynin chloride.PATIENTS AND METHODSWe reviewed 34 children, followed for>1 year, who were prospectively crossed‐over from oxybutynin to tolterodine because of side‐effects. The initial diagnosis was dysfunctional voiding in 31 patients. All patients were placed on a behavioural modification protocol. When their symptoms did not improve after 6 months, treatment with an anticholinergic agent was considered. Urodynamic studies were conducted in 20 patients, confirming uninhibited contractions in 19. The remaining 14 patients were empirically started on antimuscarinic or anticholinergic agents. The 34 patients were treated with oxybutynin for a median (range) of 6 (2–84) months. When significant side‐effects were reported, they were crossed over to tolterodine. The efficacy of tolterodine was assessed as defined by the International Children's Continence Society, with tolerability assessed and side‐effects documented using a questionnaire.RESULTSThe mean age at the first dose of tolterodine was 8.9 years; the dose was 1 mg twice daily for 12 patients and 2 mg twice daily for 22. The median treatment with tolterodine was 11.5 months, with 20 (59%) patients reporting no side‐effects; six described the same but tolerable side‐effects as with oxybutynin. Eight patients discontinued tolterodine because of side‐effects after a median (range) of 5 (1–11) months. The efficacy of tolterodine was comparable with that of oxybutynin, as reported by the questionnaire and voiding diaries. The reduction in wetting episodes at 1 year was> 90% in 23 (68%), more than half in five and less than half (or failure) in six patients.CONCLUSIONTolterodine is tolerated well in children. In this subgroup of patients who could not tolerate oxybutynin, 77% were able to continue tolterodine treatment with no significant side‐effects.
Hand‐assisted laparoscopic vs the open (flank incision) approach to radical nephrectomy
Authors: Busby E. , Das S. , Rao Tunuguntla H.S.G. , Evans C.P. 
Published: March 2003

OBJECTIVETo compare the outcome in contemporaneous groups of patients undergoing hand‐assisted laparoscopic radical nephrectomy (HALRN) or open (flank) radical nephrectomy (ORN), as many series worldwide have confirmed the feasibility and advantages of LRN in managing renal cell carcinoma (RCC).PATIENTS AND METHODSWe retrospectively evaluated 44 patients who underwent radical nephrectomy for RCC from 1999 to 2001, 22 by HALRN and 22 by ORN, through an extraperitoneal 11th or 12th rib flank incision. Standard perioperative variables were assessed; a validated questionnaire was also sent to each patient after surgery, allowing them to report their overall satisfaction and the period needed for them to return to both routine and full activities. The outcomes of HALRN and ORN were compared using Wilcoxon rank‐sum analysis.RESULTSThere was a statistically significant difference between HALRN and ORN in operative duration, length of hospital stay, total narcotic requirement, pain scores at 1 week and 1 month after surgery, and the time to resume routine and full activity, with all variables (except operative duration) lower in the HALRN group. There were no significant differences between the groups in pain at 1–3 days, estimated blood loss or overall satisfaction.CONCLUSIONCompared with ORN, HALRN is associated with lower narcotic requirement, pain scores, a shorter hospital stay and earlier resumption of routine and full activities. However, several obstacles remain, including increased operative duration and the increased equipment costs.
Loss of CD38 correlates with simultaneous up‐regulation of human leukocyte antigen‐DR in benign prostatic glands, but not in fetal or androgen‐ablated glands, and is strongly related to gland atrophy
Authors: Kramer G. , Steiner G.E. , Sokol P. , Mallone R. , Amann G. , Marberger M. 
Published: March 2003

As genes and their products are identified to play important roles in disease. Understanding what and how they are regulated has significant importance, as these gene products could then be blocked before they are expressed. NF‐κB represents an important transcription factor that drives the expression of specific gene product, ie proteins. The paper by Lessard et al. demonstrates the localization of this transcription factor in prostate cancer. Targeting this transcription factor could well represent an interesting therapeutic site to prevent the expression of proteins that may contribute to the development of the disease. OBJECTIVETo determine whether CD38 loss in benign and malignant prostatic disease is related to human leukocyte antigen (HLA)‐DR up‐regulation, by assessing the histopathology of the prostate and the effect of androgen deprivation.MATERIALS AND METHODSSerial sections of frozen fetal (eight), infant (six), normal adult (10), benign hyperplastic (BPH, 24), and primary (10) and hormone‐treated (11) carcinomatous human prostatic tissues were analysed by immunohistology for anti‐CD38 and HLA‐DR antigens.RESULTSIn BPH samples there was a significant correlation between CD38 loss (mean 21% of acini) and HLA‐DR up‐regulation (mean 20%; P < 0.001). Moreover, 76% of all CD38‐negative acini in BPH had HLA‐DR up‐regulation in the same prostate epithelial cells, predominantly in atrophic and cystic glands, and in cells with retained secretions (74%). In contrast to the uniform expression in normal adult prostate, CD38 was negative or partly expressed in fetal acini (mean 19%) and almost completely negative in acini of the early infant period (mean 0.7%). In contrast to BPH, cancer cells did not selectively up‐regulate HLA‐DR when CD38 was lost. In patients with cancer treated by androgen deprivation, cancer cells were CD38‐negative.CONCLUSIONSThe absence of CD38 and presence of HLA‐DR expression in prostatic epithelium is consistent in BPH and tissue surrounding tumour, and strongly related to gland atrophy. This is particularly interesting as HLA‐DR triggering can induce apoptosis of cells, whereas CD38 prevents it. A permissive role for androgens to maintain full CD38 expression in epithelial cells is suggested.
Association of British Clinical Diabetologists (ABCD): survey of specialist diabetes care services in the UK, 2000. 3. Podiatry services and related foot care issues
Authors: Winocour P. H. , Morgan J. , Ainsworth A. , Williams D. R. R. ,   the Association of British Clinical Diabetologists
Published: March 2003

AbstractAim To examine the provision of, and variations in, podiatry and other services for diabetic foot care in the UK.Method A postal survey of secondary care providers of diabetes services in the UK in 2000.Results Following two reminders a 77% response rate was achieved. The responses indicated that 97% had a state‐registered podiatrist attached to the service, providing three (median) sessions each week for diabetes care, although only 44% had availability at all diabetic clinics, and only 3% had availability at paediatric diabetic services. Podiatry access at all diabetic clinics increased the likelihood of associated preventative as opposed to reactive (‘trouble shooting’) care (P < 0.05). All individuals with feet at ‘high risk’ of ulceration had access to ‘at least 2 monthly review’ in 15% of trusts, and with active foot ulceration at least weekly in 43%. Over 70% used at least one form of equipment to assess peripheral neuropathy, but peripheral blood flow was only formally measured in 13%. Although podiatry input to patient education was common (84%), only 6% had received formal training in education. Guidelines and strategies for management of active foot problems were available in 50−74% of cases. Orthotic input was highly variable, and absent in 15% of responses. Podiatrist fitting and application of foot protective apparatus was only recorded in 22−61% of responses. Access to isotopic and/or MR foot imaging and peripheral angiography and angioplasty was recorded in 75−83% of responses. Separate specialist foot clinics were available in 49%, and where this was the case the use of newer foot ulcer healing applications was higher (P < 0.01). Clear regional differences were apparent in the nature of the service, the use of newer treatments, and in access to an orthotist, a local ‘dedicated’ foot surgeon or a separate diabetic foot clinic. Of 245 documented bids for service improvements, only 19 related to foot care and only 21% of bids were successful.Conclusions Despite an increase in podiatry support to diabetes care over the last 10 years, the level of access and the nature of the services provided is much less than recommended in many advisory documents. The strategy of a co‐ordinated ‘team’ approach to foot care still takes place in less than 50% of centres. There are clear regional differences in diabetes foot care services. Both providers and purchasers of diabetes services may not have given sufficient attention to this area, given the relatively small number of documented bids for service improvements in this area, and the very low success rate of such bids.
Current status of screening for diabetic retinopathy in the UK
Authors: Younis N. , Broadbent D. M. , James M. , Harding S. P. , Vora J. P. 
Published: March 2003

AbstractThis article reviews the current status of retinopathy screening schemes in the UK. There is evidence that high‐quality diabetic retinopathy screening schemes are in existence but provision is patchy. Many health authorities have ad hoc screening programmes reaching only about 60% of patients, with unacceptable or undocumented efficacy and minimal quality control. Several models of screening are currently in use with the current preferred option being camera‐based screening. Digital imaging systems offer the best prospects for image acquisition, although at present evidence of adequate effectiveness only exists for 35 mm film‐based systems. The final report of the National Diabetic Retinopathy Screening Programme commissioned by the UK National Screening Committee for inclusion into the national service framework for diabetes, is thus eagerly awaited and should set standards for screening programmes, in order to improve the care of all those with diabetes. Quality assurance will be the main driver in the immediate future of improvements in screening programmes. Research data will provide the evidence to refine techniques and set targets in the longer term, with the emphasis on cost‐effectiveness and quality of life.
Screening for Type 2 diabetes mellitus in the UK Indo‐Asian population
Authors: Davies M. J. , Ammari F. , Sherriff C. , Burden M. L. , Gujral J. , Burden A. C. 
Published: March 2003

Summary Aims Type 2 diabetes mellitus (DM) has a high prevalence in Asian subjects. A simple method of screening using self‐testing for postprandial glycosuria achieved a good response rate and a sensitivity which compared favourably to more expensive and invasive methods in a semirural Caucasian population. We examined its effectiveness in Asian subjects. Methods Caucasian and Indo‐Asian subjects aged 35–70 years in two general practices in Leicester (n = 9896 (6198 = Asian subjects, 3698 = Caucasian)) were screened. Those known to have diabetes were excluded. Subjects were asked to self‐test for glycosuria 1 h after their main meal. Instruction and response cards were translated in Punjabi and Gujarati and sent to the Asian subjects, depending on age and surname. Results Response rate was 34.4% in Asian subjects compared to 54.0% in Caucasian subjects. Prevalence of glycosuria was 8.2% in Asian subjects and 3.2% in Caucasian subjects. Two hundred and thirty‐nine subjects recorded glycosuria and 202 (84.5% of the total, 86.9% of Asian subjects, 78.1% of Caucasian) attended for oral glucose tolerance test (OGTT). Sixty‐three (31.2%) were found to have diabetes (46, 73% Asian), 29 (14.4%) impaired glucose tolerance (24, 82.8% Asian) and 110 (54.4%) normal glucose tolerance (82, 74.6% Asian). Thus 30% of Asian subjects and 34% of Caucasian subjects had diabetes on OGTT. The prevalence of diabetes in 35–70 years in the total population after screening was 5.6% (6.8% in Asian subjects, 3.6% in Caucasian) and in the screened population was 12.7% (17.9% in Asian subjects, 6.3% in Caucasian). Conclusions Screening for diabetes using this method, in terms of response rate, is not as effective in a large city setting, particularly in the Asian population. However, the yield of diabetes in the age group 35–64 years compares well to much more expensive and labour intensive approaches and its use in this population in a primary care setting is justified.Diabet. Med. 16, 131–137 (1999)
A comparative study of the Podotrack, a simple semiquantitative plantar pressure measuring device, and the optical pedobarograph in the assessment of pressures under the diabetic foot
Authors: Van Schie C. H. M. , Abbott C. A. , Vileikyte L. , Shaw J. E. , Hollis S. , Boulton A. J. M. 
Published: March 2003

Summary Aims To test the Podotrack, a simple inexpensive semiquantitative footprint mat, for potential use as a screening tool for high plantar pressures, against the optical pedobarograph (a computerized device). Methods The Podotrack was superimposed on the pedobarograph for simultaneous measurement of pressures from both systems. Three independent observers quantified the pressures of Podotrack footprints from healthy controls and diabetic patients, both before (n = 164) and after (n = 183) training. The sensitivity of the Podotrack to identify high pressure areas measured by the pedobarograph (> 12.3 kg/cm2) was 78.7%, 45.8% and 44.3% (observer A, B and C) before training, but improved to 96.2%, 92.4% and 91.1% after training (P < 0.01). Specificity for all three observers was more than 90% before and after training. Inter‐observer agreement improved significantly after training (P < 0.001). Conclusion After a simple training of the observers, the Podotrack identified approximately all high pressure areas, suggesting that the Podotrack could be a useful screening tool to identify areas at risk of ulceration in diabetic patients. We recommend a standard training package for new Podotrack users, to optimize identification of diabetic patients at risk of foot ulceration.Diabet. Med. 16, 154–159 (1999)
Codon 54 polymorphism of the fatty acid binding protein gene and insulin resistance in the Japanese population
Authors: Ito K. , Nakatani K. , Fujii M. , Katsuki A. , Tsuchihashi K. , Murata K. , Goto H. , Yano Y. , Gabazza E. C. , Sumida Y. , Adachi Y. 
Published: March 2003

Summary Aim To determine the relationship of the polymorphism at codon 54 of the intestinal fatty acid binding protein gene (FABP2) with insulin resistance and susceptibility to Type 2 diabetes mellitus (DM) in the Japanese population. Methods We evaluated the polymorphism by the polymerase chain reaction‐restriction fragment length polymorphism (PCR‐RFLP) in 150 Type 2 DM patients and 147 healthy control subjects. The frequency of alleles encoding threonine (Thr54) and alanine (Ala54) at codon 54 of FABP2 in Type 2 DM patients was compared with that of healthy controls. Insulin sensitivity was assessed by the hyperinsulinaemic euglycaemic clamp in Type 2 DM patients with Ala54 homozygotes, Ala54/Thr54 heterozygotes and Thr54 homozygotes and by homeostasis model assessment (HOMA) in the nondiabetic group. Results The frequency of alleles encoding Ala54 and Thr54 was 0.59 and 0.41 in Type 2 DM patients, respectively, similar to that observed in nondiabetic controls (0.64 for Ala54 and 0.36 for Thr54). Insulin sensitivity was not significantly different between subjects with and without Thr54 allele either within the DM group or healthy controls. Conclusions The allele encoding threonine in the FABP2 does not predispose to Type 2 DM or insulin resistance in the Japanese populationDiabet. Med. 16, 119–124 (1999)
Impaired fasting glucose is not a risk factor for atherosclerosis
Authors: Hanefeld M. , Temelkova‐Kurktschiev T. , Schaper F. , Henkel E. , Siegert G. , Koehler C. 
Published: March 2003

Summary Aim To determine a new category of dysfunctional glucose homeostasis – impaired fasting glucose (IFG) – introduced by the American Diabetes Association (ADA) and the World Health Organization (WHO) defining those with abnormal but nondiabetic fasting glucose values and with a possible risk for developing diabetes. It is not known whether IFG is a risk factor for atherosclerosis, as is impaired glucose tolerance (IGT).Methods In this case‐control cross‐sectional study in which the oral glucose tolerance (75‐g OGTT) and the carotid intima‐media thickness (IMT) with B mode ultrasound, as a marker of atherosclerosis, were measured, together with HbA1c, lipids, plasminogen activator (PAI), insulin and proinsulin concentrations in blood plasma. Out of 788 subjects of the risk factors in IGT for Atherosclerosis and Diabetes (RIAD) study we found 104 IFG cases that were compared to 104 controls with fasting plasma glucose (FPG) < 6.1 mmol/l, matched for age, sex and body mass index. Subjects with 2 h postprandial (pp) plasma glucose ≥ 11.1 mmol/l were excluded. The rest were subdivided into those with 2 h plasma glucose < 7.8 mmol/l (63 pairs, NGT) and those with plasma glucose > 7.8 mmol/l and < 11.1 mmol/l (41 pairs, IGT).Results The case and control groups showed no significant differences in the major risk factors except for waist‐to‐hip ratio (WHR) which was higher in the IFG with NGT. IFG with NGT exhibited significantly higher levels of HbA1c, true insulin and proinsulin. In IFG with IGT, only HbA1c and proinsulin were significantly increased vs. controls. IMT was in the same range for cases and controls in both subgroups. However, IMT mean and IMTmax were significantly increased in IFG with IGT vs. IFG with NGT (0.95 mm vs. 0.80 mm and 1.10 mm vs. 0.90 mm). Cumulative distribution analysis of IMT illustrates that IMT in IFG with IGT is more shifted to higher artery wall thickness than in IFG with NGT.Conclusions In our case‐control study IFG alone was not related to increased IMT. Only IFG in a combination with IGT exhibited atherosclerotic changes of the carotid arteries. IFG is not analogous to IGT as a risk factor for atherosclerosis.Diabet. Med. 16, 212–218 (1999)
Effect of management policy upon 120 Type 1 diabetic pregnancies: policy decisions in practice
Authors: Brown S. Carron , Kyne‐Grzebalski D. , Mwangi B. , Taylor R. 
Published: March 2003

Summary Aims To evaluate the outcome of two specific changes in the policy of managing pregnancy in Type 1 diabetes over a 5‐year period. The need for change had been identified following an audit in the previous 5‐year period: firstly, the need for intensive effort to improve the uptake of pre‐pregnancy counselling; secondly, a modest relaxation of the targets for blood glucose control during labour to minimize the risk of maternal hypoglycaemia. Methods Data were collated from maternal and neonatal case notes from all women with Type 1 diabetes mellitus managed by Newcastle obstetric services between August 1989 and July 1994 (n = 80), comparing data with 40 such women looked after between November 1985 and July 1989. Results The age of the women, blood glucose control during pregnancy, gestation at delivery, and birth weight were similar in the 5‐year period under study to those previously reported for the first study period. Mean blood glucose in labour for Period 2 was 5.5 + 0.6 mmol/l, exactly 1.0 mmol/l higher than the mean blood glucose achieved in labour for Period 1. As a consequence, only 22.5% women (18/80) experienced one or more episodes of blood glucose less than 3.0 mmol/l compared with 40.0% women in Period 1 (16/40) (P < 0.01). There was no effect of maternal blood glucose on neonatal blood glucose provided the former was within the range 4–8 mmol/l during labour. However, if maternal blood glucose was over 10 mmol/l, the infant’s blood glucose was always low (1.3 ± 0.8 vs. 2.5 ± 1.5 P < 0.02). Macrosomia (over the 90th percentile for gestational age) was observed in 43.1% of infants in Period 1, and the mean birth weight was not different from Period 1. In the initial 5‐year period 27.5% (11/40) women received specific pre‐pregnancy care for their diabetes, compared with 21.3% (17/80) in Period 2 despite the intensive programme of education. There were six cases of congenital abnormality and two antepartum deaths (10% adverse outcome). Conclusions The target range for blood glucose control in labour of 4–7 mmol/l minimizes maternal hypoglycaemia in labour and the data indicate that an upper limit of 8 mmol/l would not increase the risk of neonatal hypoglycaemia. Fresh thought is required about the matter of preventing congenital abnormalities by achieving better pre‐pregnancy and peri‐conception blood glucose control.