bluuebunny/crossref_metadata_2025_split huggingface dataset:
Magnesium status of patients with renal stones and its effect on urinary citrate excretion
Authors: Reungjui S. , Prasongwatana V. , Premgamone A. , Tosukhowong P. , Jirakulsomchok S. , Sriboonlue P. 
Published: March 2003

Objectives  To assess the magnesium status and its effect on urinary citrate excretion in patients with renal stones, as they have a low muscular magnesium content.Patients, subjects and methods  Using a magnesium‐tolerance test (0.1 mmol/L MgSO4/kg body weight, delivered intravenously), the magnesium status was assessed in 17 patients with renal stones from rural North‐east Thailand, and in three groups of normal subjects from different environments (i.e. 17 from rural Central Thailand, 16 from urban and 14 from rural North‐east Thailand). Participants with magnesium deficiency (magnesium retention > 50%) were supplemented with 300 mg chelated magnesium daily for 1 month and reassessed. Their urinary citrate excretion was also measured before and after supplementation.Results  Nine of the patients with renal stones were magnesium deficient, as were six normal subjects from the same area, whereas only one and two of the rural Central and urban North‐east Thais had magnesium deficiency. The magnesium status of the 13 deficient subjects significantly improved (P = 0.003) after supplementation with chelated magnesium. The supplement also caused a significant increase in mean (sd) urinary citrate excretion, from 237.7 (173.1) to 361.3 (284.1) mg/day (P= 0.012).Conclusions  These results indicate that magnesium deficiency is common among patients with renal stones in rural North‐east Thailand, and that the probable cause is environmental. The increase in urinary citrate excretion after magnesium supplementation suggests that magnesium is important in renal stone formation, through its effect on citrate metabolism.
Long‐term efficacy and safety results of the two‐stage implantation technique in sacral neuromodulation
Authors: Scheepens W.A. , Van Koeveringe G.A. , De Bie R.A. , Weil E.H.J. , Van Kerrebroeck Ph.E.V. 
Published: March 2003

Objective  To assess the long‐term efficacy and safety of two‐stage sacral neuromodulation with an implantable pulse generator (IPG) in patients treated for urinary urge incontinence (UI) and/or urinary retention (UR).Patients and methods  The two‐stage technique is used if patients have a good response during the acute phase of the percutaneous nerve evaluation (PNE) test, but have a poor response during the following 4–7 days (subchronic phase). In the first stage only the permanent electrode was implanted and connected to a temporary external stimulator, allowing patients to be assessed for longer. If the main symptoms improved by more than half the patient proceeded to the second stage, the insertion of the IPG. We reviewed all patients who underwent two‐stage implantation; all had signed an informed consent and were asked to complete voiding diaries and a questionnaire to assess the subjective effects of the therapy. Safety was assessed from relevant medical events, management, and relative to the thera‐py and resolution. Residual urine was assessed by self‐catheterization. The long‐term voiding diary results were compared with baseline estimates and analysed statistically using the two‐sided Student's t‐test.Results  Between 1991 and 1998, 15 patients (13 women and two men, mean age 53 years, range 44–66) underwent the two‐stage technique; the mean (median, range) follow‐up was 4.9 (5.2, 2.5–7.5) years. Seven patients had UI and seven had UR, with one having both. The mean (range) number of PNEs undertaken in each patient was 2.1 (1–4) and these all failed in the subchronic phase. All patients underwent a first‐ and second‐stage implant after a mean (range) screening period of 12.2 (2–29) days. One patient was explanted after implantation of only the first stage, and two others explanted in a later phase because the IPG was ineffective during the follow‐up. The voiding diary results of the remaining 12 patients showed improvement in all the main variables, and in the subjective assessment 11 reported an improvement and were satisfied with the therapy. There were 17 adverse events, 14 of which were resolved and seven of which required surgical intervention.Conclusion  The long‐term results of the two‐stage implantation show clinically and statistically significant improvements, probably because the implantation of the lead (first stage) more closely resembles the final therapy. If a temporary PNE test is not optimal (lead migration, longer testing needed), the two‐stage technique can offer a good and safe alternative of comparable efficacy in the long‐term. If the two‐stage technique had not been available to these 12 patients they would not have been offered neuromodulation.
Virtual reality flexible cystoscopy: a validation study
Authors: Shah J. , Darzi A. 
Published: March 2003

Objectives  To validate a flexible cystoscopy simulator by determining if it could differentiate between expert and novice cystoscopists.Subjects and methods  Seventeen subjects (10 novices with no previous endoscopic experience and seven urologists who had all carried out > 1000 flexible cystoscopies each) were asked to undertake a flexible cystoscopy task on the URO Mentor (Simbionix, Israel) virtual reality (VR) machine. In the task used the bladder mucosa has 10 flags (numbered 1–10) at key positions in the bladder; by visualizing each of the 10 flags and photographing them the subject will have indirectly visualized the entire mucosa. Subjects were asked to carry out the task 10 times, to allow their rate of acquisition of skill to be assessed. The total time taken for the task and the number of flags visualized were used as measures of performance.Results  The experienced urologists were significantly better at flexible cystoscopy than the medical students on the first trial for the mean number of flags seen (9.57 vs 8.0, P = 0.01) and the mean time to complete the task (2.33 vs 4.89 min, P = 0.03). At the 10th trial there was still a significant difference for the time taken, between the medical students and the urologists (2.33 vs 0.81 min, P = 0.01) but not for the number of flags seen (9.2 vs 9.6, P = 0.46). The medical students improved between the first and the 10th attempt, being significantly quicker for trial 10 than trial 1 (P = 0.005). However, although the medical students appeared to see more flags (8.0 vs 9.2) this was not significant (P = 0.05). The urologists did not differ in the number of flags visualized between the first and 10th trial, although they were significantly quicker in completing the task (P = 0.02). The urologists were significantly faster in trial 2 than trial 1, but no faster thereafter (P = 0.04).Conclusions  Using the URO Mentor simulator, it was possible to assess the level of experience of flexible cystoscopy, and therefore the system has construct validity. As in the real situation there is a period of learning during which the subject becomes familiar with the computer/machine/human interface, the task and the handling of the instruments. These results support the view that there is a role for VR simulators in urological training.
Posterior urethral injuries and the Mitrofanoff principle in children
Authors: Freitas Filho L.G. , Carnevale J. , Melo Filho A.R. , Vicente N.C. , Heinisch A.C. , Martins J.L. 
Published: March 2003

OBJECTIVETo report our experience of children with trauma causing posterior urethral injury who at some stage underwent a Mitrofanoff intervention, as post‐traumatic urethral injuries can demand long‐term treatment which (regardless of the surgical intervention) requires a period of dilatation of the reconstructed urethra.PATIENTS AND METHODSFrom 1992 to 2001, 14 patients with urethral injuries underwent a Mitrofanoff procedure. Thirteen had been run over by a motor vehicle and had severe hip injuries, and one had a direct non‐penetrating perineal impact lesion (13 boys and one girl, aged 2–13 years at the time of the accident). In all cases the Mitrofanoff procedure involved interposing the appendix between the bladder and the umbilicus. Only one of the children (because of extremely high bladder filling pressures) also underwent an augmentation cystoplasty and closure of the bladder neck because there were bony fragments in the urethra.RESULTSThe Mitrofanoff technique was considered useful in most cases. All patients during a given period used the Mitrofanoff conduit to empty their bladder every 3 h; 10 of the 14 are currently voiding urethrally, with an adequate flow, and four are not, but emptying the bladder periodically via the appendicovesicostomy. The only girl in the group has a major hip deformity and is unlikely to undergo urethroplasty; two patients are expecting definitive treatment and the other, although having a patent urethra, has no urinary flow. He is currently 19 years old and has no erections.CONCLUSIONSThe treatment of posterior urethral injuries represents a challenge to surgical teams. Although primary suturing of the separated urethral ends is accepted as the best treatment, the construction of a temporary continent urinary diversion may be considered in the most severe cases.
Spontaneous tibial compartment syndrome in Type 1 diabetes mellitus
Authors: Smith A. L. , Laing P. W. 
Published: March 2003

SummaryWe present a case of a patient with Type 1 diabetes mellitus (DM) who spontaneously developed severe bilateral anterior tibial compartment syndromes which required extensive surgical treatment. While infarction of skeletal muscle in Type 1 DM remains rare and usually affects the larger compartments of the thigh, this diagnosis must be entertained in any patient presenting with acute leg pain. If a patient displays any features of acute compartment syndrome, prompt fasciotomy must be undertaken.Diabet. Med. 16, 168–169 (1999)
Troglitazone in combination with sulphonylurea improves glycaemic control in Type 2 diabetic patients inadequately controlled by sulphonylurea therapy alone
Authors: Buysschaert M. , Bobbioni E. , Starkie M. , Frith L. , Group For The Troglitazone Study 
Published: March 2003

Summary Aim The aim of this study was to investigate the effectiveness of troglitazone (a peroxisome proliferator‐activated receptor‐γ agonist developed primarily for the treatment of Type 2 diabetes mellitus (DM)), 100 or 200 mg/day, in terms of glycaemic control, lipid profile and tolerability, when given in addition to existing sulphonylurea therapy. Methods A 16‐week, randomized, parallel‐group placebo‐controlled trial in 259 Type 2 diabetic patients already on sulphonylurea therapy. Results At week 16, adjusted geometric mean HbA1c with troglitazone 100 mg (7.7%; P = 0.023) and 200 mg (7.4%; P < 0.001) was lower with sulphonylurea alone (8.2%). At all weeks, adjusted geometric mean fasting serum glucose levels were lower in both troglitazone groups, compared with sulphonylurea alone (P = 0.007 to P < 0.001). At week 16, both troglitazone groups showed reductions in immune reactive insulin compared with sulphonylurea alone (200 mg, 13%; P = 0.032: 100 mg, 5%; NS). Troglitazone reduced serum levels of nonesterified fatty acids at week 16 (100 mg, 12%; P = 0.042) and at all weeks (200 mg, 17–24%; P = 0.014 to P < 0.001). The incidence of drug‐related adverse events was similar in all groups (23–24% of patients). There was no apparent association between hypoglycaemia and the addition of troglitazone to sulphonylurea therapy. Conclusions Troglitazone 100 or 200 mg added to usual sulphonylurea therapy in patients with Type 2 DM is associated with a significant improvement in glycaemic control, without altering the adverse‐event profile of the sulphonylurea.Diabet. Med. 16, 147–153 (1999)
A population‐based survey of frequencies of self‐reported spontaneous and induced abortions in Danish women with Type 1 diabetes mellitus
Authors: Lorenzen T. , Pociot F. , Johannesen J. , Kristiansen O. P. , Nerup J. , Epidemiology The Danish IddM. , Group Genetics 
Published: March 2003

Summary Aims Whether pregnant women with Type 1 diabetes mellitus (Type 1 DM) have an increased risk of abortions is controversial. The aim of the present Danish population‐based study of 33% of the Danish population was to describe the pattern of self‐reported miscarriage and stillbirths from 1304 women with Type 1 DM. Methods Data were obtained by questionnaire. The current age of the women was 20–65 years and their age at diabetes onset was 30 years or less. Results The frequency of spontaneous abortions (SA) and induced abortions (IA) reported from women diagnosed with Type 1 DM prior to pregnancy was 17.5% (95% CI 15.5–19.9%) and 18.0%. (95% CI 16.0–20.0%), respectively. No significant differences in abortion frequencies before or after 1980 were reported. Previous findings of a decreasing stillbirth‐rate in diabetic pregnancies during the last decades were supported. Conclusions The reported SA frequency of 17.5% (95% CI 15.5–19.9%) in pregnant women with Type 1 DM is higher than previously reported SA rates of 10–12% in Danish nondiabetic women and the SA rate is more than twice the SA rate found in a previous Danish study from a highly specialized obstetrical centre for diabetic women. These data suggest an urgent need for further improvement in the general management of Danish pregnant women with Type 1 DM.
Contra‐indications to metformin therapy are largely disregarded
Authors: Holstein A. , Nahrwold D. , Hinze S. , Egberts E. ‐H. 
Published: March 2003

Summary Aims To investigate the current metformin treatment practice and in particular to examine the consideration given to its contraindications. Methods A cross‐sectional analysis of 308 consecutive Type 2 diabetic patients (mean age 66 ± 11.3 years) previously treated with metformin on an outpatient basis and admitted to a German general hospital during the period from 1 January 1995 to 31 May 1998 because of acute disease or in order to optimize their diabetes management. All patients underwent a basic investigation comprising a documentation of their medical history, a physical examination, an electrocardiogram, and an extensive laboratory profile; 34% also had acute coronary angiography. Results On admission to hospital, 73% of the patients were found to have contra‐indications, risk factors, or intercurrent illnesses necessitating discontinuation of metformin; 51% of these patients had several of these conditions. As major contra‐indications to metformin, renal impairment was present in 19% of all patients, heart failure in 25%, respiratory insufficiency in 6.5%, and hepatic impairment in 1.3%. The risk factors to metformin included advanced coronary heart disease in 51%, atrial fibrillation in 9.8%, chronic alcohol abuse in 3.3%, advanced peripheral vascular disease in 2%, and pregnancy in 0.7%. As intercurrent illnesses, cerebral ischaemia occurred in 9.8% under metformin treatment and malignancies were diagnosed in 6.5%. The patients with contra‐indications or requiring caution to metformin were significantly older and had previously been treated with more cardiovascular medication than those without such reservations (P < 0.001). Conclusions Despite the considerable risk of lactic acidosis in the majority of patients, no cases were observed.
Metformin treatment leads to an increase in basal, but not insulin‐stimulated, glucose disposal in obese patients with impaired glucose tolerance
Authors: Morel Y. , Golay A. , Perneger T. , Lehmann T. , Vadas L. , Pasik C. , Reaven G. M. 
Published: March 2003

Summary Aims This study was initiated to test the hypothesis that metformin treatment leads to enhanced glucose disposal at ambient insulin concentrations. Methods Nineteen obese patients with impaired glucose tolerance (IGT) were treated with either metformin or placebo in a randomized, double‐blind, placebo‐controlled, cross‐over study. Insulin secretion and insulin resistance were quantified using the homeostasis model assessment (HOMA) and insulin‐stimulated glucose disposal were measured by determining the steady‐state plasma glucose (SSPG). Results The average benefit of metformin was 0.6 mmol/l for glucose (95% confidence interval (CI) 0.2–0.9 P = 0.002), 2.8 pmol/l for insulin (95% CI 0.2–5.4, P = 0.019). Insulin resistance, as quantified by HOMA, was improved by 1.1 (95% CI 0.2–2.0, P = 0.004), without any change in insulin secretion. Basal and insulin‐stimulated glucose oxidation were comparable in the placebo and metformin‐treated groups at the end of each treatment period, as was the SSPG concentration. However, both systolic and diastolic blood pressures fell significantly following metformin administration as compared to treatment with placebo. Conclusions These results indicate that metformin administration to patients with IGT is associated with enhanced glucose disposal at baseline insulin concentrations and a fall in blood pressure. In contrast, neither glucose oxidation nor glucose disposal were increased in association with metformin treatment under conditions of physiological hyperinsulinaemia.
Endothelial dysfunction in Type 1 diabetes mellitus: relationship with LDL oxidation and the effects of vitamin E
Authors: Pinkney J. H. , Downs L. , Hopton M. , Mackness M. I. , Bolton C. H. 
Published: March 2003

Summary Aims To examine the hypothesis that increased susceptibility of low density lipoproteins (LDL) to oxidation predisposes to endothelial dysfunction in patients with Type 1 diabetes mellitus. Methods A cross‐sectional study of 46 non‐nephropathic diabetic and 39 control subjects and in the diabetic patients, a 3‐month duration, randomized, placebo‐controlled double‐blind trial of vitamin E 500 U/day. Flow‐mediated vasodilatation (FMD) was measured in the forearm by high resolution ultrasound. LDL oxidation by Cu2 +  was measured in vitro. Results Diabetic patients had greater basal and reactive forearm blood flow (geometric mean (
sd%) flow (ml/min) 110.15 (19.19%) vs. 74.99 (23.17%); P=  0.045, and 344.35 (20.84%) vs. 205.17 (21.48%); P=  0.007), compared with controls, but there was no difference in FMD (median (interquartile range) 0.00 ( − 0.01–0.02) vs. 0.02 ( − 0.01–0.02) cm2; P=  0.78). Diabetic LDL oxidation lag time correlated with postdilatation brachial artery area (r=  0.32; P=  0.05) but not with FMD. Lag‐times and total LDL oxidation by Cu2 + , lipoprotein and vitamin E concentrations were similar in diabetic and control groups. Antibody titres to oxidized LDL (oxLDL) were higher in non‐diabetic than diabetic subjects, and were unrelated to FMD. In diabetic patients, vitamin E increased mean (
sd) plasma vitamin E levels (24.0 (6.5) to 47.5 (7.5) μmol/l; P=  0.0006) and resulted in increased FMD (Δ 0.00 ( − 0.02–0.01) vs. 0.01 (0.01–0.02)) cm2; P=  0.0036), but no changes in LDL Cu2 +  oxidation profiles were observed. Conclusions FMD is no different in Type 1 diabetic and non‐diabetic subjects and nor are indices of lipid peroxidation and in vitro LDL oxidation although levels of antibody to oxLDL are lower in diabetes. Vitamin E supplementation increases plasma vitamin E levels and may enhance FMD in diabetes but, in the absence of changes in LDL oxidation, this may not be mediated by reduced oxidation of LDL.
Macular oedema with associated uveitis and cataract following presentation of Type 1 diabetes mellitus in severe ketoacidosis
Authors: Gordon D. , Browne B. H. 
Published: March 2003

AbstractWe present a case of cystoid macular oedema presenting in a newly diagnosed diabetic teenager. She had developed anterior uveitis prior to diabetes and whether this contributed to the subsequent ocular complications remains speculative. The macular changes resolved spontaneously over 6 months without the use of grid laser photocoagulation.
Screening for Type 2 diabetes mellitus: a decision analytic approach
Authors: Goyder E. C. , Irwig L. M. 
Published: March 2003

Summary Aims Screening for asymptomatic Type 2 diabetes mellitus has been advocated on the grounds that diabetes is a common condition associated with increased morbidity and mortality, but uncertainty remains about the impact of early treatment. This study aimed to determine whether the potential benefits of screening are likely to outweigh the potential harm and to explore which variables significantly influence the balance of benefit and harm resulting from screening. Methods A decision analysis comparing the relative impact of using a single fasting blood glucose screening test, between the ages of 45 and 60 years, with the impact of not screening. The model weighs the increase in quality adjusted life years (QALYs) from reduction in microvascular and cardiovascular complications against the potential decrease in QALYs associated with earlier diagnosis and treatment in an asymptomatic population. Results The baseline model suggests a saving of 10 QALYs for every 10 000 individuals screened: a gain of four from postponed microvascular complications and 17 from avoided cardiovascular complications, as opposed to a loss of 11 as a result of earlier diagnosis in screening detected cases. The balance of benefit and harm is sensitive to baseline cardiovascular risk, the effectiveness of cardiovascular interventions and the relative disutility assigned to early diagnosis and treatment for an individual without symptoms. Conclusions The immediate disutility of earlier diagnosis and additional treatment may be greater than the potential long‐term benefit from postponing microvascular complications. Screening decisions should therefore be based largely on consideration of cardiovascular risk and the availability of evidence based interventions to reduce cardiovascular risk.
Socio‐economic status, obesity and prevalence of Type 1 and Type 2 diabetes mellitus
Authors: Evans J. M. M. , Newton R. W. , Ruta D. A. , MacDonald T. M. , Morris A. D. 
Published: March 2003

Summary Aims  The influence of socio‐economic status on the prevalence of Type 1 and Type 2 diabetes mellitus, and on obesity, was explored using routinely collected healthcare data for the population of Tayside, Scotland. Methods  Among 366 849 Tayside residents, 792 and 5474 patients with Type 1 and Type 2 diabetes, respectively, were identified from a diabetes register. The Carstairs Score was used as a proxy for socio‐economic status. This is a material deprivation measure derived from the UK census, using postcode data for four key variables. Odds ratios for diabetes prevalence, adjusted for age, were determined for each of six deprivation categories (1 – least deprived, 6/7 – most deprived). The mean body mass index (BMI) in each group was also determined, and the effect of deprivation category explored by analysis of covariance, adjusting for age and sex. Results
The prevalence of Type 2 diabetes, but not Type 1 diabetes, varied by deprivation. People in deprivation category 6 and 7 were 1.6‐times (95% confidence interval 1.4–1.8) more likely to have Type 2 diabetes than those least deprived. There was no relationship between deprivation and BMI in Type 1 diabetes (P = 0.36), but there was an increase in BMI with increasing deprivation in Type 2 diabetes (P < 0.001; test of linearity P < 0.001). Conclusions  The study confirms the relationship between deprivation and the prevalence of Type 2 diabetes. There are more obese, diabetic patients in deprived areas. They require more targeted resources and more primary prevention.