bluuebunny/crossref_metadata_2025_split huggingface dataset:
A long‐term follow‐up of autoaugmentation in myelodysplastic children
Authors: Marte A. , Di Meglio D. , Cotrufo A.M. , Di Iorio G. , De Pasquale M. , Vessella A. 
Published: March 2003

Objective To evaluate the long‐term results of patients who underwent bladder autoaugmentation (BA) in whom BA was used to treat a neuropathic bladder secondary to myelomeningocele, and who presented with a high‐pressure/poorly compliant bladder. Patients and methods Eleven patients (eight girls and three boys, mean age 12.8 years, mean follow‐up 6.6 years) were selected who had undergone BA between June 1991 and June 1994. At surgery, the patients had a poorly compliant bladder with a mean leak point volume (LPV) of 94 mL and a mean leak point pressure (LPP) of 58 cmH2O. None of the patients had vesico‐ureteric reflux (VUR) at BA; five with grade III or IV VUR had undergone endoscopic correction in a day‐surgery procedure using a suburethral collagen injection 1–3 weeks before BA. The patients were evaluated using clinical, urodynamic, radiological and endoscopic assessments. The LPV, LPP and safe bladder capacity (SBC, the cystometric volume at an intravesical pressure of 40 cmH2O) were recorded. Results At 1 year after surgery the mean LPV was 297 mL; none of the patients had VUR. The most recent mean LPV was 198 mL and the SBC 167 mL. The mean LPP remained stable at 60 cmH2O. At the last follow‐up four patients had recurrent uni‐ or bilateral grade III–V VUR. At endoscopy the ‘augmented’ bladder portion had a smooth surface, compared with the grossly trabeculated lower half. From this finding all patients on clean intermittent catheterization were treated with oral oxybutynin. Some patients reported slightly less abdominal pain at maximum bladder volume; four needed pads to treat intermittent incontinence. On voiding cysto‐urethrography, one patient had an hourglass‐shaped bladder. Five patients recently underwent ileocystoplasty because of recurrent urinary tract infection, high‐grade VUR and incontinence. Conclusion These results do not justify the routine use of BA in hypertonic/poorly compliant bladders secondary to myelomeningocele. The mean follow‐up of 6.6 years showed that this procedure failed in seven of 11 patients. Further studies might be able to identify subgroups in which this approach may be more appropriate.
Intracavernosal injection of vascular endothelial growth factor induces nitric oxide synthase isoforms
Authors: Lin C.‐S. , Ho H.‐C. , Chen K.‐C. , Lin G. , Nunes L. , Lue T.F. 
Published: March 2003

Objective To identify genes that are affected by vascular endothelial growth factor (VEGF), as an intracavernosal injection with VEGF improved the recovery of erectile function in a rat model of arteriogenic impotence, specifically examining the three nitric oxide synthase (NOS) genes, nNOS, eNOS, and iNOS. Materials and methods Male rats had their pudendal arteries ligated or underwent a sham operation. They were then treated by an intracavernosal injection with 4 µg of VEGF in phosphate‐buffered saline (PBS) or PBS alone. At 6 and 24 h after treatment electrostimulation was applied to the cavernosal nerve and the intracorporal pressure measured. The erectile tissue was then harvested for RNA isolation and cryo‐sectioning. The isolated RNA was used for microarray and reverse transcription‐polymerase chain reaction (RT‐PCR) analyses, and the tissue sections for immunohistochemical analysis. Results Microarray analysis detected nNOS, eNOS and iNOS at very low expression levels in PBS‐treated rats; expression levels were higher for eNOS and iNOS in all VEGF‐treated rats. These results were further confirmed by RT‐PCR analysis. Immunohistochemical analysis identified the cavernosal endothelium and smooth muscle as the tissue types where eNOS and iNOS were up‐regulated, respectively. Conclusions This is the first report of the induction of both eNOS and iNOS in the penis after intracavernosal VEGF. These events may help support a significant recovery of erectile function after interrupting the blood supply to the penis.
Technical characterization of an ultrasound source for noninvasive thermoablation by high‐intensity focused ultrasound
Authors: Köhrmann K.U. , Michel M.S. , Steidler A. , Marlinghaus E. , Kraut O. , Alken P. 
Published: March 2003

Objective To develop a generator for high‐intensity focused ultrasound (HIFU, a method of delivering ultrasonic energy with resultant heat and tissue destruction to a tight focus at a selected depth within the body), designed for extracorporeal coupling to allow various parenchymal organs to be treated. Material and methods The ultrasound generated by a cylindrical piezo‐ceramic element is focused at a depth of 10 cm using a parabolic reflector with a diameter of 10 cm. A diagnostic B‐mode ultrasonographic transducer is integrated into the source to allow the focus to be located in the target area. The field distribution of the sound pressure was measured in degassed water using a needle hydrophone. An ultrasound‐force balance was used to determine the acoustic power. These measurements allowed the spatially averaged sound intensity to be calculated. The morphology and extent of tissue necrosis induced by HIFU was examined on an ex‐vivo kidney model. Results The two‐dimensional field distribution resulted in an approximately ellipsoidal focus of 32×4 mm (− 6 dB). The spatially maximum averaged sound intensity was 8591 W/cm2 at an electrical power of 400 W. The lesion caused to the ex‐vivo kidney at this maximum generator power with a pulse duration of 2 s was a clearly delineated ellipsoidal coagulation necrosis up to 8.8×2.3 mm (length×width) and with central liquefied necrosis of 7.9×1.9 mm. Conclusion This newly developed ultrasound generator with a focal length of 10 cm can induce clear necrosis in parenchymal tissue. Because of its specific configuration and the available power range of the ultrasound generator, there is potential for therapeutic noninvasive ablation of tissue deep within a patient's body.
The treatment of pain in urology
Authors: Heid F. , Jage J. 
Published: March 2003

SummaryContemporary medicine is characterized by sophisticated specialization of the individual physician. The specialist in urological surgery may undertake one of the most important and primary medical tasks, the mitigation and therapy of pain. This review aims to provide an overview of the concepts of pain therapy in urology. Most patients benefit from basic concepts of analgesia, including measuring and documenting pain scores at the bedside by the nursing staff. Patients undergoing very painful operative procedures require more potent techniques of analgesia, e.g. intravenous patient‐controlled analgesia and epidural analgesia. These techniques need adequate supervision by an acute pain service, but their implementation improves the outcome in some situations. Pain in acute renal obstruction varies in intensity and duration; hence, analgesic therapy has to be tailored to the individual patient. Pain syndromes from cancer can be more complex than those after surgery. Neuropathic pain is probably the most difficult to manage and requires consultation with a pain‐management specialist. In the case of neuropathic pain, treatment only with opioids is of limited efficacy and combination with co‐analgesics is necessary. In addition, invasive analgesic therapies should sometimes be considered.
The rectus myofascial wrap in the management of urethral sphincter incompetence
Authors: Mingin G.C. , Youngren K. , Stock J.A. , Hanna M.K. 
Published: March 2003

Objective  To review our experience with a modified rectus/pyramidalis myofascial sling, described more than a century ago for treating refractory urinary incontinence in children with neurogenic sphincteric incompetence. Patients and methods  Thirty‐seven patients (23 females and 14 males, aged 8–21 years) presented with urinary incontinence which failed to respond to medical treatment. In 36 patients the cause of the incontinence was a neurogenic bladder; one patient had sustained a traumatic injury to the bladder neck and urethra. Patient selection was based on videocysto‐urethrographic detection of an incompetent bladder neck, and a low maximum closure pressure during urethral pressure profilometry. The bladder was augmented in 33 of the 37 patients. Results  Of the 37 patients, 34 (92%) are dry between catheterizations; the follow‐up was 0.5–10 years. Two of the male patients continued to have persistent incontinence requiring bladder neck closure and creation of a continent stoma. One of the female patients developed stress incontinence after 4 years of being dry, with a rectus sling. Conclusion  The rectus myofascial sling provides long‐term satisfactory dry intervals between catheterizations in patients with neurogenic sphincteric incompetence. The cinch‐wrap modification appears to enhance the occlusive effect of the sling, particularly in males.
Alfuzosin in the treatment of high leak‐point pressure in children with neurogenic bladder
Authors: Schulte‐Baukloh H. , Michael T. , Miller K. , Knispel H.H. 
Published: March 2003

Objective  To decrease the detrusor leak‐point pressure (LPP) of > 40 cmH2O in children with a neurogenic bladder, using the α1‐adrenergic blocking agent alfuzosin.Patients and methods  Videocystometry was used to measure the detrusor LPP and several other variables before and 3 weeks after the oral administration of alfuzosin (2.5–7.5 mg/day) in 17 children (mean age 6.3 years) with an upper motor neurone lesion.Results  The mean (sd) detrusor LPP decreased from 68 (37) to 46 (31) cmH2O (P < 0.01), reflex volume (defined as the volume at the first uninhibited bladder contraction of > 15 cmH2O) increased from 78 (69) to 112 (118) mL (+ 44%), bladder compliance increased from 9.3 (6.1) to 19.6 (14.6) mL/cmH2O (+ 111%), maximal vesical pressure decreased from 84 (40) to 70 (47) cmH2O (− 17%), and the mean number of uninhibited bladder contractions decreased from 6.3 to 3.5 (− 44%). The therapy was well tolerated; side‐effects were rare and not severe. Intermittent catheterization could be avoided in six children.Conclusion  Alfuzosin decreases the detrusor LPP in children with a neurogenic bladder caused by an upper motor neurone lesion, significantly and therapeutically, and should be considered as an alternative or addition to intermittent catheterization and anticholinergic drugs in selected patients.
Prospective evaluation of safety and efficacy of the supracostal approach for percutaneous nephrolithotomy
Authors: Gupta R. , Kumar A. , Kapoor R. , Srivastava A. , Mandhani A. 
Published: March 2003

Objective  To prospectively evaluate the safety and efficacy of the supracostal approach for percu‐taneous nephrolithotomy (PCNL), as it is usually avoided because of concerns about potential chest complications.Patients and methods  Between August 1998 and August 2001, 465 patients underwent PCNL. Supracostal access was obtained in 62 patients (63 renal units), comprising 13% of the procedures. The indications for a supracostal approach were staghorn, upper ureteric, superior calyceal stones and high‐lying kidneys. The data were analysed for stone clearance, need for additional punctures and the complications associated with supracostal puncture.Results  The supracostal was the only access in 63% of the PCNL procedures. Additional punctures were required mainly for staghorn stones (15 of 23). Overall, 90% of the patients were rendered stone‐free or had clinically insignificant residuals with PCNL alone. In patients with staghorn stones, they were completely cleared in 84% of renal units. Significant chest complications developed in three (5%) patients, which required insertion of a chest tube. One (2%) patient developed haemothorax secondary to injury of the intercostal artery. All the patients recovered uneventfully.Conclusions  These results indicate that supracostal access provides high clearance rates with acceptable complications; it should not be avoided for fear of chest complications. A chest X‐ray after surgery should be routine, to detect any complication.
Ureteric reconstruction
Authors: Stief C.G. , Jonas U. , Petry K.‐U. , Sohn C. , Bektas H. , Klempnauer J. , Chavan A. , Galanski M. , Montorsi F. 
Published: March 2003

SUMMARYAlthough the ureter is functionally simply a tube to transport urine, ureteric surgery requires detailed anatomical knowledge and advanced surgical skills, because the ureter has a delicate blood supply. Therefore, the urological surgeon must have distinct strategies available to bridge ureteric defects of various sites and lengths. Furthermore, handling during and after surgery should be individualized to the patient's pre‐ and intraoperative situation. In this review, the indications for reconstruction of a specific ureteric defect, the required techniques and postoperative recommendations are discussed.
The number of lymph nodes examined and staging accuracy in renal cell carcinoma
Authors: Terrone C. , Guercio S. , De Luca S. , Poggio M. , Castelli E. , Scoffone C. , Tarabuzzi R. , Scarpa R.M. , Fontana D. , Rocca Rossetti S. 
Published: March 2003

OBJECTIVETo determine the number of lymph nodes that need to be examined to accurately stage the pN variable in patients undergoing radical nephrectomy (RN) for renal cell carcinoma (RCC).PATIENTS AND METHODSWe reviewed the operative and pathology reports of 725 patients with RCC submitted for RN. All tumours were classified using the fifth edition of the Tumour‐Nodes‐Metastasis classification. For each patient the number of lymph nodes removed was recorded. The patients were divided into five different groups according to the number of nodes removed, i.e. group 1, 1–4; group 2, 5–8; group 3, 9–12; group 4, 13–16; and group 5, ≥ 17. We evaluated the factors that affected the number of lymph nodes removed with nodal dissection and the variables that influenced the incidence of nodal involvement.RESULTSLymphadenectomy was performed in 608 patients (83.8%); in these patients the rate of lymph node metastases was 13.6%. The median (range) number of nodes removed was 9 (1–43); there was a statistically significant correlation between the number of nodes removed and the percentage of nodal involvement (r = 0.6; P < 0.01). The rate of pN+ was significantly higher in the patients with ≥ 13 than in those with < 13 nodes examined (20.8% vs 10.2%; P < 0.001). For organ‐confined and locally advanced tumours there was a statistically significant difference in the pN+ rate between patients with < 13 or ≥ 13 nodes examined (3.4% vs 10.5%, and 19.7% vs. 32.2%, respectively).CONCLUSIONSThe proportion of tumours classified as pN+ increased with the number of lymph nodes examined. In RCC,> 12 lymph nodes need to be assessed for optimal staging.
Knowledge of risk of developing diabetes mellitus among siblings of Type 2 diabetic patients
Authors: Farmer A. J. , Levy J. C. , Turner R. C. 
Published: March 2003

Summary Aims We set out to investigate the extent to which siblings of diabetic subjects perceived themselves likely to develop Type 2 diabetes mellitus (DM) when offered screening tests. Methods Nondiabetic siblings, aged 35–74 years, of Type 2 diabetic patients who were more than 35 years old at diagnosis had fasting plasma glucose measured in a study to determine heritability of diabetes. Questionnaires assessing perceived likelihood of developing, seriousness and knowledge about diabetes were completed. Logistic regression assessed factors predicting perceptions of diabetes risk. Results Factors predicting diabetes on screening were male sex, increasing age and body mass index (BMI) ≥ 30. Eighty‐nine per cent of 540 eligible siblings completed questionnaires. Thirty‐eight per cent saw themselves at increased risk of diabetes and 34% thought diabetes a serious problem. Predictors of perceiving an increased likelihood of developing diabetes were female sex, age 35–54 years vs. 55–74 years and having a parent with diabetes. BMI did not affect perceptions of likelihood. Conclusion A perception of reduced vulnerability to diabetes may occur due to unawareness of risk or minimization of risk. Feelings of invulnerability may affect emotional response to a subsequent result. It is not known whether providing more information about the risk of developing diabetes prior to screening would affect outcomesDiabet. Med. 16, 233–237 (1999)
Elevated serum TNF‐α level as a link between endothelial dysfunction and insulin resistance in normotensive obese patients
Authors: Winkler G. , Lakatos P. , Salamon F. , Nagy Z. , Speer G. , Kovács M. , Harmos G. , Dworak O. , Cseh K. 
Published: March 2003

Summary Aims The aim of the study was to analyse the role of tumour necrosis factor‐alpha (TNF‐α) in insulin resistance and endothelial dysfunction in patients with different types of obesity.Patients and methods Fasting serum TNF‐α immunoreactive concentration (enzyme‐linked immunosorbent assay, ELISA) and bioactivity (L929 cell cytotoxicity assay), endothelin‐1 and C‐peptide levels (radioimmunoassay, RIA) were measured in 15 patients with android‐ and 13 patients with gynoid‐type obesity and 15 lean healthy controls with normal glucose tolerance and blood pressure. Results Significantly (P< 0.01) higher TNF‐α concentration (8.92 ± 0.44 pg/ml) and bioactivity (3.12 ± 0.48 U/ml) were found in patients with android obesity as compared to patients with gynoid obesity (7.01 ± 0.30 pg/ml, 0.97 ± 0.11 U/ml) and to the lean controls (6.88 ± 0.26 pg/ml, 0.88 ± 0.08 U/ml). Serum endothelin‐1 (5.38 ± 0.30 pg/ml) and C‐peptide levels (4.82 ± 0.71 ng/ml) were also significantly higher (P < 0.01) in patients with android‐type obesity than in controls (3.89 ± 0.43 pg/ml, 1.46 ± 0.25 ng/ml, respectively). In patients with gynoid‐type obesity, only the C‐peptide levels proved to be significantly higher (2.84 ± 0.29 ng/ml). Endothelin‐1 levels, although were found to be slightly higher, did not differ statistically from in controls (4.56 ± 0.31 pg/ml). There were significant positive linear correlations only in patients with android‐type obesity between TNF‐α, body mass index (BMI), serum endothelin‐1 and C‐peptide levels.Conclusions TNF‐α may be one of the factors contributing to insulin resistance and vascular dysfunction in patients with android obesity.Diabet. Med. 16, 207–211 (1999)
Potential impact of a change in the diagnostic criteria for diabetes mellitus on the prevalence of abnormal glucose tolerance in a local community at risk of diabetes: impact of new diagnostic criteria for diabetes mellitus
Authors: Davies M. J. , Muehlbayer S. , Garrick P. , McNally P. G. 
Published: March 2003

Summary Aims To compare the prevalence of diabetes and abnormal glucose metabolism using conventional and suggested new WHO and new ADA criteria in a group of people with symptoms of diabetes. Methods We examined retrospectively the results of 154 consecutive OGTTs in such patients performed using capillary whole blood. Results With the 1985 WHO criteria. Forty‐four point eight per cent of subjects (69 subjects, with 95% confidence intervals, 37–52.6%) had diabetes, 47.8% (33 subjects, 36–59.6%) had a normal fasting glucose, 31.2% (48 subjects, 23.9–38.5%) had impaired glucose tolerance (IGT) and 76% (117 subjects, 69.3–82.7%) had abnormal glucose tolerance. Applying the ADA criteria (fasting capillary whole blood only), 33.1% (51 subjects, 25.7–40.5%) had diabetes (a 26% relative reduction) and 11% (17 subjects, 6.1–15.9%) IFG, with 44.1% (68 subjects, 36.3–51.9%) having abnormal glucose metabolism (a 42% relative reduction). If the proposed 1998 WHO criteria were used, the number with diabetes increase to 48% (74 subjects, 40.1–55.9%) a 7.2% increase on the old criteria. 27.9% (43 subjects, 20.8–35%) had IGT, so the number with some degree of abnormal glucose metabolism remains unchanged. Use of the ADA criteria, considering only the fasting glucose as suggested, will result in a significant reduction in the diagnosis of diabetes and those with abnormal glucose metabolism.Diabet. Med. 16, 343–346 (1999)
Nesidioblastosis, myelodysplastic syndrome and nodular diabetic glomerulosclerosis in an elderlynondiabetic woman: an autopsy report
Authors: Yeh S. ‐P. , Wang J. ‐S. , Wu H. , Yu M. ‐S. , Hsueh E. ‐J. , Wang Y. ‐C. 
Published: March 2003

SummaryNesidioblastosis as the cause of hyperinsulinaemic hypoglycaemia in an adult is rare. We report here an additional case of nesidioblastosis, which resulted in fatal hyperinsulinaemic hypoglycaemia in a 72‐year‐old woman with an underlying myelodysplastic syndrome. The diagnosis of nesidioblastosis was established only after post‐mortem examination with a careful exclusion of minute insulinoma. To our surprise, the renal pathology disclosed typical diabetic nodular glomerulosclerosis in the same patient who had no previous history of diabetes mellitus (DM). Nesidioblastosis has been reported to cause ‘reversal’ of Type 1 DM and insulinoma causing ‘reversal’ of Type 2 disease. We therefore hypothesize that our patient might have had an undiagnosed DM in the past, which resulted in the typical diabetic nodular glomerulosclerosis. The nesidioblastosis caused a ‘reversal’ of DM and even the ultimate development of hyperinsulinaemic hypoglycaemia.Diabet. Med. 16, 437–441 (1999)
Improvement of blood glucose control in Type 1 diabetic patients treated with lispro and multiple NPH injections
Authors: Colombel A. , Murat A. , Krempf M. , Kuchly‐Anton B. , Charbonnel B. 
Published: March 2003

Summary Aims To evaluate a multiple daily injections (MDI) regimen combining lispro with multiple NPH insulin injections in order to replace basal insulin optimally. Methods Twenty‐five C‐peptide negative Type 1 patients already trained to MDI were randomized to lispro (lispro + NPH 5 min before breakfast and lunch, lispro before dinner, NPH at bedtime) or soluble insulin (20–30 min before each meal and NPH at bed‐time) for 3 months before crossing over to the other regimen for another 3 months. The mean initial HbA1c level was 8.32 ± 1.5%. Results The variability of capillary blood glucose values was significantly lower with lispro (MAGE 0.75 ± 0.36 g/l vs. 0.99 ± 0.50, P < 0.01; MODD 0.64 ± 0.26 g/l vs. 0.80 ± 0.40, P < 0.05). There was a nonsignificant reduction in HbA1c with lispro: –0.40 ± 0.86 vs. –0.08 ± 0.71. Mean daily blood glucose levels were significantly lower with lispro (1.53 ± 0.48 g/l vs. 1.82 ± 0.57 g/l, P < 0.05). The frequency of all hypoglycaemic episodes was the same with both regimens but the number of severe hypoglycaemic events was reduced with lispro, P = 0.048. At the end of the study, 75% of the patients chose the lispro associated with multiple NPH regimen for their own treatment. The total insulin doses was the same with both regimens but the proportion of NPH was higher with lispro (53% vs. 34%). Conclusions An MDI regimen using lispro combined with multiple NPH compared to a standard MDI regimen using soluble insulin reduced day‐to‐day blood glucose fluctuations, was generally preferred by patients and was associated with a reduced incidence of severe hypoglycaemia with no loss of overall control.Diabet. Med. 16, 319–324 (1999)