bluuebunny/crossref_metadata_2025_split huggingface dataset:
Observations and warning signs prior to cardiac arrest. Should a medical emergency team intervene earlier?
Authors: Nurmi J. , Harjola V. P. , Nolan J. , Castrén M. 
Published: April 2005

Background:  The Medical Emergency Team (MET) has evolved in some hospitals as a means of delivering effective treatment early enough to prevent cardiac arrests. Our aim was to analyze the effectiveness of observation practice to detect abnormalities in vital signs prior to cardiac arrest and to determine the need for a MET system in Finnish hospitals.Methods:  The charts of patients who suffered cardiac arrest during 18 months in four hospitals were reviewed. The vital signs, symptoms and interventions during 8 h prior to arrest were recorded and analyzed against trigger criteria of the MET.Results:  During the study period, 110 patients suffered cardiac arrest in hospitals, and 56 (51%) of the arrests occurred on the wards. Of those patients, 30 (54%) had an abnormal vital sign fulfilling the MET criteria, documented on average 3.8 h prior to the arrest. During this period, 13 patients did not receive any intervention (e.g. supplemental oxygen or medication), eight received intervention within 1 h and nine received intervention after more than 1 h. Response to the first intervention was not attained in any patient; nevertheless re‐interventions took place in one patient only.Conclusion:  Significant physiological deterioration seems to be common in the hours before a cardiac arrest on the wards of Finnish hospitals, suggesting that implementation of a MET‐system may be worthwhile. However, the practice of vital sign observation by the nursing staff should be improved before maximal benefit of a MET can be achieved.
Oxygen extraction in pigs subjected to low‐dose infusion of endotoxin after major abdominal surgery
Authors: Porta F. , Takala J. , Kolarova A. , Ma Y. , Redaelli C. A. , Brander L. , Bracht H. , Jakob S. M. 
Published: April 2005

Background:  Sepsis may impair O2 extraction due to blood flow redistribution or decreased utilization of the available oxygen.Methods:  We assessed the effect of endotoxemia on systemic and regional O2 extraction and lactate handling in pigs, randomized to receive either endotoxin (0.4 µg kg−1 h−1; n = 10) or saline infusion (controls; n = 9) for 12 h.Results:  High baseline regional and systemic O2 extraction in the endotoxin group (median 56%, range 45–77%) and in the controls (67%, 49–72%) was maintained until the end of the experiment (endotoxin group: 60%, 50–71%; controls: 60%, 50–74%) despite hypotension and a decrease in stroke volume in endotoxic animals. Hepatic lactate exchange decreased during endotoxemia from 14 µmol kg−1 min−1 (range 10–28 µmol kg−1 min−1) to 10 (range 3–15) µmol kg−1 min−1; P < 0.01), but remained stable in the controls, with 13 µmol min−1 (4–18 µmol min−1) at baseline and 7 µmol min−1 (3–17 µmol min−1) after 12 h of saline infusion.Conclusions:  The high and sustained oxygen consumption and oxygen extraction in this endotoxemic model speak against any major impairment of hepatosplanchnic or systemic oxygen extraction and oxidative metabolism. The reduced hepatic lactate exchange despite an unchanged hepatic lactate influx suggests altered metabolic activities independent of oxygen consumption.
Intentional lateral epidural catheter placement for anterior cruciate ligament reconstruction
Authors: Dauri M. , Sidiropoulou T. , Fabbi E. , Mariani P. P. , Sabato A. F. 
Published: April 2005

Background:  Unilateral epidural block might constitute a clinical option in lower limb orthopedic surgery.Methods:  Seventy‐five patients undergoing anterior cruciate ligament reconstruction (ACLR) were randomized to either a laterally directed epidural catheter (IUEC, n = 40) or a classic midline catheter (CMEC, n = 35). Paresthesia encountered during catheter insertion was registered. The start dose of the anesthetic mixture clonidine 60 µg (0.4 ml), sufentanil 15 µg (0.3 ml) and ropivacaine 10 mg ml−1(10.3 ml) in 11 ml of total volume) was set at 5 ml and was increased by 2 ml if anesthesia was inadequate after assessment for sensory blockade to cold and pin‐prick. Data were registered intra‐ and postoperatively regarding pain scores as well as motor block, hemodynamic parameters, adverse effects and need for supplemental analgesia other than a continuous postoperative epidural infusion.Results:  In the IUEC group 80% of patients reported a light paresthesia of the affected side during catheter insertion, whereas 71% of patients in the CMEC group reported no paresthesia at all. The amount of anesthetic used to establish surgical anesthesia was lower in the IUEC group (6.2 ± 0.8 vs. 8 ± 1.9 ml, P < 0.001). Motor block (Bromage score) of the unaffected side was significantly lower in the IUEC group (P < 0.001). Pain intensity scores, hemodynamic parameters, and supplemental analgesia given were similar between the two groups except for VAS scores at 12 h postoperatively, which were higher in the CMEC group (P < 0.01). Urinary retention was significantly more frequent in the CMEC group (19/35 vs. 5/40, P < 0.001).Conclusion:  These results suggest that the IUEC technique is a feasible and efficient method for providing anesthesia and analgesia for ACLR and is associated with a lower consume of anesthetics, less motor block and a reduced incidence of urinary retention.
Efficacy of vertical infraclavicular plexus block vs. modified axillary plexus block: a prospective, randomized, observer‐blinded study
Authors: Heid F. M. , Jage J. , Guth M. , Bauwe N. , Brambrink A. M. 
Published: April 2005

Background:  Despite containing severe risks, infraclavicular approaches to the brachial plexus gained increasing popularity. Likewise, the vertical infraclavicular plexus block improved anesthesia compared to the standard axillary approach but contains the risk of pneumothorax. Therefore we modified the standard axillary technique by inserting a proximal directed catheter, referred to as a high axillary plexus block. We prospectively compared quality and onset of neural blockade after vertical infraclavicular plexus block (VIP) and high axillary plexus block (HAP) in two randomized groups (30 patients in each).Methods:  In group VIP the insulated needle was inserted midway between the ventral process of the acromion and the jugular notch. In group HAP, first an axillary needle was placed. Through this a stimulating catheter was inserted in a proximal direction (10–15 cm); correct placement was confirmed by nerve stimulation. All patients received 40 ml ropivacaine 0.75% (300 mg). Discriminating between analgesia and anesthesia, a blinded observer assessed progression of neural blockade every 5 min for 60 min by pin prick. Incomplete blocks were supplemented 60 min after initial injection.Results:  All patients in both groups demonstrated sufficient surgical anesthesia. No patient needed systemic supplementation or general anesthesia. However, vertical infraclavicular plexus block indicated superior anesthesia compared to high axillary plexus block, regarding musculocutaneous, axillary and radial nerve, which were completely blocked with a higher success rate and in a shorter time interval (P < 0.05).Conclusions:  While both techniques provide sufficient surgical anesthesia, vertical infraclavicular plexus block demonstrated a partially higher success rate and a faster onset than high axillary plexus block.
Altered expression of aquaporin‐2 in human explants with chronic renal allograft dysfunction
Authors: Ho Kossen M.T. , Li Amy Z.L. , Yiu Ming K. , Lee Kam C. , Lui Vincent C.H. , Fung Peter C.W. , Yiu Tim F. , Tam Paul K.H. 
Published: April 2005

OBJECTIVETo investigate the distribution of aquaporins, a recently discovered family of transmembrane water channels, in human renal explants, with specific reference to chronic renal allograft dysfunction (CRAD).MATERIALS AND METHODSImmunohistochemistry for aquaporin‐1 and ‐2 was used in 11 explants, of which five had clinically and histologically confirmed CRAD. Controls were taken from the six explants unaffected by CRAD and from histologically normal areas of six kidneys excised for renal tumours.RESULTSIn the renal tumour control group, aquaporin‐1 immunoreactivity was detected in the glomerular endothelium, Bowman's capsule, the proximal convoluted tubules and the thin limb of the loop of Henle, whereas immunoreactivity for aquaporin‐2 was detected in the collecting ducts only. Of the explants without CRAD, where architecture was preserved, immunoreactivity for aquaporin‐1 and ‐2 was the same as in the renal tumour controls. In the two explants with no CRAD and loss of collecting ducts, there was no aquaporin‐2 immunoreactivity. In five explants with CRAD, immunoreactivity for aquaporin‐2 was decreased or absent from the medulla to the cortex. The apparent decreased immunoreactivity of aquaporin‐1 in this group was secondary to a decrease in the number of viable proximal tubules.CONCLUSIONThere was less aquaporin‐2 immunoreactivity in human renal explants diagnosed with CRAD, starting from the medullary region. In explants with no CRAD and viable collecting ducts, or in normal controls, aquaporin‐2 immunoreactivity remained unchanged. Aquaporins might be useful as markers for CRAD.
Decline in the overall incidence of regional‐distant prostate cancer in Olmsted County, MN, 1980–2000
Authors: Mullan Rebecca J. , Jacobsen Steven J. , Bergstralh Erik J. , Slezak Jeffrey M. , Tindall Donald J. , Lieber Michael M. , Roberts Rosebud O. 
Published: April 2005

There are many papers in this section covering a wide range of topics relating to prostate, kidney and bladder cancer. Authors from the Mayo Clinic evaluate trends in the incidence of regional‐distant prostate cancer before and after the introduction of PSA screening in 1987 in their residents in Olmsted County. They found a decrease in the overall incidence of this type of disease, regardless of stage at initial diagnosis.Authors from the Royal Marsden describe their policy of active surveillance and contrast it with watchful waiting, differentiating clearly between the policies. These are early results, but they make interesting reading. The authors mention ongoing studies which seek to optimise the active surveillance protocol.OBJECTIVETo describe trends in the incidence of regional‐distant prostate cancer over the entire course of the disease, before and after the introduction of prostate‐specific antigen screening in 1987.PATIENTS AND METHODSAll residents of Olmsted County, MN, USA, with a diagnosis of prostate cancer from 1964 to 2000 were identified using the resources of the Rochester Epidemiology Project. Their community medical records were examined to identify men with documented evidence of locally advanced (T3/4 or N+ disease) or metastatic prostate cancer between 1980 and 2000.RESULTSIn all, 407 men had regional‐distant prostate cancer, based on clinical or pathological staging at the time of initial diagnosis of prostate cancer and/or on radiological information over the entire course of their illness. The age‐adjusted incidence per 100 000 men increased from 47.4 in 1980–86 to 65.8 in 1987–93, and declined to 33.3 in 1994–2000 (P < 0.001). Based on clinical and radiological information over the entire course of illness (268 men) the age‐adjusted incidence of regional‐distant disease was 42.3 in 1980–86, 41.2 in 1987–93, and declined to 18.1 in 1994–2000 (P < 0.001). These latter rates were 27%, 32% and 47% higher for the three periods, respectively, than rates based on clinical staging at initial diagnosis of prostate cancer.CONCLUSIONSThe overall incidence of regional‐distant stages of prostate cancer has declined in recent years, regardless of the stage at initial diagnosis. This may be a result in part of early detection and curative treatments. These findings also indicate that assessing the incidence of regional‐distant prostate cancer only at the initial diagnosis underestimates the full impact of the benefits of early detection and treatment.
Early outcomes of active surveillance for localized prostate cancer
Authors: Hardie Claire , Parker Chris , Norman Andrew , Eeles Ros , Horwich Alan , Huddart Robert , Dearnaley David 
Published: April 2005

OBJECTIVETo describe the preliminary clinical outcomes of active surveillance (AS), a new strategy aiming to individualize the management of early prostate cancer by selecting only those men with significant cancers for curative therapy, and illustrate the contrast with a policy of watchful waiting (WW).PATIENTS AND METHODSEighty men with early prostate cancer began AS at the authors’ institution between 1993 and 2002. Eligibility included histologically confirmed prostatic adenocarcinoma, fitness for radical treatment, clinical stage T1/T2, N0/X, M0/X, a prostate specific antigen (PSA) level of ≤ 20 ng/mL, and a Gleason score of ≤ 7. PSA was measured and a digital rectal examination conducted at 3–6 month intervals. The decision between continued monitoring or radical treatment was informed by the rate of rise of PSA, and was made according to the judgement of each patient and clinician. During the same period, 32 men with localized prostate cancer (any T stage, N0/X, M0/X, any PSA, Gleason score ≤ 7) were managed by WW; hormonal treatment was indicated for symptomatic prostate cancer progression. The PSA doubling time (DT) was calculated using linear regression of ln(PSA) against time, using all pretreatment PSA values.RESULTSAt a median follow‐up of 42 months, 64 (80%) of the 80 patients on AS remained under observation, 11 (14%) received radical treatment and five (6%) died from other causes. No patient developed evidence of metastatic disease, none started palliative hormone therapy, and there were no deaths from prostate cancer. Of the 11 patients who received radical treatment all remained biochemically controlled with no clinical evidence of recurrent disease. The median PSA DT while on AS was 12 years. Twenty (62%) of the 32 patients on WW remained on observation, eight (25%) received palliative hormonal therapy and four (12%) died, including one from prostate cancer.CONCLUSIONSAS is feasible in selected men with early prostate cancer. The natural history of this disease often appears extremely indolent, and most men on AS will avoid radical treatment. There is a marked contrast between AS (with radical treatment for biochemical progression) and WW (with palliative treatment for symptomatic progression). Ongoing studies are seeking to optimize the AS protocol, and to compare the long‐term outcomes with those of immediate radical treatment.
C‐reactive protein is significantly associated with prostate‐specific antigen and metastatic disease in prostate cancer
Authors: Lehrer Steven , Diamond Edward J. , Mamkine Boris , Droller Michael J. , Stone Nelson N. , Stock Richard G. 
Published: April 2005

OBJECTIVETo further analyse the relationship of c‐reactive protein (CRP) levels to prostate cancer, by measuring CRP in men with prostate cancer and benign prostatic hypertrophy (BPH), as chronic inflammation has long been linked to cancers with an infectious cause and CRP is a nonspecific marker for inflammation, associated with prostate cancer incidence and progression.PATIENTS AND METHODSData from 114 men, most of whom had had radioactive seeds implanted, were evaluated from November 1990 to April 2002. In addition, 27 men were included who had biopsy‐confirmed BPH. CRP was assessed with an automated chemiluminometric high‐sensitivity assay kit.RESULTSThere was no significant difference in CRP levels in men with localized prostate cancer or BPH but levels were significantly higher in men with bone metastases. There was also a significant correlation of CRP level with prostate‐specific antigen (PSA) in those with cancer. Because PSA is correlated with disease stage, multiple linear regression was used with CRP as the dependent variable, and PSA and disease stage as independent variables. The regression was significant overall (P < 0.001) and the effect of disease stage on CRP (P < 0.001) was independent of the effect of PSA level (P = 0.001).CONCLUSIONThe strong association of CRP with PSA, independent of tumour stage, suggests that inflammation might be fundamental in prostate cancer, and that chronic inflammation may be a legitimate target for prostate cancer chemoprevention and treatment.
A phase I/II dose‐escalation study of exisulind and docetaxel in patients with hormone‐refractory prostate cancer
Authors: Ryan Christopher W. , Stadler Walter M. , Vogelzang Nicholas J. 
Published: April 2005

OBJECTIVETo determine the safety and efficacy, in a dose‐escalation study, of exisulind (an oral sulphone metabolite of sulindac thought to induce apoptosis in malignant cells by inhibiting cGMP‐phosphodiesterase) combined with docetaxel in men with hormone‐refractory prostate cancer (HRPC), as pre‐clinical studies suggested activity against prostate cancer and synergy with cytotoxic agents.PATIENTS AND METHODSThirty‐four patients with HRPC were treated with oral exisulind twice daily for 21‐day cycles and intravenous docetaxel given for 1 h on the first day of each cycle. Three dose levels were assessed, combining exisulind 150 and 250 mg twice daily with docetaxel at 60 or 75 mg/m2. Toxicity was then evaluated using standard criteria.RESULTSThe recommended phase II dose was determined to be exisulind 250 mg and docetaxel 60 mg/m2, with escalation to 75 mg/m2 after cycle 1, as tolerated. The most common grade 3–4 toxicities among all patients were neutropenia (56%), infection (24%) and hyperglycaemia (18%). Twelve of 32 evaluable patients (38%, 95% confidence interval, CI, 23–55%) had a decline in PSA by at least half. Only four of 17 evaluable patients (95% CI, 1–47%) treated at the phase II dose level had such a decline in PSA. The median (95% CI) overall survival of all patients was 16 (12.9–19.7) months and median progression‐free survival 4.7 (2.7–5.2) months.CONCLUSIONThe combination of exisulind and docetaxel was tolerable in patients with HRPC. The PSA response rates do not suggest an improvement over historical data with single‐agent docetaxel in this population.
Is a digital rectal examination necessary in the diagnosis and clinical staging of early prostate cancer?
Authors: Philip Joe , Dutta Roy Subhajit , Ballal Mohammed , Foster Christopher S. , Javlé Pradip 
Published: April 2005

OBJECTIVETo assess the role of a digital rectal examination (DRE) in the clinical diagnosis of prostate cancer and in predicting the pathological stage, as the diagnosis of early prostate cancer usually comprises prostate‐specific antigen (PSA) testing, a DRE and transrectal ultrasonography (TRUS)‐guided biopsies.PATIENTS AND METHODSOver the 4 years between 2000 and 2004, 408 consecutive patients (mean age 63.8 years) referred with age‐specific PSA levels of 2.5–10.0 ng/mL and who had a TRUS‐guided 12‐core prostate biopsy were included in the study. They had a DRE by either of two experienced consultant urologists. The results of the DRE and core biopsy histology were compared with the histology and the radical prostatectomy specimen in a subset (82 men) of the study population.RESULTSCancer was detected on biopsy in 152 patients; of the 196 with an abnormal DRE, 47% had cancer on biopsy. In the patients with a normal DRE, 59 cancers were detected. Men with cancer were older and had a higher median PSA level. There was no correlation between the DRE and biopsy findings, and none between an abnormal DRE and histological diagnosis of cancer. Of the patients who had a radical prostatectomy, 38% had a normal DRE.CONCLUSIONThere was no correlation between the DRE, biopsy findings and pathological staging. The DRE did not contribute to managing patients with prostate cancer, but this does not mean that there is no longer a place for the DRE in assessing the urological patient. If patients are appropriately counselled before PSA testing, a DRE may not be essential for patients with a PSA level of 2.5–10 ng/mL.
Influence of nitrate levels in drinking water on urological malignancies: a community‐based cohort study
Authors: Volkmer Bjoern G. , Ernst Birgitta , Simon Joerg , Kuefer Rainer , Bartsch Georg , Bach Dietmar , Gschwend Juergen E. 
Published: April 2005

OBJECTIVETo evaluate the effect of nitrate levels in the drinking water on the incidence of urological malignancies in a German community.PATIENTS AND METHODSFor 28 years (1957–86) the community of Bocholt, Germany (70 000 inhabitants) had a drinking water supply with different nitrate levels, i.e. 60 mg/L in group A (57 253 inhabitants) and 10 mg/L in group B (10 037 inhabitants). All newly diagnosed cases of urological malignancies were registered from 1986 to 1997. The incidence was calculated using an age standardization based on the German population.RESULTSIn all, there were 527 urological malignancies recorded (urothelial cancer 39.8%, renal cell carcinoma 10.8%, testicular tumours 8.0%, penile carcinoma 1.7%, prostate cancer 39.7%). The incidence per 100 000 inhabitants/year of urinary tract tumours was 33.8 in group A and only 17.1 in group B (relative risk, RR 1.98, 95% confidence interval, CI, 1.10–3.54). The RR was 0.87 (0.34–2.22) for renal tumours, 0.66 (0.14–2.88) for penile cancer and 1.06 (0.76–1.48) for prostate cancer. For testicular tumours there was an inverse association with nitrate level, with a RR of 0.43 (0.21–0.90).CONCLUSIONThis study showed an association of nitrate load in drinking water and the incidence of urothelial cancer in both genders, with an inverse correlation to testicular tumours and no correlation with renal, penile and prostatic tumours.
The utility of screening renal ultrasonography: identifying renal cell carcinoma in an elderly asymptomatic population
Authors: Malaeb Bahaa S. , Martin David J. , Littooy Fred N. , Lotan Yair , Waters William B. , Flanigan Robert C. , Koeneman Kenneth S. 
Published: April 2005

OBJECTIVETo evaluate the efficacy and utility of screening renal ultrasonography (RUS) in older patients with a high prevalence of risk factors for renal cell carcinoma (RCC), as with the widespread use of advanced imaging techniques the identification of incidental RCC has increased, and although previous studies in low‐risk groups reported little use for screening RUS, its utility in high‐risk groups is unknown.PATIENTS AND METHODSFrom 1993 to 1997, screening RUS was completed for 6678 consecutive patients in conjunction with the Aneurysm Detection and Management study. Patient demographics, medical and social history were recorded for each patient. Screening RUS was completed by one ultrasonographer using a 3.5‐MHz sector scanner. A urologist verified any abnormalities identified by RUS during consultation. Additional imaging tests were obtained selectively and intervention was recommended based on the results of the genitourinary evaluation.RESULTSFrom the screened population of 6678 patients, 817 (12.3%) renal anomalies were found, including a solid renal mass in 22 (0.32%), simple renal cysts in 627 (9.4%), hydronephrosis in 21 (0.31%), renal calculi in 121 (1.8%), or other abnormalities in 24 (0.36%). Treatment was completed for 15 renal cancers; 13 were organ‐confined on pathological review. At a mean follow‐up of >55 months, 12 of the 15 patients with RCC survived.CONCLUSIONSIn this older cohort, retroperitoneal RUS was an effective tool for case‐finding by detecting significant findings in an asymptomatic population. The prevalence of solid renal masses (0.32%) was higher than reported with other screening protocols. Although probably not the best method for generalized primary screening, the use of RUS may still be beneficial for ‘secondary’ screening in a more selected patient population.