bluuebunny/crossref_metadata_2025_split huggingface dataset:
Benign scrotal pathology: should all patients undergo surgery?
Authors: Menon V.S. , Sheridan W.G. 
Published: March 2003

Objective To evaluate the justification for operative intervention in patients undergoing surgery for benign scrotal pathology, and to assess the associated morbidity. Patients and methods Consecutive patients in two surgical firms who underwent surgery for benign intrascrotal pathology over a 5‐year period were studied retrospectively. Results In all, 102 patients were included in the study (mean age 51.6 years, range 16–86). Most patients had either epididymal cysts (59) or hydroceles (31) or a combination of the two (eight). Some patients (37) underwent ultrasonography before surgery. The indications for surgery were deemed to be strong in 25% of patients but weak or absent in the remainder. Complications occurred in 31 patients, being minor in 18, but significant in 13, resulting in four re‐admissions to hospital. There was no significant difference in the complication rate between those patients with strong indications for surgery (37%) and those with weak indications (28%). Conclusions Surgery for benign intrascrotal pathology is frequently undertaken for weak clinical indications and carries significant associated morbidity. This could be avoided in many cases by simple reassurance. Judicious use of ultrasonography is advised. A policy of selective surgical intervention is strongly advocated.
Nurse‐led cystoscopy: the next step
Authors: Taylor J.M. , Pearce I. , O'Flynn K.J. 
Published: March 2003

Objectives  To determine and compare the accuracy of flexible cystoscopy and subsequent management by a specialist urology registrar (SpR) and a specialist urology nurse (SUN). Patients and methods  Flexible cystoscopy was undertaken on 50 patients by both endoscopists each unaware of the results of the other's examination. The findings and management plans were independently declared and then compared. Any cystoscopic discrepancies were assessed by one consultant with the patients under a general anaesthetic. Results  Tumours were found in 20% of patients; there was a consensus of the endoscopic findings and subsequent management plan between the SpR and the SUN in 94% of the patients. Any missed tumours (all surveillance) were minute and clinically insignificant. The chance‐corrected proportional agreement (kappa value) between the SUN and final diagnosis and management was 0.94. Conclusion  A properly trained SUN can undertake both diagnostic and surveillance flexible cystoscopy, and decide upon further management to the same degree as can a urology SpR.
Laparoscopic adrenalectomy: comparison of transperitoneal and retroperitoneal approaches
Authors: Naya Y. , Nagata M. , Ichikawa T. , Amakasu M. , Omura M. , Nishikawa T. , Yamaguchi K. , Ito H. 
Published: March 2003

Objective To compare the effectiveness and efficiency of transperitoneal anterior laparoscopic adrenalectomy with that of retroperitoneal posterior laparoscopic adrenalectomy. Patients and methods A retrospective comparison was undertaken of 28 patients who underwent transperitoneal anterior laparoscopy with 22 patients who underwent retroperitoneal posterior laparoscopy between April 1994 and November 2000. There were 18 men and 32 women (mean age 51.0 years, range 23–68) with varying diagnoses. Of the 50 patients, 31 had primary aldosteronism, eight had Cushing's syndrome, three had phaeochromocytoma, one had an 18‐hydroxydeoxycorticosterone‐induced adenoma and seven had non‐functioning adrenal adenoma. Adrenal tumours were confirmed by hormonal assays, biochemical tests and computed tomography. To determine the site of the functioning adenoma, hormones were assayed from adrenal vein sampling. Thirty adrenal tumours were located on the right and 20 on the left. Results There were no significant differences in general demographic variables between the transperitoneal and retroperitoneal groups. The mean duration of surgery for transperitoneal and retroperitoneal laparoscopy was 202 and 221 min, respectively, and the mean blood loss 113 and 192 mL, respectively. The time to first oral intake, days to full diet, time until ambulatory and duration of hospitalization did not differ significantly between the two approaches. As the body mass index increased, the duration of surgery increased for both approaches. As more procedures were performed the duration of surgery decreased for both approaches. Conclusions There were no significant differences between the transperitoneal and retroperitoneal approaches for laparoscopic adrenalectomy.
The use of porcine dermal implant in a minimally invasive pubovaginal sling procedure for genuine stress incontinence
Authors: Barrington J.W. , Edwards G. , Arunkalaivanan A.S. , Swart M. 
Published: March 2003

Objective To assess the outcome of a suburethral sling using a porcine dermal implant (Pelvicol™, Bard Urology, UK) in the surgical management of urinary stress incontinence. Patients and methods Forty women with urodynamically confirmed genuine stress incontinence were recruited into the study and followed up at 6 weeks and at least 6 months (mean 12 months, range 6–18). The sling was inserted using a minimal‐access technique, which allowed 23 women to be operated as day‐cases. Outcome measures included continence rates, voiding dysfunction, satisfaction scores and whether the patients would recommend the operation to a friend or relative. Results The cure rate was 85%, with sustained benefit; a further 10% of the women were improved by surgery. Voiding dysfunction rates were low and satisfaction scores high. Most women would undergo the procedure again if they became incontinent in the future and would recommend the procedure to a friend or relative. Conclusion A minimal access pubovaginal sling using Pelvicol™ is effective in treating stress incontinence. The complication rate is low and the procedure can be performed as a day‐case with no loss of efficacy.
How to master absorption during transurethral resection of the prostate: basic measures guided by the ethanol method
Authors: Hultén J.O. 
Published: March 2003

Objective To evaluate the effect of basic measures to minimize the absorption of irrigating fluid during transurethral resection of the prostate (TURP) to the planned end‐point, using the ethanol method to guide the surgeon. Patients and methods Forty‐six patients underwent TURP with intermittent irrigation using sterile water and 2% ethanol. The ethanol content in the expired breath of the patients was assessed every 5 min using a breath‐alcohol monitor. In 25 patients no absorption was indicated but 21 showed some absorption according to the ethanol analyses. The operator was then immediately alerted, paused briefly to determine the route of absorption and to take advantage of blood clots to seal off leakage sites. On resuming the resection, attention was given to the pressure gradients in the operating field, based on bladder compliance and the flow in the irrigating jet. Repeated ethanol analyses were used to assess the result and to guide the surgeon's efforts. Results No operation had to be terminated prematurely; the mean absorption in the 21 patients in whom any ethanol was detected was 121 (75–230) mL. In 14 patients absorption occurred once, in six twice and in one there were three small absorption events. The group with absorption did not differ significantly from that with no absorption in operative duration (mean 48 and 47 min), resected weight (mean 32.8 and 31.6 g) or blood loss (mean 550 and 483 mL). Conclusions If the surgeon is alerted at the first positive ethanol reading, effective measures to minimize absorption can be taken early. Regular use of the ethanol method as an alarm system should permit TURP with a minimum of absorption and avoid an early interruption or premature termination of surgery because of absorption.
Mechanical properties and innervation of the smooth muscle layers of the urethra of greyhounds
Authors: Van der Werf B.A. , Creed K.E. 
Published: March 2003

Objective To investigate the properties of the smooth muscle layers in the urethral wall of male and female greyhounds, and to consider their roles in continence and micturition.Materials and methods The distribution and innervation of the smooth muscle layers of the prostate capsule and membranous urethra of male greyhounds were assessed. Strips of smooth muscle from these regions were used to determine the neuropharmacological properties by assessing the excitatory and inhibitory responses to nerve stimulation, and the effects of blocking agents. These were compared with strips from the proximal urethra and from the female urethra.Results The smooth muscle of the membranous urethra comprised 9% of the wall and received its innervation exclusively in branches from the pelvic plexus. The cholinergic innervation in the male produced 80% of the total contractile response in the longitudinal membranous urethra, 50% in the prostate capsule and 13% in the circular muscle of the proximal urethra. In the female all areas had poor contractile responses. Inhibitory fibres produced relaxation in all parts of male and female urethrae with the major effect caused by nitric oxide. Adrenergic nerves contributed to both residual excitation (α receptors) and inhibition (β receptors).Conclusions The longitudinal smooth muscle of the male membranous urethra probably shortens the urethra during micturition, through the activity of cholinergic nerves, whereas the circular smooth muscle of the proximal urethra, under adrenergic control, may be contracted during continence and ejaculation. In the female, the smooth muscle plays a minor role.
Intermittent testicular pain: fix the testes
Authors: Kamaledeen S. , Surana R. 
Published: March 2003

OBJECTIVETo analyse the presenting features, signs and operative findings of children presenting with intermittent testicular pain, as testicular torsion is a relatively common and serious emergency in children that can lead to testicular loss in up to 80%, although half of these children have previous episodes of pain suggestive of intermittent torsion.PATIENTS AND METHODSData were collected prospectively for all patients presenting with recurrent pain between December 2000 and June 2001. Variables assessed included presenting symptoms, age, size, lie and position of the testis when supine and erect, the operative findings and follow‐up.RESULTSEight children had at least two previous episodes of testicular pain; four of these were admitted on six occasions. Two had undergone previous scrotal exploration. On clinical examination, six boys had a transverse testicle and two a discrepancy in testicular size. All children had their testes fixed. At operation in all patients there was abnormal attachment of the tunica vaginalis with a typical ‘bell clapper’ deformity. On follow‐up only one patient still complains of pain.CONCLUSIONIn view of high incidence of abnormalities we consider that to improve the testicular salvage rate and prevent testicular atrophy, bilateral testicular fixation is recommended for boys with intermittent testicular pain and positive clinical findings.
The role of the human bladder lamina propria myofibroblast
Authors: Wiseman O.J. , Fowler C.J. , Landon D.N. 
Published: March 2003

OBJECTIVESTo describe the ultrastructure and relationship to nerves of the myofibroblast in the human bladder lamina propria, and discuss its possible role in bladder function, including sensing stretch, as the response of the bladder to stretch has been thoroughly investigated by afferent nerve recordings, but specialized stretch sensing organs have yet to be identified.MATERIALS AND METHODSFlexible cystoscopic bladder biopsies were obtained from patients with detrusor hyper‐reflexia and from controls. Systematic electron micrographs were obtained throughout the lamina propria, and the presence and location of cells with ultrastructural characteristics of myofibroblasts noted, together with their relation to surrounding nerves.RESULTSWithin the lamina propria there was a layer of cells with the cytological characteristics of both fibroblasts and smooth muscle cells, that included bundles of fine cytoplasmic filaments, dense bodies, linear arrays of subsurface vacuoles, and the presence of an interrupted basal lamina. This combination of features is characteristic of the myofibroblast. These cells had close contacts with unmyelinated axonal varicosities containing a mixture of clear and large dense‐cored vesicles, or clear vesicles alone.CONCLUSIONSThere is a layer of cells with the ultrastructural characteristics of myofibroblasts within the human bladder lamina propria. Their close contacts with nerves containing both small clear, and small clear with dense‐cored, vesicles implies they have both an efferent and an afferent nerve supply, possibly functioning as a bladder stretch receptor. Furthermore, because of their similarities with the interstitial cells of Cajal in the gut, which are claimed to modulate small intestinal function, we discuss other possible roles for bladder lamina propria myofibroblasts.
The fear of prostate cancer in men with lower urinary tract symptoms: should symptomatic men be screened?
Authors: Brown C.T. , O'Flynn E. , Van Der Meulen J. , Newman S. , Mundy A.R. , Emberton M. 
Published: March 2003

OBJECTIVETo explore the concerns and worries in men with uncomplicated lower urinary tract symptoms (LUTS, but no evidence of prostate cancer) relating to their symptoms.Patients and methodsThere is no current prostate cancer screening programme in the UK. Evidence suggests that men with LUTS have the same risk of prostate cancer as aged‐matched asymptomatic men. However, most men with LUTS are ‘screened’ with a digital rectal examination (DRE) and prostate specific antigen (PSA) testing as part of routine assessment. Whether this screening offers any benefit to patients and whether national screening for prostate cancer and subsequent early treatment offer any long‐term survival or quality of life benefit is uncertain. Thus 30 men with uncomplicated LUTS were qualitatively interviewed to explore their concerns and worries about their symptoms. Interviews were transcribed verbatim and subjected to content analysis using validated techniques.RESULTSOf the 30 men, 22 (73%) expressed a fear of prostate cancer at the time of their initial presentation. This fear was independent of race, social class and symptom severity; older men were less worried. Of the 22, 15 (68%) stated that after reassurance their symptoms were less bothersome and easier to cope with.CONCLUSIONSThese findings suggest there is a considerable gain in health by explicitly addressing the concerns of prostate cancer in men with uncomplicated LUTS. Informing these men of their true risk of prostate cancer (before or after a DRE and PSA estimate) may alleviate much of the bother associated with their symptoms. Despite no evidence of any greater risk of prostate cancer than in asymptomatic men, symptomatic men should continue to be screened after appropriate counselling.
The role of antiandrogen monotherapy in the treatment of prostate cancer
Authors: Anderson J. 
Published: March 2003

SUMMARYThe mainstay of hormonal therapy in prostate cancer has been medical or surgical castration, both of which are associated with loss of libido and impotence, and may not always be acceptable to the patient. Antiandrogen monotherapy is an alternative treatment option to castration. There are two types of antiandrogen, i.e. steroidal (cyproterone acetate, CPA), and nonsteroidal (bicalutamide, flutamide and nilutamide). Data comparing survival outcome with CPA and castration are limited and conflicting. Furthermore, CPA is associated with loss of libido and erectile dysfunction. Large phase III trials have established that monotherapy with bicalutamide 150 mg once daily provides a survival outcome that is not significantly different to that after castration in men with locally advanced, non‐metastatic disease, while conferring significant advantages for sexual interest and physical capacity. Current data are inadequate to draw conclusions on the comparative efficacy of flutamide and castration, while nilutamide is not licensed for monotherapy. Recent data reveal that bicalutamide 150 mg given once daily in addition to standard care (radical prostatectomy, radiotherapy or ‘watchful waiting’) significantly delays the progression of early (localized or locally advanced) prostate cancer. Bicalutamide has a more favourable side‐effect profile than the other antiandrogens and is more likely to promote compliance.
Time‐action profile of the soluble, fatty acid acylated, long‐acting insulin analogue NN304
Authors: Heinemann L. , Sinha K. , Weyer C. , Loftager M. , Hirschberger S. , Heise T. 
Published: March 2003

Summary Aims To compare the pharmacokinetic and pharmacodynamic properties of subcutaneously injected NN304, a novel long‐acting insulin analogue, to NPH‐insulin during euglycaemic glucose clamps in 11 healthy volunteers. Methods On three study days NN304 was injected in three different doses (0.15, 0.3, 0.6 U/kg body weight), while NPH‐insulin (0.3 U/kg) was injected in identical dose on two other days. Results Injection of NN304 resulted in a linear and proportional increase in total NN304 concentrations (AUC0–1440 min: 0.15 U/kg: 344 ± 43, 0.3 U/kg: 666 ± 82, 0.6 U/kg: 1295 ± 210 nmol/l; P < 0.001). Maximal concentrations (609 ± 140, 1046 ± 283, 2033 ± 460 pmol/l; P < 0.001) were reached after 4–6 h. The metabolic response (expressed as maximal glucose infusion rates (GIR)) induced by subcutaneous injection of NN304 did not show the pronounced peak seen with NPH‐insulin in an identical dose: GIRmax 3.2 ± 1.1 vs. 4.4 ± 1.8 mg/kg/min (P < 0.05 for 0.3 U/kg NN304 vs. NPH‐insulin; mean of both study days with NPH‐insulin, all others not significant). NN304 also showed a slower onset of action, as indicated by a significantly higher tmax (446 ± 162 vs. 359 ± 175 min) and lower AUC0–240 min (0.5 ± 0.3 vs. 0.8 ± 0.4 g/kg/240 min; P < 0.05, respectively). The three different doses of NN304 induced a significantly different glucose consumption in the first 720 min after injection (AUC0–720 min 1.1 ± 0.6, 1.9 ± 0.8, 1.7 ± 0.8 g/kg; P < 0.05 for 0.15 U/kg), but not over the whole study period (AUC0–1440 min 1.8 ± 1.1, 3.1 ± 1.3, 2.8 ± 1.4 g/kg). Conclusions Injection of NN304 at different doses resulted in an increase in total NN304 concentration in a linear dose–response effect and a more even metabolic effect than NPH‐insulin. However, we found no clear dose–response in its metabolic effect.Diabet. Med. 16, 332–338 (1999)
Novel surgical treatment and gastric pathology in diabetic gastroparesis
Authors: Ejskjaer N. T. , Bradley J. L. , Buxton‐Thomas M. S. , Edmonds M. E. , Howard E. R. , Purewal T. , Thomas P. K. , Watkins P. J. 
Published: March 2003

Summary Aims Observations are made on four Type 1 diabetic patients with the rare syndrome of intractable vomiting from confirmed gastroparesis, to determine whether radical surgery would alleviate their symptoms and subsequently to examine in detail the gastric histopathology. Methods The surgical approach consisted of an ≈ 70% resection of the stomach, including the antrum and pylorus, with closure of the duodenum and restoration of gastrointestinal continuity with a 60‐cm Roux‐en‐Y jejunal loop. Four longstanding Type 1 diabetic patients were examined and treated as described. They were all women in the age range 27–41 years with grossly abnormal autonomic function tests in whom other causes for gastric paresis had been excluded. Results Vomiting episodes leading to multiple hospital admissions (6–8) in the year preceeding surgery were eliminated in three of the four patients, while in the fourth initial success was followed by the need for dialysis for renal failure. Gastric histopathology showed evidence of smooth muscle degeneration and fibrosis, with eosinophilic inclusion bodies (M‐bodies) which appear to be unique to this condition. The findings suggest the presence of a gastromyopathy. Conclusions Satisfactory relief of intractable vomiting from diabetic gastroparesis was achieved by a novel radical surgical procedure. Histopathological findings suggest that gastromyopathy may contribute to the production of this syndrome.
Type 1 diabetes mellitus, coeliac disease, and lymphoma: a report of four cases
Authors: O’connor T. M. , Cronin C. C. , Loane J. F. , O’meara N. M. , Firth R. G. , Shanahan F. , O’halloran D. J. 
Published: March 2003

SummaryIntroduction Patients with Type 1 diabetes mellitus have a high prevalence of coeliac disease, symptoms of which are often mild, atypical, or absent. Untreated coeliac disease is associated with an increased risk of malignancy, particularly of lymphoma. We describe four patients with Type 1 diabetes mellitus and coeliac disease who developed lymphoma.Case reports Two patients were male and two female. In three patients, coeliac disease and lymphoma were diagnosed simultaneously. Enteropathy‐associated T cell lymphoma occurred in two patients, Hodgkin’s disease in one, and B cell lymphoma in one. Response to treatment was in general poor, and three patients died soon after the diagnosis of lymphoma was made.Conclusion As the relative risk of lymphoma is reduced by a gluten‐free diet, a high index of suspicion for coeliac disease should exist in all Type 1 diabetic patients with unexplained constitutional or gastro‐ intestinal symptoms.Keywords coeliac disease, lymphoma, Type 1 diabetes mellitus
Ions, genes and insulin release: from basic science to clinical disease Based on the 1998 R. D. Lawrence Lecture
Authors: Dunne M. J. 
Published: March 2003

SummaryIn 1968, reports of the first microelectrode recordings of insulin‐secreting cells were published. Thirty years later it is now established that electrical responses of β‐cells play a critical role in stimulus‐secretion coupling. It is now also clear that defects in ion channel genes compromise the mechanisms which govern secretion and lead to the onset of disease. Here, the physiology of insulin release is reviewed in the context of ion channels, the ionic control of insulin release and the pathophysiology of hyperinsulinism of infancy.
Increasing prevalence of diabetes mellitus and impaired glucose tolerance among 60‐year‐old Danes
Authors: Drivsholm T. , Ibsen H. , Schroll M. , Davidsen M. , Borch‐Johnsen K. 
Published: March 2003

SUMMARY Aims  The age‐specific prevalence of diabetes mellitus and impaired glucose tolerance (IGT) was estimated in 60‐year‐old individuals in 1996/97 and compared to the prevalence in 1974/75. The study also examined whether or not the change in prevalence of diabetes and IGT could be explained by changes in body mass index (BMI) and physical activity.Methods  Diabetes and IGT were diagnosed by a standardized oral glucose tolerance test (OGTT) in two Danish population‐based, age‐specific, birth cohorts.Results  The prevalence of diabetes in 1996/97 was 12.3% among 60‐year‐old men and 6.8% among women, representing an increase in diabetes of 58% in men and 21% in women compared to 1974/75. The prevalence of IGT was 15.9% among men and 13.1% among women, representing increases of 109 and 16%, respectively. A concurrent increase in BMI in the 22‐year period between the two studies explained the increase found in the prevalence of diabetes and IGT.Conclusions  A marked increase in the prevalence of diabetes and IGT among 60‐year‐old individuals over a 22‐year period was observed – especially in men. The increase was fully explained by a concurrent increase in BMI.