bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chronic idiopathic slow transit constipation: pathophysiology and management
Authors: El‐Salhy M. 
Published: December 2004

AbstractObjective  Patients with idiopathic slow‐transit constipation comprise a small proportion of the total population complaining of constipation. The purpose of this review is to present an update of pathophysiology of this disorder and its application in clinical management.Methods  Medline was used to search English language articles published up to the end of September 2002 on the subject of slow‐transit constipation.Results and conclusions  Patients with idiopathic slow‐transit constipation can be divided into 2 subgroups: 1. patients with normal proximal gastrointestinal motility and with onset of constipation in connection with childbirth or pelvic surgery. This subgroup may benefit from consideration of surgical treatment; 2. patients who have a dysfunctional enteric nervous/neuroendocrine system and exhibit colonic dysmotility as part of a generalised gastrointestinal dysmotility. Surgical approach in this subgroup seems to be unhelpful and medical treatment appears to be a better approach.
Health‐related quality of life after radical cystectomy for bladder cancer: a comparison of ileal conduit and orthotopic bladder replacement
Authors: Hara I. , Miyake H. , Hara S. , Gotoh A. , Nakamura I. , Okada H. , Arakawa S. , Kamidono S. 
Published: December 2004

Objective To compare the health‐related quality of life (HRQoL) after radical cystectomy in patients with an ileal conduit or an orthotopic neobladder. Patients and methods The study included 85 men who underwent radical cystectomy for bladder cancer, comprising 48 with an orthotopic neobladder (26 with an ileal and 22 with a colon neobladder) and 37 with an ileal conduit. HRQoL was evaluated using the Short Form‐36 survey containing 36 questions assessing eight aspects, including physical functioning, role‐physical functioning, bodily pain, general health, vitality, social functioning, role‐emotional functioning and mental health. Results The mean follow‐up periods for patients with a neobladder (ileal and sigmoid) and with an ileal conduit was 45.9 (38.2 and 53.1, respectively) and 130.9 months, respectively. Scale scores were not affected by the duration of follow‐up in either group. There was no significant difference in any scale scores between the neobladder and ileal conduit groups. However, general health and social functioning in both the neobladder and ileal conduit groups appeared to be significantly lower than those in the general population in the USA. Furthermore, patients with a colon neobladder had a significantly higher score for role‐emotional functioning than those with an ileal neobladder, while there was no significant difference in the remaining seven scores between patients with ileal and colon neobladders. Conclusions Six of the eight scales of HRQoL were favourable in both patients with a neobladder or an ileal conduit, and there was no significant difference between these groups. In addition, the HRQoL of patients with an orthotopic neobladder (except for role‐emotional functioning) was unaffected by the segment of the intestine used for neobladder construction. Therefore, patients with both types of urinary diversion were generally satisfied with their overall health and quality of life.
Extraordinarily high rates of male circumcision in South Korea: history and underlying causes
Authors: Pang M.G. , Kim D.S. 
Published: December 2004

Objective To investigate the high circumcision rate in South Korea and its rapid increase in the short period since its introduction. Subjects and methods From January to December 2000, 5434 South Korean males (or their parents) aged 0–92 years were interviewed in detail about their circumcision status, their age at circumcision, and the possible effect of circumcision on their sexuality. In addition, 267 practising medical doctors were surveyed about their basic understanding of circumcision and phimosis. Results Currently the circumcision rate for high‐school boys is > 90% and for those > 70 years old is < 10%. The circumcision rate in 1945 was < 0.1%. When averaged over the whole population, the present South Korean circumcision rate is ≈ 60%; the rate has increased dramatically with time and particularly in the past 20 years, when the estimated number of male circumcisions has exceeded the number of male births. Although circumcision in South Korea has been strongly influenced by American culture, it has never been predominantly neonatal. The age at circumcision has continued to decrease and boys are now circumcised at ≈ 12 years old. Of those who were circumcised long after they had been sexually active, > 80% reported no noticeable difference in sexuality, but a man was twice as likely to have experienced diminished sexuality than improved sexuality. Of the doctors who were surveyed, 41% carried out circumcision but, unlike in America, gynaecologists and paediatricians rarely did so. Among the doctors, basic knowledge on circumcision and phimosis was generally lacking, regardless of whether they practised circumcision or not. Amongst the factors contributing to the high circumcision rate was the mistaken notion held by both doctors and the general public that circumcision is directly correlated with industrialization and general progress of living standards. Many doctors believe the out‐dated and sometimes controversial benefits of circumcision, i.e. prevention of cervical cancer and sexually transmitted diseases, and improved sexuality. Thus the vast majority of doctors recommend circumcision regardless of the patient's age. Peer pressure was also an important contributing factor. Conclusion South Korea has an unusual history of circumcision. The mistaken and out‐dated notions about circumcision and lack of knowledge of phimosis by physicians seem to be a leading contributory factor to the extraordinarily high circumcision rate.
Prevalence and risk factors of urinary incontinence in young and middle‐aged women
Authors: Peyrat L. , Haillot O. , Bruyere F. , Boutin J.M. , Bertrand P. , Lanson Y. 
Published: December 2004

Objective To assess the prevalence of and risk factors for urinary incontinence (UI) in young and middle‐aged women. Subjects and methods During 1998 the prevalence of overall, stress, urge and mixed UI was assessed in women working in a French academic hospital. Women (2800) received a questionnaire at the same time as their yearly interview with a staff physician in occupational medicine. The usual risk factors for constitutional events, i.e. increasing age, obesity (defined as a body mass index of 25), obstetric events (pregnancy, previous Caesarean delivery, previous vaginal delivery, postpartum incontinence) and gynaecological events (hysterectomy) were evaluated. Results Of the 1700 women (mean age 40.0 years) who returned the questionnaire, 467 (27.5%, 95% confidence interval, CI, 25.4–29.7) reported UI, comprising 210 (12.4%, 10.8–14.0) with stress UI, 28 (1.6%, 1.1–2.4) with urge UI and 229 (13.5%, 11.9–15.2) with mixed UI. Thirty‐eight women (8.1%) had frequent urinary leakage, comprising one (0.5%), four (14.3%) and 33 (14.4%) with stress, urge and mixed UI. The prevalence of UI increased significantly with age 40 years, with a relative risk (95% CI) of 2.16 (1.86–2.57), and with pregnancy (2.22, 1.71–2.87), previous vaginal delivery (2.15, 1.72–2.69), postpartum incontinence (2.57, 2.22–2.97), and hysterectomy (1.52, 1.11–2.08). Obesity (1.14, 0.99–1.32) and previous Caesarean delivery (2.15, 1.72–2.69) did not significantly increase the risk of UI. The risk factors for stress UI were age  40 years, pregnancy, previous vaginal delivery, postpartum incontinence and hysterectomy, but there was no relationship between stress UI and obesity or previous Caesarean delivery. Conclusion There was a high prevalence of UI among young adult and middle‐aged women hospital workers who had easy access to medical resources. Gynaecological and obstetric events (pregnancy, particularly previous vaginal delivery and hysterectomy) were the most prominent risk factors, especially for stress UI.
Outcome of hypospadias fistula repair
Authors: Shankar K.R. , Losty P.D. , Hopper M. , Wong L. , Rickwood A.M.K. 
Published: December 2004

Objectives  To examine the long‐term results of hypospadias fistula repair, the factors involved in recurrence and the outcome in cases where this has occurred. Patients and methods  The study comprised 113 children undergoing urethrocutaneous fistula repair between 1984 and 1996. Most of the fistulae were closed in two to three layers, with or without a transpositional skin flap. Tunica vaginalis or a scrotal dartos flap was used in patients with inadequate vascularized tissue adjacent to the fistula. Success rates were calculated for each attempt at fistula repair until the patient was cured. Results
The median (range) age at primary fistula repair was 40 (18–169) months and the median follow‐up after the most recent repair 7.5 (2.3–17) years. The overall success rate of primary fistula repair was 71%. Fistulae which were >2 mm (11 of 21, 52%) were more likely to recur than were those 2 mm (22 of 92, 24%). Recurrence did not relate to the initial form of hypospadias repair, to the means of skin closure nor, with the exception of multiple lesions, to the location of the fistula. The success rates of subsequent repairs were 70% at the second and 50% at the third, fourth and fifth repairs. One child was cured at the sixth attempt. The use of tunica vaginalis or scrotal dartos as a ‘waterproofing’ layer was limited to the third or subsequent repairs and was successful in five of six cases. Conclusion  A simple layered closure with or with no transpositional skin flap is effective in 71% of repairs. For recurrent fistulae, tissues from an unscarred area (tunica vaginalis or scrotal dartos layer) should be used to cover the fistula.
Over‐expression of apoptosis‐related proteins contributes to muscular damage in the obstructed ureter of the rat
Authors: Chuang Y.‐H. , Chuang W.‐L. , Huang S.‐P. , Huang C.‐H. 
Published: December 2004

Objective To determine the role of apoptosis‐related proteins (Myc, Bax, Bcl‐2, and Bcl‐XL) in muscular damage in obstructed rat ureters. Materials and methods The in situ end‐labelling of DNA fragments and the expression of apoptosis‐related proteins were assessed, using immunohistochemistry, in 54 female Sprague‐Dawley rats in which unilateral ureteric obstruction was caused by ureteric ligation. Results The severity of ureteric damage increased during the period of obstruction. Apoptotic cells and the expression of Bax were detected in the smooth muscle layer from 14 days after ligation. The percentage of apoptotic cells and the expression of Bax in the smooth muscle layer increased and reached a peak 21 days after ligation, and then declined. The expression of Myc was also detected in the smooth muscle layer 14 days after ligation but reached a peak at 28 days. The expressions of Bcl‐2 and Bcl‐XL in the smooth muscle layer were only detected 21 and 28 days after ligation. The numbers of apoptotic cells in the smooth muscle layer correlated significantly with the expressions of Myc and Bax (r = 0.7360 and 0.7432, respectively; both P < 0.005), and with the expression index of Bax/Bcl‐2 and Bax/Bcl‐XL (r = 0.8909 and 0.8592, respectively; both P < 0.001). Conclusions Apoptosis‐related proteins might be important in regulating cell apoptosis in ureteric damage during the development of obstructive uropathy.
Improving prostate cancer detection with an extended‐core transrectal ultrasonography‐guided prostate biopsy protocol
Authors: Durkan G.C. , Sheikh N. , Johnson P. , Hildreth A.J. , Greene D.R. 
Published: December 2004

Objective To investigate whether taking two transition zone (TZ) and four lateral peripheral zone (PZ) biopsies in addition to routine parasaggital sextant biopsies would improve detection rates in men with suspected prostate cancer. Patients and methods The study included 493 consecutive men (mean age 68.7 years, sd 8.2) with elevated serum prostate‐specific antigen (PSA) levels and/or abnormal findings on a digital rectal examination who underwent transrectal ultrasonography‐guided prostate biopsy. In addition to sextant biopsies, six further biopsies were obtained, two from the TZ (mid‐gland) and four from the lateral PZ (base and mid‐gland). Pathological findings for the additional biopsies were compared with those of the sextant regions. Results Prostatic adenocarcinoma was diagnosed in 164 of the 493 (33%) men biopsied. Men with cancer were older, had smaller prostates and higher median PSA levels than men with negative biopsies. Sextant biopsies were positive for cancer in 133 of 164 (81%) men. All three sets of biopsies were positive in 53 (32%) cases. In 50 (30%) men both the sextant and lateral PZ biopsies were positive, while in six (4%) men, both sextant and TZ biopsies were positive. Thirty‐one (19%) tumours were not detected by sextant biopsies, 10 (6%) where the lateral PZ biopsies alone were positive, 17 (10%) where the TZ biopsies alone were positive and four (3%) where both the TZ and lateral PZ together were positive. There were no differences in median PSA concentration, total prostate volume or TZ volume between men with an isolated TZ cancer and men with cancer elsewhere in the prostate. However, 77% of men with TZ cancer had a PSA of > 10 ng/mL, compared with 60% of men with cancer at other sites within the prostate (P = 0.015). Conclusion An extended‐core biopsy protocol significantly improves the detection rate for prostate cancer when compared with the standard sextant biopsy protocol alone. Routine TZ biopsies should be considered for men with serum PSA levels of >10 ng/mL.
The migration of Proteus mirabilis and other urinary tract pathogens over Foley catheters
Authors: Sabbuba N. , Hughes G. , Stickler D.J. 
Published: December 2004

Objective To examine the ability of organisms that infect the catheterized urinary tract to migrate over the surfaces of Foley catheters. Materials and methods In a simple laboratory model, organisms were challenged to migrate across sections of hydrogel‐coated latex, hydrogel/silver‐coated latex, silicone‐coated latex and all‐silicone catheters. The sections (1 cm long) were placed as bridges in channels between blocks of agar and the test organisms inoculated onto the agar adjacent to one side of each bridge. The plates were incubated at 37 °C for 24 h and examined for growth of the test organisms on the agar on the other side of the bridges. A collection of swarming, swimming and nonmotile species were tested in the model. The relative mobilities of the test organisms were expressed as migration indices, calculated as the percentage of tests in which bacterial migration was observed over each type of catheter bridge. Results The swarmer cells of Proteus mirabilis and P. vulgaris migrated successfully (migration indices of 73–100) over all four types of catheter. The migration index of Serratia marcescens swarmers was reduced to 33 over the silver‐coated catheters, but these cells crossed over the other catheter surfaces with ease (indices of 100). Pseudomonas aeruginosa was the most mobile of the swimming, non‐swarming organisms with indices of 70–22, but this group was less capable of migration than the swarmers. Indices were 0–33 for nonmotile organisms. The mean migration indices for the nine species for each type of catheter were 57 (hydrogel‐coated latex), 49 (silver/hydrogel‐coated latex), 41 (silicone‐coated latex) and 35 (all‐silicone). The swarmer cells of P. mirabilis moved through populations of Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Enterococcus faecalis, and then migrated over sections of hydrogel‐coated latex catheters with little or no reduction in migration index. They were also capable of transporting the nonmotile cells of K. pneumoniae and S. aureus over the catheters. The migration index of P. mirabilis swarmers was substantially reduced in the presence of Ps. aeruginosa and S. marcescens. Conclusions Hydrogel coatings facilitate the migration of urinary tract pathogens over catheter surfaces. With the exception of S. marcescens, the incorporation of silver into the hydrogel did not inhibit migration. Swarmer cells were particularly effective at moving over catheters and P. mirabilis swarmers were also capable of transporting other species. This suggests that inhibitors of swarming could be useful in controlling catheter‐associated infection and the complications resulting from the spread of bacterial biofilm over catheters.
Prediction of stone disease by discriminant analysis and artificial neural networks in genetic polymorphisms: a new method
Authors: Chiang D. , Chiang H.‐C. , Chen W.‐C. , Tsai F.‐J. 
Published: December 2004

OBJECTIVETo use information from genetic polymorphisms and from patients (drinking/exercise habits) to identify their association with stone disease, the main analytical and predictive tools being discriminant analysis (DA) and artificial neural networks (ANNs).PATIENTS, SUBJECTS AND METHODSUrinary stone disease is common in Taiwan; the formation of calcium oxalate stone is reportedly associated with genetic polymorphisms but there are many of these. Genotyping requires many individuals and markers because of the complexity of gene‐gene and gene‐environmental factor interactions. With the development of artificial intelligence, data‐mining tools like ANNs can be used to derive more from patient data in predicting disease. Thus we compared 151 patients with calcium oxalate stones and 105 healthy controls for the presence of four genetic polymorphisms; cytochrome p450c17, E‐cadherin, urokinase and vascular endothelial growth factor (VEGF). Information about environmental factors, e.g. water, milk and coffee consumption, and outdoor activities, was also collected. Stepwise DA and ANNs were used as classification methods to obtain an effective discriminant model.RESULTSWith only the genetic variables, DA successfully classified 64% of the participants, but when all related factors (gene and environmental factors) were considered simultaneously, stepwise DA was successful in classifying 74%. The results for DA were best when six variables (sex, VEGF, stone number, coffee, milk, outdoor activities), found by iterative selection, were used. The ANN successfully classified 89% of participants and was better than DA when considering all factors in the model. A sensitivity analysis of the input parameters for ANN was conducted after the ANN program was trained; the most important inputs affecting stone disease were genetic (VEGF), while the second and third were water and milk consumption.CONCLUSIONSWhile data‐mining tools such as DA and ANN both provide accurate results for assessing genetic markers of calcium stone disease, the ANN provides a better prediction than the DA, especially when considering all (genetic and environmental) related factors simultaneously. This model provides a new way to study stone disease in combination with genetic polymorphisms and environmental factors.
Effects of benzalkonium chloride treatment on the intramural innervation of the upper urinary tract
Authors: Rolle U. , Chertin B. , Puri P. 
Published: December 2004

OBJECTIVETo establish a model for investigating the pathophysiology of pelvi‐ureteric junction (PUJ) obstruction, using benzalkonium chloride (BCI) treatment of the upper urinary tract of rabbits, and thus further elucidate the pathophysiology of PUJ obstruction, the most common urinary tract obstruction in children.MATERIALS AND METHODSAlthough various histological abnormalities have been described, PUJ obstruction may be functional. Defective innervation in PUJ has been suggested to be a major factor in the failure to transmit peristaltic waves across the PUJ. Previously established animal models of hydronephrosis deal mostly with surgical obstruction of the PUJ, which does not correlate with human congenital hydronephrosis. BCl has been used to ablate selectively neurones of the gastrointestinal myenteric plexus, which generated spastic segments with impaired peristalsis. Thus 12 rabbits were treated with BCl at the PUJ; the right upper urinary tract was dissected extraperitoneally and treated with a local application of 0.1% or 0.5% BCl (six each) for 15 min. The controls were four sham‐operated animals treated with saline. The animals were assessed by intravenous urography (IVU) at 4 and 8 weeks after treatment, after which the animals were killed, the upper urinary tracts removed and whole‐mounts prepared. Acetylcholinesterase (AChE) histochemistry, and neurofilament and tyrosine hydroxylase (TH) single‐enzyme immunohistochemistry were used to detect the intrinsic innervation.RESULTSNone of the animals had hydronephrosis on the IVU or at death. AChE histochemistry, TH and neurofilament immunohistochemistry showed no or very few nerve fibres within the BCl‐treated PUJs in both (0.1% and 0.5%) groups. After saline treatment there was normal development of the neuronal plexus within the submucosal, muscular and adventitial layers of the upper urinary tract.CONCLUSIONThese results suggest that treatment with BCl is useful for ablating the intrinsic innervation in the upper urinary tract. Defective intrinsic innervation of the upper urinary tract did not lead to clinically or radiologically evident hydronephrosis. Further physiological studies using this model are needed to further elucidate the neuronal and myogenic influence on the development of PUJ obstruction.
Endourethral injection of bulking agents for urinary incontinence in children
Authors: Godbole P. , Bryant R. , MacKinnon A.E. , Roberts J.P. 
Published: December 2004

ObjectiveTo assess the early and late outcome of endourethral injection with bulking agents in children with urinary incontinence (a neuropathic bladder or exstrophy‐epispadias complex), by reviewing our experience over a 5‐year period.Patients and methodsThe records of 15 children (10 boys) were reviewed retrospectively; 10 had spina bifida and a neurogenic bladder, four had a neurogenic bladder from other causes and one had epispadias. All children had a stable low‐pressure detrusor and a compliant bladder with sphincteric weakness on preoperative urodynamic testing. Four children had undergone previous enterocystoplasty with a Mitrofanoff stoma, with concomitant urethral lengthening in two and a Goretex™ bladder neck sling in two. Three children voided spontaneously while 12 depended on intermittent catheterization. The agent was injected under general anaesthesia in all patients but one, with an endourethral submucosal injection of the bulking agent into four or more points at the junction of the bladder neck and proximal urethra, aiming to obtain visual occlusion of the urethra. The median (range) number of injections was 2 (1–3); five children had one injection, seven had two and three had three. There were no procedure‐related complications and most were day‐case procedures. Initially PTFE paste was used as the bulking agent, being replaced by bovine collagen or polydimethylsiloxane in the latter half of the series.ResultsAt a median (range) follow‐up of 28 (11–65) months three children were completely dry after a single injection; there was no change in four and a short‐term improvement (median 25 months, range 4 days to 37 months) in eight. After this period all children deteriorated to their original incontinence grade; hence the overall cure rate was three of 15.ConclusionThis experience with a long‐term follow‐up differs from previously reported high success rates for the endourethral injection of bulking agents for urinary incontinence in children. Despite a short‐term benefit, in the long‐term this technique was unreliable and often ineffective. Patients and their carers should be given a realistic and guarded prognosis.