bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enlargement of calcium oxalate stones to clinically significant size in an in‐vitro stone generator
Authors: Ananth K. , Kavanagh J.P. , Walton R.C. , Rao P.N. 
Published: March 2003

Objective  To develop and validate an in vitro method suitable for the quantitative investigation of the growth of calcium oxalate stones through to a clinically significant size.Materials and methods  Small fragments of calcium oxalate calculi were suspended in a mixed suspension/mixed product removal crystalliser supplied with artificial urine supersaturated with calcium oxalate. The fragments were weighed at regular intervals until they reached ≈ 500 mg. The results were plotted as weight against time and fitted to equations corresponding to constant increase in diameter, surface area‐controlled and constant‐deposition growth patterns. The choice of the most appropriate model was based on the squared regression coefficient (r2).Results  Eight fragments (2–6 mm in diameter) were grown to ≈ 10 mm in diameter over periods from 137 to 369 h. Seven of the growth curves were best‐fitted (r2 ≥ 0.988) by the equation w = kt(3/2) + c, where w is the weight, k is a growth constant, t is the time and c is a constant approximating to the initial weight. This corresponds to a surface area‐dependent mechanism.Conclusions  The growth of these small fragments to a clinically significant size accelerated throughout the experimental period in a way which was consistent with a surface area‐dependent mechanism. We have developed a resilient model suitable for studying the kinetics of calcium oxalate stone growth in vitro.
Nocturnal enuresis in the adolescent: a neglected problem
Authors: Nappo S. , Del Gado R. , Chiozza M.L. , Biraghi M. , Ferrara P. , Caione P. 
Published: March 2003

Objective To assess the features of adolescent bedwetters, as few data are available on enuresis in this age group.Patients and methods A specific database for adolescents and young adults was created with the collaboration of various specialists (paediatricians, urologists, gynaecologists, psychiatrists). Questions focused on family and personal history, stressful events, age of attaining urinary and fecal control, characteristics of enuresis (primary vs secondary, monosymptomatic vs enuresis associated with daytime urinary symptoms), school performance, diagnostic examination and physical examinations, and treatment and its response.Results Data were collected from 107 enuretic adolescents (mean age 15.3 years, median 14, range 13–23; 63 males and 44 females). A positive family history for enuresis was recorded in 82%. Enuresis was primary in 79 patients (74%), secondary in 28 (26%), monosymptomatic in 76 (71%) and associated with daytime urinary symptoms in 31 (29%). In males monosymptomatic enuresis was significantly more frequent than in females (P < 0.01). Urinary tract infections were reported by 13 patients, all females; eating disorders (anorexia, polyphagia) were present in six. In 85 patients (80%) enuresis was considered severe (≥ three nights/week). Of the 107 patients, 27 (20%) had never consulted a doctor about their problem and 43 (40%) had received no therapy; 66 received desmopressin monotherapy, with a good response (half the number of wet nights) in 44 (79%). There was no relation between response to desmopressin and gender, age, type and severity of enuresis or positive family history of enuresis. Eight patients were provided with a nocturnal alarm but this was not tolerated by two. Altogether, 25 patients refused any therapy or did not comply with the given therapy.Conclusions Enuresis can persist into adolescence and be a significant problem; 80% of these patients had severe enuresis and 31% also had associated daytime urinary symptoms, with 40% receiving no previous therapy. The treatment of enuresis can be particularly difficult at this age; 22% of patients did not respond to desmopressin and 23% had low compliance with the given therapy. Enuresis in adolescents requires further study; hopefully more enuretic children will receive adequate treatment before reaching adolescence.
Spermatogenesis and spectral echo‐colour Doppler traces from the main testicular artery
Authors: Biagiotti G. , Cavallini G. , Modenini F. , Vitali G. , Gianaroli L. 
Published: March 2003

Objective  To assess whether the peak systolic velocity (PSV), end‐diastolic velocity (EDV) and resistive index (RI) of testicular arteries may be useful in distinguishing the various causes of dyspermia when compared with follicle‐stimulating hormone (FSH) and testicular volume.Patients, subjects and methods  The study included nine men with obstructive and 20 with unobstruc‐tive azoospermia, 17 with oligoasthenospermia and clinical varicoceles, with male accessory glans inflammation (MAGI), 38 with undetermined oligoasthenospermia, 19 with MAGI, 11 with clinical varicoceles, 32 subjects with normal sperm analysis and recent paternity (fertile controls), and 15 with normal sperm analysis and a varicocele with recent paternity (fertile + varicoceles). Testicular volume, FSH, PSV, EDV and RI were compared among the dyspermic and/or control groups using analysis of variance.Results  The PSV and RI were useful for identifying the different groups of patients, while EDV, FSH and testicular volume were not. Men with varicoceles, varicoceles + MAGI or fertile with varicoceles had the highest PSV and RI; fertile controls, those with obstructive azoospermia and MAGI had similar PSVs and RIs, those with unexplained oligoasthenospermia had a significantly lower PSV and RI, and men with unobstructive azoospermia had the lowest PSV and RI.Conclusions  The RI and PSV are reliable indicators for routine clinical use to identify infertile/dyspermic men, while EDV, FSH and testicular volume are not. The RI and especially PSV clearly differentiated obstructive from unobstructive azoospermia.
Validation of a flexible cystoscopy course
Authors: Shah J. , Montgomery B. , Langley S. , Darzi A. 
Published: March 2003

Objective  To examine the instructional effectiveness of a course for nurses wishing to learn flexible cystoscopy, using a virtual reality flexible cystoscopy simulator to measure the outcome.Subjects and methods  Fourteen urology nurse practitioners with no previous experience of cystoscopy were taught the basic techniques of flexible cystoscopy. They then had supervised group instruction during which they practised flexible cystoscopy on an inanimate latex model, and were taught how to handle the cystoscope, followed by unsupervised practice, including use of the virtual reality (VR) simulator (URO Mentor, Simbionix, Israel). They then undertook a cystoscopy task on the simulator; within the bladder there were 10 flags (numbered 1–10) at key positions. By visualizing and photographing each of the flags the subject would have visualized the entire bladder mucosa. The number of flags seen was thus used as a measure of how much of the bladder mucosa was examined. The VR simulator also measured the total procedure time. After a day of training the subjects were reassessed and the changes in performance evaluated. Subjects were also asked their opinion of the use of VR for flexible cystoscopy.Results  The median (range) time to complete the procedure before the course was 3.33 (2–5.5) min and the number of flags seen 7 (6–9). After the course, the median time decreased to 2.85 (1.5–4.42) min and the number of flags seen increased to 8 (6–9). The change in time was significant (P = 0.03) but the difference in the number of flags was not (P = 0.12). All 14 subjects enjoyed the use of VR for learning flexible cystoscopy; they all reported that they were more confident in handling a flexible cystoscope and in undertaking flexible cystoscopy.Conclusion  The virtual reality simulator was an effecctive tool for teaching flexible cystoscopy.
Current approaches to assessing the quality of life in children and adolescents
Authors: Gerharz E.W. , Eiser C. , Woodhouse C.R.J. 
Published: March 2003

SUMMARYUrologists are well aware of the importance of the quality of life (QoL) in determining the success of their treatments. The public are increasingly aware of this aspect of medicine. The advent of fetal ultrasonography has made knowledge of QoL in long‐term survivors of congenital anomalies essential in counselling about pregnancy termination. It is becoming mandatory that clinical trials involving adults include an assessment of QoL. For children, measuring QoL has been restricted to life‐threatening conditions such as cancer or transplantation medicine. Measuring QoL is difficult in children and adolescents, and this is reflected in the few suitable instruments available. The development of sexuality contributes a further difficulty as many anxieties typical of those with genital anomalies may be common to all teenagers. Several instruments rely on the opinions of a proxy (parent or carer) but self‐assessment by the child is preferable where possible. The need for child self‐assessment is supported by finding little concordance between child and proxy assessments. While measuring QoL is challenging, we provide a substantial case for greater consideration of QoL in paediatric urology.
Quality control in urodynamics: a review of urodynamic traces from one centre
Authors: Sullivan J. , Lewis P. , Howell S. , Williams T. , Shepherd A.M. , Abrams P. 
Published: March 2003

OBJECTIVETo investigate quality control in our unit and to enable other units to compare their results, as experience from central reviews of urodynamic traces for multicentre trials has suggested that poor quality control is common.PATIENTS AND METHODSAll consecutive male urodynamic tests conducted over 1 year were reviewed. A list of criteria to assess the quality of the records was devised, based upon International Continence Society guidelines on ‘good urodynamic practice’, and on other sources. Eligible traces were analysed for aspects of quality control, e.g. baseline pressures and coughs to test pressure transmission. The data were analysed to establish how often quality criteria were met, and identify areas for improvement.RESULTSIn 100 eligible traces, the baseline detrusor pressure was 0–10 cmH2O in 86, and − 5 to +10 cmH2O in 94%. Baseline intravesical and abdominal pressure were 30–50 cmH2O in 68% and 73% of cases, respectively. Coughs were present before filling in 94%, during filling in 95%, before voiding in 72% and after voiding in 87% of cases. The cough‐test frequency was sufficient in 30% of traces. In 11 the intravesical pressure line fell out during voiding.CONCLUSIONMost of the traces assessed met the quality criteria defined, but significant defects were not uncommon. Some of the problems identified suggest areas of urodynamic technique which should be studied in more detail. We intend to modify our quality control practices, and hope to show an improvement on re‐audit. We hope that other urodynamic departments will be encouraged to review their practice, and we aim to improve our results.
Pharmacological management of erectile dysfunction
Authors: Montorsi F. , Salonia A. , Deho' F. , Cestari A. , Guazzoni G. , Rigatti P. , Stief C. 
Published: March 2003

SUMMARYErectile dysfunction (ED) is a common medical condition that affects the sexual life of millions of men worldwide. Many drugs are now available for treating ED; oral pharmacotherapy represents the first‐line option for most patients with ED. Sildenafil, an inhibitor of the enzyme phosphodiesterase type 5, is currently the most widely prescribed oral agent and has a very satisfactory efficacy‐safety profile in all patient categories. Apomorphine SL is a dopamine D1‐ and D2‐receptor agonist which has recently been approved for marketing in Europe. It is best selected for treating patients with mild to moderate ED. Vardenafil and tadalafil are new phosphodiesterase type 5 inhibitors which are expected to be approved this year. Both of them have significant positive efficacy‐safety profiles. Patients who do not respond to oral pharmacotherapy or who cannot use it are good candidates for intracavernosal and intraurethral therapy. Alprostadil is the most widely used drug, both for injection therapy and for the intraurethral route. The efficacy of second‐line treatment is high but the attrition rate remains significant.
Blood pressure control, microalbuminuria and cardiovascular risk in Type 2 diabetes mellitus
Authors: Marshall S. M. 
Published: March 2003

SummaryType 2 (noninsulin‐dependent) diabetes mellitus (DM) affects about 3% of the UK population. Diabetes often coexists with a cluster of other potent cardiovascular risk factors, including hypertension, dyslipidaemia and increased tendency for thrombosis, and increases the risk of early death from cardiovascular causes by about threefold. Microalbuminuria or proteinuria also may be present, further increasing the risk of cardiovascular mortality. Cardiovascular risk factors must be treated aggressively in patients with Type 2 diabetes and control of blood pressure at 140/85 mmHg or lower is a priority. The management of hypertension in patients from some ethnic groups demands special consideration because they have a high incidence of diabetes and hypertensive complications. Patients must be urged to adopt appropriate lifestyle changes in the first instance but additional drug treatment for hypertension is usually required. All the major classes of antihypertensive agents lower blood pressure in Type 2 diabetic patients but have different effects on metabolic risk factors in different ways. Low‐dose thiazide diuretics, β‐blockers, calcium channel blockers and angiotensin converting enzyme (ACE) inhibitors have been shown to reduce cardiovascular risk. Individually, the effects of low‐dose thiazide diuretics and β‐blockers on glucose and lipid metabolism is clinically insignificant, though in combination much larger metabolic effects are seen. ACE inhibitors and calcium channel blockers have no, or small, beneficial effects on glucose and lipid metabolism, while the greater beneficial effects of α1‐blockers on lipid profiles may render them especially useful in the Type 2 diabetic patient. Long‐acting calcium‐channel blockers and ACE inhibitors protect renal function and are suitable as first line therapy in patients with microalbuminuria or proteinuria. Until results from the current batch of randomized, placebo‐controlled trials comparing different classes of antihypertensive agents are available, the choice of antihypertensive agent is difficult. Addressing overall cardiovascular risk factors, rather than hypertension alone, is essential in the management of the hypertensive Type 2 diabetic patient.Diabet. Med. 16, 358–372 (1999)
Hypothalamic arousal, insulin resistance and Type 2 diabetes mellitus
Authors: Björntorp P. , Holm G. , Rosmond R. 
Published: March 2003

Summary Aims Type 2 diabetes mellitus (DM) develops when insulin resistance overcomes the capacity of compensatory insulin secretion. Insulin resistance may be induced via psychoneuroendocrine pathways, a possibility which has received little previous attention. Methods We have used salivary cortisol measurements to monitor the activity of the hypothalamic–pituitary–adrenal (HPA) axis, the major controller of hormones involved in the regulation of peripheral insulin sensitivity under everyday conditions. The influence of external challenges, as well as the sensitivity of feedback regulation, were followed in randomly selected middle‐aged population samples. Results In health there is a rhythmicity of cortisol secretion, with a high plasticity and efficient feedback control. In contrast, a group of subjects were identified with a flat, rigid day curve and poor feedback control, who showed consistent abnormalities in stress‐related cortisol secretion, including inhibited secretions of sex steroids and growth hormone; insulin resistance; abdominal obesity; elevated leptin levels; hyperglycaemia; dyslipidaemia and hypertension with elevated heart rate. The endocrine abnormalities are probably responsible for the anthropometric and metabolic abnormalities. The circulatory perturbations seem to be induced by a parallel activation of the central sympathetic nervous system suggesting an ‘hypothalamic arousal syndrome’, gradually developing into an independent risk for disease. An associated cluster of environmental factors, including psychosocial and socio‐economic stress, traits of depression and anxiety, alcohol consumption and smoking, all factors known to activate hypothalamic centres, has been identified. A polymorphism of the glucocorticoid receptor gene, with 13.7% homozygotes in the male Swedish population, parallels receptor dysfunction, and may be responsible for the associated insulin resistance, central obesity and hypertension. Conclusions This is the first detailed examination of psychoneuroendocrinological processes in the natural environment on a population basis in relation to somatic health. The results suggest that an hypothalamic arousal syndrome, with parallel activation of the HPA axis and the central sympathetic nervous system, is responsible for development of endocrine abnormalities, insulin resistance, central obesity, dyslipidaemia and hypertension, leading to frank disease, including Type 2 DM. We suggest that this syndrome is probably based on environmental pressures in genetically susceptible individuals.Diabet. Med. 16, 373–383 (1999)
Diabetes and driving: towards equitable, evidence‐based decision‐making
Authors: MacLeod K. M. 
Published: March 2003

SummaryIn January 1998, the British government introduced new restrictions on licensing of people with insulin‐treated diabetes mellitus to drive. These restrictions were based on the second EU driver licensing directive (91/4389) and looked to be costing insulin‐treated diabetic individuals their entitlement to drive light goods and small passenger‐carrying vehicles. In response to concerns expressed by the diabetes community in Britain, the British Diabetic Association commissioned a report examining and interpreting the available evidence of accident risk in insulin‐treated diabetic patients, particularly that related to unexpected hypoglycaemia. The following article is drawn from that report.
The British Diabetic Association Cohort Study, I: all‐cause mortality in patients with insulin‐treated diabetes mellitus
Authors: Laing S. P. , Swerdlow A. J. , Slater S. D. , Botha J. L. , Burden A. C. , Waugh N. R. , Smith A. W. M. , Hill R. D. , Bingley P. J. , Patterson C. C. , Qiao Z. , Keen H. 
Published: March 2003

Summary Aims To assess mortality in patients with diabetes incident under the age of 30 years. Methods A cohort of 23 752 diabetic patients diagnosed under the age of 30 years from throughout the United Kingdom was identified during 1972–93 and followed up to February 1997. Following notification of deaths during this period, age‐ and sex‐specific mortality rates, attributable risks and standardized mortality rates were calculated. Results The 23 752 patients contributed a total of 317 522 person‐years of follow‐up, an average of 13.4 years per subject. During follow‐up 949 deaths occurred in patients between the ages of 1 and 84 years, 566 in males and 383 in females. All‐cause mortality rates in the patients with diabetes exceeded those in the general population at all ages and within the cohort were higher for males than females at all ages except between 5 and 15 years. The relative risk of death (standardized mortality ratio, SMR), was higher for females than males at all ages, being 4.0 (95% CI 3.6–4.4) for females and 2.7 (2.5–2.9) for males overall, but reaching a peak of 5.7 (4.7–7.0) in females aged 20–29, and of 4.0 (3.1–5.0) in males aged 40–49. Attributable risks, or the excess deaths in persons with diabetes compared with the general population, increased with age in both sexes. Conclusions This is the first study from the UK of young patients diagnosed with diabetes that is large enough to calculate detailed age‐specific mortality rates. This study provides a baseline for further studies of mortality and change in mortality within the United Kingdom.
Elevated plasma semicarbazide‐sensitive amine oxidase (SSAO) activity in Type 2 diabetes mellitus complicated by retinopathy
Authors: Garpenstrand H. , Ekblom J. , Bäcklund L. B. , Oreland L. , Rosenqvist U. 
Published: March 2003

Summary Aims To measure plasma semicarbazide‐sensitive amine oxidase (SSAO) activities and detect retinopathy in Type 2 diabetes mellitus (DM). Methods Cross‐sectional, population‐based study of 65 diabetes patients (61 diagnosed from the age of 30 years) with or without retinopathy as determined by fundus photography in primary care. HbA1c was analysed by ion exchange chromatography on a Mono S for HbA1c column. SSAO activities were assayed radiometrically and formaldehyde‐albumin adducts by ELISA in plasma samples from patients and 136 healthy controls. Results Subjects with diabetes had higher plasma SSAO activity, measured as nmol benzylamine.ml plasma‐1.h‐1(mean 20.6), than controls (mean 14.3), P < 0.0001; 95% confidence interval (CI) for difference 4.9–7.7. SSAO activity was higher in patients with retinopathy (mean 23.2) than in those without (mean 18.9), P = 0.012; 95% CI for difference 1.0–7.5, and related to the HbA1c value. No statistically significant relationship between diabetes duration and SSAO activity was found. With HbA1c values and insulin treatment entered into a multiple logistic regression model, SSAO activity no longer predicted retinopathy, P increasing from 0.025 to 0.17. SSAO activity and the presence of any retinopathy were unrelated to titres of antibodies against formaldehyde‐treated human serum albumin. Conclusions SSAO activity, earlier found to be elevated in Type 1 DM, is also elevated in Type 2 DM. The SSAO family of enzymes may be involved in the development of diabetic retinopathy, possibly by catalysing the formation of toxic metabolites. A potent and specific inhibitor of human SSAO might help prevent retinopathy in Type 1 and Type 2 DM.
Relative hypoleptinaemia in women with mild gestational diabetes mellitus
Authors: Festa A. , Shnawa N. , Krugluger W. , Hopmeier P. , Schernthaner G. , Haffner S. M. 
Published: March 2003

Summary Aims There is increasing evidence suggesting that leptin plays a major role in the regulation of energy homeostasis, as well as in the neuroendocrine and reproductive systems. Leptin is synthesized in the human placenta. The aim of this study was to relate serum leptin levels during pregnancy to glucose tolerance, body mass index (BMI) and specific metabolic variables, such as specific insulin and proinsulin. Methods A 2‐h 75 g oral glucose tolerance test was performed in 221 pregnant women at 22–29 weeks of gestation (median 25th week). Serum leptin was measured using a radioimmunoassay. In 49 women, sequential leptin measurements were performed (during pregnancy and post partum (median 5 months)). Results During pregnancy serum leptin was significantly related to body weight (r = 0.49), BMI (r = 0.51), fasting immunoreactive insulin (r = 0.46), specific insulin (r = 0.43) and proinsulin (r = 0.29) (all P‐values < 0.0001). In women with mild gestational diabetes (GDM, n = 55), leptin levels were lower compared to women with normal glucose tolerance (n = 166) after adjusting for BMI and fasting insulin (26.9 vs. 19.4 ng/ml, P = 0.0001). Leptin was significantly higher during pregnancy compared to post partum (mean ± se: 24.3 ± 1.5 vs. 19.6 ± 1.6 ng/ml, P = 0.0003), even after adjustment for changes in BMI and changes in fasting insulin (P = 0.013). Conclusions Leptin levels are elevated in pregnancy. Women with mild GDM presented with relative hypoleptinaemia compared to women with normal glucose tolerance.