bluuebunny/crossref_metadata_2025_split huggingface dataset:
The restoration of a shallow lake by introducing Potamogeton spp.: The impact of waterfowl grazing
Authors: Lauridsen Torben L. , Sandsten Håkan , Hald Møller Poul 
Published: December 2003

AbstractSubmerged macrophytes were introduced by transplantation and enclosure experiments were performed in shallow, eutrophic Lake Engelsholm, Denmark. We investigated whether or not transplantations were possible, whether protection from grazing had a significant positive influence on the recolonization potential of plants and whether the impact of grazing on macrophytes differed over the season. Enclosure experiments showed that transplanted Potamogeton crispus disappeared in early summer if not protected against waterfowl grazing. The results were supported by subsequent experiments that showed partial disappearance of Potamogeton pectinatus in early summer and a significant biomass reduction later in the season. We suggest that it is primarily waterfowl (coot, Fulica atra, and mallard, Anas platyrhynchos) that up‐root young plants and graze on larger plants. Therefore, in order to promote recolonization of submerged, vascular macrophytes after fish manipulation, P. pectinatus, Potamogeton perfoliatus and Potamogeton lucens were transplanted into protected areas. During the first two years following transplantation, plant density development varied widely, from a decrease in initial density to an overall six‐fold increase. We conclude that macrophytes can be introduced by means of transplantation, although grazing might have a significantly negative influence even when waterfowl densities are relatively low (< 5.6 individuals ha−1). Therefore, we suggest that transplants should be protected from waterfowl until established stands are formed to facilitate submerged macrophyte growth and dispersal, and to optimize their positive effects on the lake ecosystem as a whole. Furthermore, we suggest that protection from grazing is more important in early summer than in late summer and autumn.
The resting eggs of zooplankton from a tropical, eutrophic reservoir (Pampulha Reservoir, south‐east Brazil)
Authors: Maia‐Barbosa P. M. , Eskinazi‐Sant'Anna E. M. , Valadares C. F. , Pessoa G. C. D. 
Published: December 2003

AbstractResting eggs of rotifers and cladocerans were collected within 5 cm of sediments from the eutrophic Pampulha Reservoir. All the collected species were successfully hatched and reared in the laboratory. Although the hatching success of rotifer eggs was high (60–80%), it constituted only about 10% of the level of cladoceran eggs. The egg abundance in Pampulha Reservoir varied from 203.2 × 103 eggs m−2 to 80 × 103 eggs m−2. The low densities of resting eggs suggest that the recovery activities directed to the reservoir, such as constant dredging of the sediment, might be affecting this potential genetic pool and, consequently, the maintenance of the remaining and pioneer zooplanktonic populations.
Numerical modification of the Los Angeles classification of gastroesophageal reflux disease fails to decrease observer variation
Authors: Kusano Motoyasu , Sugimoto Sayaka , Kawamura Osamu , Minashi Keiko , Maeda Masaki , Shimoyama Yasuyuki , Ino Kyoko , Mimura Naoko , Higuchi Tatsuya , Kon Yoichi , Kikuchi Kazuma , Shirota Tohko , Mizuide Masahumi , Oshimoto Naoko , Toki Munetoshi , Ohwada Tsuneo , Mori Masatomo 
Published: December 2003

Background:  We previously reported that a new endoscopic classification of gastroesophageal reflux disease, the Los Angeles classification, showed considerable observer variation depending on the experience of the endoscopist. In the present study, we evaluated some modifications of the classification to determine whether we could decrease observer variation.Methods:  Fifty endoscopic photographs, each showing four images of the squamo‐columnar junction, were prospectively obtained from 50 consecutive patients with gastroesophageal reflux disease. Two groups of eight endoscopists divided by their endoscopic experience, group 1 (100–500 procedures) and group 2 (more than 500 procedures), assessed the photographs using classifications with the following modifications: (i) addition of grade O to describe healed mucosal breaks and setting grade B as more than 5 mm or 10 mm; or (ii) addition of grade O and setting grade D as 75–99% or 100% circumferential.Results:  Changing the definition of grade B or grade D did not increase the kappa values for either group of observers.Conclusions:  These modifications of the Los Angeles classification were unable to decrease observer variation.
Endoscopic treatment for benign biliary strictures: Can placement of a covered metallic stent be an option in refractory cases?
Authors: Enya Masamichi , Yasuda Ichiro , Mukai Tsuyoshi , Shinoda Tohru , Otsuji Kentaro , Iwasa Junpei , Nakai Minoru , Tomita Eiichi , Moriwaki Hisataka 
Published: December 2003

Background:  Recently, endoscopic treatment has been attempted to counter benign biliary strictures. It is expected to be an alternative to surgical operation because of its lower morbidity and its convenience, but the long‐term results have not yet been sufficiently elucidated. Here, we evaluate the short‐ and long‐term results of endoscopic stenting in patients with benign biliary strictures, and also describe a new technique using a covered metallic stent (CMS) in the refractory cases.Methods:  The charts of 22 consecutive patients with benign biliary stricture treated endoscopically at our institutions between December 1995 and December 2002 were analyzed retrospectively.Results:  Stricture etiology was as follows: postoperative, nine; chronic pancreatitis, seven; primary sclerosing cholangitis (PSC), three; and other, three. The stent initially placed was a 7 Fr in 11 patients and a 10 Fr in 11 patients. Eighteen of 22 patients (82%) were successfully treated by the initial treatment, and stents were removed after a mean duration of 3.1 months (range: 1–14 months). In the remaining four patients, stents were exchanged once to four times after that, and a CMS was placed as the second endoprosthesis in two patients with chronic pancreatitis. These stents, including CMS, were finally removed from these four patients after a mean duration of 14.8 months (range: 8–22 months). Over a median follow‐up period of 26 months (range: 6–78 months), one recurrence has been observed, in which case a CMS was placed in a patient with chronic pancreatitis. The CMS was removed successfully 6 months after the insertion, and no recurrence was observed during the 6‐month follow‐up period.Conclusions:  Endoscopic stenting for benign biliary stricture is an alternative to surgery because it shows satisfactory results. Placement of a CMS would also be an option in refractory strictures, such as those due in chronic pancreatitis, if the certainty of removal is proven by cumulative experience with a large number of patients.
Advance directives and emergency department patients: ownership rates and perceptions of use
Authors: Taylor D. McD. , Ugoni A. M. , Cameron P. A. , McNeil J. J. 
Published: December 2003

Abstract Background: Advance directives (ADs) are rarely avail­able in Australia to guide management but may become more important as our population ages.Aims: The present study aimed to determine patient knowledge, perception and ownership rates of ADs and the factors that impact upon these variables.Methods: A cross‐sectional survey of emergency department patients was undertaken. The main outcome measures were: (i) prior discussion about the extent of medical treatment and ADs, (ii) knowledge and perceptions of ADs, (iii) present AD ownership rates and (iv) likelihood of future AD ownership. Generalized linear models were used for analysis.Results: Four hundred and three patients were enrolled. The mean age of patients was 73 years and 239 (59.3%) were male. Two hundred and forty patients (59.6%) had discussed the extent of treatment. Only 81 patients (20.1%) had discussed the use of an AD. One hundred and thirty‐seven patients (34.0%) knew of one type of AD and 333 patients (82.6%) thought some ADs were a good idea. Only 32 patients (7.9%) owned an AD, although 276 (68.5%) would consider owning one. The main reason for never obtaining an AD was ‘always wanting full treatment’ (93 patients, 23.1%). Level of education was the only characteristic that impacted significantly upon an outcome measure. Patients with a higher level of education were more likely to have known and spoken about ADs, to own an AD and to consider owning one.Conclusions: AD knowledge and ownership rates were low. However, most patients perceive them favourably and many would consider owning one. Intervention strategies to improve AD awareness are indicated. This may empower patients to more effectively participate in their own advance care planning. (Intern Med J 2003; 33: 586−592)
Management of dyspepsia at the beginning of the twenty‐first century
Authors: Duggan A. 
Published: December 2003

Abstract Dyspepsia remains a frequent intercurrent management problem for the non‐gastroenterologist. However, the causes for dyspepsia have changed markedly in recent decades. In contrast to gastro‐oesophageal reflux ­disease, both gastro‐oesophageal malignancy and peptic ulcer disease have become uncommon causes for ­dyspepsia. Concurrent with these changes, management strategies for dyspepsia have changed. Once aware of these changes the non‐gastroenterologist can effectively manage the majority of patients with dyspepsia. The present paper reviews these key changes in dyspepsia management. (Intern Med J 2003; 33: 604−609)
Adults with cystic fibrosis: meeting the challenge!
Authors: Dobbin C. J. , Bye P. T. P. 
Published: December 2003

Abstract The number of adults with cystic fibrosis (CF) is increasing. They are striving for independence and a fulfilling life with focus on career, relationships, education and finances at a time when lung function is likely to be declining and complications of this multi‐system disease are increasing. Maintaining the quality and improving the duration of life are continuing challenges for the ­clinician and the patient. Increased hope and greater expectations have been provided by a number of recent clinical advances and active research into novel treatments, including gene therapy.There has been increased recognition of the necessity for early diagnosis, adequate monitoring and effective intervention for complications such as diabetes and osteo­porosis. Research into multi‐resistant bacteria and clonal strains of Pseudomonas aeruginosa is ongoing and attention has focused on infection control policies. Although more high‐level evidence is required on many issues confronting people with CF, a considerable effort has been made over the last decade to provide a more evidence‐based approach to therapy with a number of large controlled clinical trials. For the adult with CF, there are also more decisions to be made. There is focus on reproductive health, with most couples enjoying the real possibility of having children. For those with advanced disease, the option for lung transplantation is well established.Maintenance of quality care will require adequate planning, effective transition programmes from paediatric to adult care, specialized training for doctors, nurses and allied health professionals and the allocation of sufficient resources to accommodate the inevitable increase in patient numbers. (Intern Med J 2003; 33: 593−597)
Cavernosal nerve mapping: current data and applications
Authors: Klotz L. 
Published: December 2003

There are four reviews in this month's section, two relating to the technical aspects of treating prostate cancer, one to genetic instability and bladder cancer, and the final one about continence surgery in urogenital prolapse. The authors are from Canada, the USA, and the UK. The messages from all of the reviews are clear, and provide interesting reading. The contributions to this section continue to give considerable information, and there are many more to follow.Although nerve‐sparing prostatectomy is widely practised, the results with respect to preserving potency often do not meet expectations. The concept of intraoperative cavernosal nerve stimulation is reasonable. Data that link the response to sildenafil after prostatectomy with bilateral nerve sparing has increased the importance of optimizing nerve sparing. The cavernosal nerves are often difficult to visualize and may have a variable course. A tumescent response to nerve stimulation can be shown consistently; the response may be subtle, and characterized by a minimal increase in penile circumference and blood flow. Immediately after prostatectomy, proximal nerve stimulation identifies whether neural continuity has been maintained, and is predictive of recovery of erectile function. The CavermapTM system (Uromed Corporation, Boston, MA, USA) was developed to permit intraoperative nerve stimulation with tumescence monitoring. An initial phase 2 and subsequent phase 3 single‐blinded, randomized, multicentre study that compared Cavermap‐assisted prostatectomy with conventional nerve sparing showed a significant benefit in terms of the duration of nocturnal tumescence at 1 year. Other approaches are being explored, including incorporating the device into sural or genito‐femoral nerve grafting, use of nerve stimulation during cystectomy or abdominal‐perineal resection, and direct corpus cavernosal pressure monitoring during nerve stimulation. These approaches warrant further evaluation.
Radiotherapy and hyperthermia in the treatment of patients with locally advanced prostate cancer: preliminary results
Authors: Van Vulpen M. , De Leeuw A.A.C. , Raaymakers B.W. , Van Moorselaar R.J.A. , Hofman P. , Lagendijk J.J.W. , Battermann J.J. 
Published: December 2003

OBJECTIVETo report an interim clinical evaluation of combined external beam irradiation (EBRT) and interstitial or regional hyperthermia in the treatment of locally advanced prostate cancer.PATIENTS AND METHODSFrom 1997 to 2001, 26 patients with T3‐4/NX/0M0 prostate carcinoma were treated with a combination of conformal EBRT and hyperthermia. Fourteen patients received five weekly regional hyperthermia treatments within an optimization (phase II) study, using the coaxial transverse electrical magnetic system. Twelve patients received one interstitial hyperthermia treatment within a feasibility study (phase I), using the multi‐electrode current source system. Irradiation was delivered using a conformal three‐field technique, administering 70 Gy in 2‐Gy fractions in 7 weeks.RESULTSThe mean initial prostate‐specific antigen level was 26 ng/mL. Three patients had a T4 and 23 a T3 tumour; the tumours were classified as well (four), moderately (16) and poorly (six) differentiated. The mean follow‐up was 36 months. In the combined treatments there was no toxicity of more than grade 2. In regional hyperthermia the mean index temperature (T90and T50, i.e. exceeded by 90% and 50% of the measurements) was 40.2 °C and 40.8 °C, and for interstitial hyperthermia 39.4 °C and 41.8 °C, respectively. All patients survived; seven patients had a biochemical relapse (27%), three in the regional and four in the interstitial group. The actuarial probability of freedom from biochemical relapse was 70% at 36 months for all patients together, 79% for regional and 57% for interstitial. No factors were found that could be used to predict relapse.CONCLUSIONSThe clinical outcome in these patients with advanced localized prostate cancer seems to compare favourably with most series using irradiation alone, and the treatment caused no severe complications.
Patients’ preferences for communicating a prostate cancer diagnosis and participating in medical decision‐making
Authors: Davison B.J. , Parker P.A. , Goldenberg S.L. 
Published: December 2003

OBJECTIVESTo assess patients’ preferences about how physicians’ deliver news of a prostate cancer diagnosis, and patients’ preferred participation in medical decision‐making, with a secondary objective being to validate the Measure of Patients’ Preferences (MPP) scale with these patients.PATIENTS AND METHODSEighty‐seven men (mean age 62.4 years) referred to an ultrasound/radiology department for their first transrectal ultrasonography (TRUS)‐guided biopsy completed the MPP and Control Preferences measures. Patients were asked to identify how they would like to be told about a potential prostate cancer diagnosis by their physician, and what role they would like in making treatment‐related decisions with their physicians.RESULTSMost patients wanted either an active (43%) or collaborative (47%) role in medical decision‐making if the TRUS showed prostate cancer. Men rated content items (what and how much information is provided by their physician) as more important than supportive (emotional support during interaction) or facilitative (setting and context variables) items. Men who preferred a collaborative role in the patient–physician interaction wanted significantly (P = 0.04) more content (detailed information on available treatments and the effect of these treatments on their quality of life) than men who had a preference for either an active or passive role in medical decision‐making. Demographic characteristics were not indicative of either preferred role in decision‐making or communication preferences. The MPP was shown to be reliable.CONCLUSIONSMen have expectations about how physicians disclose a diagnosis of prostate cancer and how they wish to participate in making treatment decisions. These results underline the importance of identifying patient preferences before embarking on treatment discussions, as the way ‘bad news’ is disclosed has previously been identified as a predictor of the outcome of the patient‐physician interview.
A randomized trial of choice of treatment in prostate cancer: the effect of intervention on the treatment chosen
Authors: Auvinen A. , Hakama M. , Ala‐Opas M. , Vornanen T. , Leppilahti M. , Salminen P. , Tammela T.L.J. 
Published: December 2003

OBJECTIVETo determine whether different approaches in the choice of treatment affect the treatment chosen by the patient for prostate cancer.PATIENTS AND METHODSWe conducted a randomized trial with 210 men who had a histologically confirmed diagnosis of prostate cancer in 1993–94 at four major hospitals in Finland. After obtaining informed consent the men were randomized either to an intervention arm, in which there was greater patient participation in the choice of treatment following a structured procedure, or a control arm in which the standard approach, i.e. a standardized treatment protocol, was used. The main outcome measure of the analysis was the primary treatment chosen for prostate cancer.RESULTSIn the enhanced participation arm patients not eligible for radical prostatectomy chose orchidectomy less frequently and favoured nonsurgical endocrine treatment than in the treatment protocol arm. Radical prostatectomy was the most commonly chosen treatment option in both arms among men with operable cancer. The way treatment options were presented affected the treatment chosen for prostate cancer.CONCLUSIONPatients with prostate cancer are willing and able to take an active role in making decisions. The preferences of patients with prostate cancer in the choice of treatment may differ from the priorities of the physicians.
Significance of cancer detection in the anterior lateral horn on systematic prostate biopsy: the effect on pathological findings of radical prostatectomy specimens
Authors: Miyake H. , Sakai I. , Ishimura T. , Hara I. , Eto H. 
Published: December 2003

OBJECTIVETo clarify the significance of cancer detection in the anterior lateral horn (ALH) on systematic prostate biopsy in relation to its effect on the pathological findings from retropubic radical prostatectomy (RRP) specimens.PATIENTS AND METHODSThe study included 84 consecutive patients who underwent RRP at our institution between January 1999 and December 2002, after being diagnosed as having prostate cancer, based on systematic prostate biopsies that included the areas taken by standard sextant biopsies and the bilateral ALHs. Several clinicopathological factors of these patients were analysed in relation to the presence or absence of cancer in the ALH on systematic biopsy.RESULTSOf the 84 patients, cancer was detected in the ALH in 44 (group A), but not in the remaining 40 (group B). There were no significant differences in age, preoperative serum prostate‐specific antigen level, or prostate volume between the groups. However, the incidence of bilateral positive cores and the percentage of positive biopsy cores in group A were significantly higher than those in group B. Pathological examinations of RRP specimens showed no significant differences in the incidence of lymphatic invasion, vascular invasion and perineural invasion, or Gleason score between the groups, but group A had a significantly larger tumour volume and higher incidence of extraprostatic disease than group B.CONCLUSIONSDespite similar biological tumour characteristics and irrespective of the cancer location in the ALH, advanced and extensive disease frequently involves the ALH. Therefore, more aggressive treatment should be considered if cancer is detected in the ALH by systematic prostate biopsy.
T1G3 transitional cell carcinoma of the bladder: recurrence, progression and survival
Authors: Peyromaure M. , Zerbib M. 
Published: December 2003

OBJECTIVESTo report our experience with T1G3 bladder tumours over the last 10 years.PATIENTS AND METHODSWe analysed the outcome of 74 consecutive patients treated for a T1G3 bladder cancer between 1991 and 2001. Fifty‐seven patients (77%) were treated with transurethral resection (TUR) plus six weekly instillations of bacillus Calmette‐Guérin (BCG) therapy. Ten patients (13.5%) with contraindications to BCG or with a small T1a tumour were treated with TUR plus mitomycin‐C, and seven (9.5%) were treated with TUR alone because of their age. Patients treated with BCG had systematic biopsies taken at the end of the first course. Patients with residual tumour received a second course of six weekly instillations. Patients with negative biopsies received maintenance BCG therapy consisting of intravesical instillations each week for 3 weeks given 3, 6, 12, 18, 24, 30 and 36 months after the first course.RESULTSThe median follow‐up was 53 months. The overall recurrence rate was 46% and the overall progression rate 19%. The rate of delayed cystectomy was 8% and that of disease‐specific survival 91%. In patients who received BCG therapy, the recurrence and progression rates were 42% and 23%, respectively. In this group the rate of disease‐specific survival was 88%.CONCLUSIONThis study confirms that maintenance BCG therapy is an effective treatment for T1G3 bladder tumours, with an acceptable rate of bladder preservation.
Does extended lymphadenectomy increase the morbidity of radical cystectomy?
Authors: Brössner C. , Pycha A. , Toth A. , Mian C. , Kuber W. 
Published: December 2003

OBJECTIVETo report the events during and after radical cystectomy and urinary diversion for bladder cancer, in terms of major and minor complications, comparing a minimal with an extended lymphadenectomy, as more lymph nodes obtained during radical cystectomy may improve staging and thus the outcome.PATIENTS AND METHODSWe reviewed 92 consecutive patients who underwent radical cystectomy from March 1998 to February 2002; 46 had a minimal (group A) and 46 an extended lymphadenectomy (group B). Cases were selected according to the American Society of Anesthesiologists classification, only including those graded 2 or 3. We specifically evaluated the incidence and type of complications within 30 days after surgery.RESULTSBecause of extending the lymphadenectomy the operative duration was a median of 63 min longer in group B (P < 0.01). Complications requiring surgical interventions occurred in four (9%) patients in group A and five (11%) in group B (P = 0.28). Complications requiring no surgical intervention were also similar in both groups. Three patients died, two in group A and one in group B (P = 0.57).CONCLUSIONExtended lymphadenectomy in radical cystectomy does not increase the morbidity within 30 days of surgery.