bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does delaying pyeloplasty affect renal function in children with a prenatal diagnosis of pelvi‐ureteric junction obstruction?
Authors: Chertin B. , Rolle U. , Farkas A. , Puri P. 
Published: March 2003

Objective  To evaluate retrospectively children with an antenatal diagnosis of pelvi‐ureteric junction (PUJ) obstruction who required pyeloplasty for deteriorating renal function during the follow‐up, specifically assessing the recovery of function after surgery. Patients and methods

Between 1988 and 2000, 44 consecutive patients with a prenatal diagnosis of PUJ obstruction who were initially treated by observation underwent pyeloplasty because their renal function deteriorated during the follow‐up. Patients with bilateral disease, a single kidney or vesico‐ureteric reflux were excluded from the study. The mean (
sd
) age of the patients was 13.3 (4.5) months and their mean (range) initial renal function 39.7 (30.4–45)%. In all patients the diagnostic criteria and indications for surgery were identical. The main indication for surgery was deteriorating renal function of >5%, confirmed by renal scintigraphy. Of 44 patients, 35 (77%) had severe dilatation of the renal pelvis by >3 cm. The mean (
sd
) deterioration in renal function during the follow‐up, just before surgery, was 8.2 (2.4)%, and the mean time between the last acceptable renogram and the study showing deterioration was 8.3 (1.3) months; the mean follow‐up was 5.1 (1.6) years. The results were assessed statistically using the unpaired nonparametric Mann–Whitney
U ‐test. Results  An improvement in hydronephrosis was confirmed in all patients, with renal function returning to the initial levels in 36 of 44 (81%) patients 6–12 months after surgery, although in two patients renal function did not improve after surgery. There was no significant difference between the preoperative characteristics and the degree of hydronephrosis, renal function or patient age with the level of renal functional improvement after surgery. Conclusion  In patients with an antenatal diagnosis of PUJ obstruction, expectant management is recommended and spares the children unnecessary surgery. Even if renal function deteriorates, delayed pyeloplasty recovers the initial functional level.
Gap junctions and connexin expression in human suburothelial interstitial cells
Authors: Sui G.P. , Rothery S. , Dupont E. , Fry C.H. , Severs N.J. 
Published: March 2003

Objective  To determine whether suburothelial interstitial cells of the human bladder express gap junctions, and if so, to establish their extent and composition, using immunocytochemistry, confocal microscopy and electron microscopy. Materials and methods  Bladder tissue was obtained at cystectomy; the tissue was: (i) frozen for cryosectioning and Northern blot analysis; (ii) fixed and embedded for standard thin‐section electron microscopy; and (iii) processed using low‐denaturation conditions in Lowicryl for immunogold‐label electron microscopy. Cryosections were immunofluorescently labelled using antibodies against connexins 43, 40 and 45, vimentin, desmin and c‐Kit ligand, and examined by confocal microscopy. Double labelling was used to determine the spatial relationship of labelling for connexin43 with that of vimentin and desmin. Thin‐section electron microscopy was used to investigate interstitial cell ultrastructure and permit unequivocal identification of gap junctions, and immunogold labelling of Lowicryl sections was applied to localize connexin43. Results  Immunoconfocal microscopy showed prominent labelling for the gap junction protein, connexin43, in a suburothelial band of cells that was also strongly positive for vimentin. The connexin43/vimentin‐positive cells showed only weak labelling for desmin and c‐Kit ligand, and were immunonegative for connexins 40 and 45. Northern blotting showed a corresponding abundance of connexin43 transcript in the mucosal layer but not the detrusor layer of the bladder wall. Electron microscopy revealed abundant gap junctions, recognized by their pentalaminar structure, between the cell processes of interstitial cells in the suburothelial zone. That these interstitial cell gap junctions were the source of the connexin43 immunolabelling observed by immunoconfocal microscopy was confirmed by immunogold labelling in sections of Lowicryl‐embedded tissue examined by electron microscopy. Conclusion  A network of interstitial cells, extensively linked by connexin43‐containing gap junctions, is located beneath the urothelium in human bladder. As gap junctions provide pathways for direct cell‐to‐cell communication, the interstitial cellular network may operate as a functional syncytium, integrating signals and responses in the bladder wall.
Thermo‐expandable intraprostatic stents in bladder outlet obstruction: an 8‐year study
Authors: Perry M.J.A. , Roodhouse A.J. , Gidlow A.B. , Spicer T.G. , Ellis B.W. 
Published: March 2003

Objective To assess the use of a thermo‐expandable intraprostatic stent (Memokath®, Engineers and Doctors A/S, Copenhagen, Denmark) for bladder outlet obstruction in men unable to undergo transurethral resection of the prostate (TURP), assessing symptoms, complications and duration of stent life. Patients and methods The Memokath stent is a coil of a nickel‐titanium alloy which has ‘shape memory’, the lower end expanding when heated to 55 °C. Risks associated with inserting the stent with a flexible cystoscope under local anaesthesia are minimal. Men were selected who were either permanently or temporarily unfit for TURP. Indications included severe respiratory and cardiovascular disease. Exclusion criteria included bladder carcinoma, calculi or detrusor failure; in all, 211 men were fitted with 217 intraprostatic stents over 8 years. Results There were 1511 TURPs during the study period; the mean age of men receiving a stent was 80.2 years, compared with 70.2 years for those undergoing TURP. The International Prostate Symptom Score decreased from a mean of 20.3 to 8.2 (P < 0.001) in the first 3 months after stent placement; there was virtually no change over 7 years. During the follow‐up, 38% of men died with their stents in situ, 34% remain alive, 23% have had their stents removed for failure and 4% were removed as they were no longer required. There was a 13% migration rate and 16% repositioning rate. There were few side‐effects (pain 3%, haematuria 3%, incontinence 6% and infection 6%). These frail men were more likely to die than have their stent fail. Conclusion The Memokath intraprostatic stent is a valuable addition to the armamentarium of the urologist treating elderly or frail men with advanced bladder outlet obstruction and complements existing technologies.
Surgical treatment of disseminated peritoneal metastases from urological cancer: results from a prospective study
Authors: Otto T. , Suhr J. , Krege S. , Goebell P.J. , Wishahi M. , Bier U.W. , Kimmig R. , Rübben H. 
Published: March 2003

Objective  To report a prospective phase II study of patients with disseminated peritoneal carcinomatosis and symptomatic disease, in whom the peritoneal metastases were resected.Patients and methods  From 1995 to 1999, 32 patients (20 men and 12 women, median age 56 years, range 32–75) with peritoneal carcinomatosis were enrolled in the trial. Pain and ascites were determined according to the National Cancer Institute score/criteria, and performance scored according to the World Health Organisation criteria.Results  All patients had intraperitoneal disseminated malignancies with clinically evident ascites, and presented with abdominal pain. The median (range) operative duration was 2.9 (1–5.5) h and the hospital stay 25 (10–44) days, with no deaths at 30 days. The ascites was completely cured in 25 of the 32 patients, pain relieved in 28 and the performance score improved in 25. The median survival time was 1 year; the 1‐ and 2‐year survival rates were 45% and 38%, respectively. Patients with residual metastases after incomplete resection had a significantly worse prognosis, but the prognosis was significantly better in those with a low tumour burden.Conclusions  Peritoneal carcinomatosis is treatable; radical peritonectomy improves the performance score in selected patients with cancer‐related ascites and/or pain, and is now the standard approach in the authors’ Cancer Centre.
A randomized, double‐blind crossover study of tamsulosin and controlled‐release doxazosin in patients with benign prostatic hyperplasia
Authors: Kirby R.S. 
Published: March 2003

OBJECTIVETo compare the effects of the doxazosin gastrointestinal therapeutic system, extended‐release (doxazosin‐GITS) formulation, and tamsulosin, another α1‐antagonist, on total International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Qmax) in treating patients with benign prostatic hyperplasia (BPH).PATIENTS AND METHODSData were analysed from a prospective, randomized, double‐blind, crossover study of men aged 50–80 years with concomitant BPH and hypertension as inclusion criteria. Fifty‐two men were treated in four phases: phase I, placebo run‐in for 2 weeks; phase II, first study drug doxazosin‐GITS or tamsulosin for 8 weeks; phase III, washout with placebo for 2 weeks; and phase IV, second study drug tamsulosin or doxazosin‐GITS for 8 weeks. Doxazosin‐GITS was started at 4 mg/day and tamsulosin at 0.4 mg/day, and then titrated to 8 mg/day and 0.8 mg/day, respectively, after 4 weeks of therapy if the increase in Qmax was < 3 mL/s or the reduction in total IPSS was < 30%. Efficacy assessments included the IPSS and Qmax. Changes in blood pressure were not analysed, as most patients were actually not hypertensive. Endpoint efficacy data were analysed using an analysis of covariance model, with terms for sequence, phase, patients and sequence within patients, in addition to the baseline as covariate. Forty‐seven men were treated in both efficacy arms of the study and were evaluable for analysis.RESULTSDoxazosin‐GITS and tamsulosin significantly relieved lower urinary tract symptoms and significantly increased Qmax from baseline (P = 0.001). Doxazosin‐GITS produced significantly greater improvements than tamsulosin in total IPSS (P = 0.019) and obstructive subscores (P = 0.004) at the last treatment visit. The difference between doxazosin‐GITS and tamsulosin in improving Qmax approached significance in favour of the former (mean change from baseline 2.6 vs 1.7 mL/s, respectively; between‐group difference P = 0.089). Both treatments were well tolerated.CONCLUSIONSTreatment with doxazosin‐GITS was significantly more effective than tamsulosin in relieving lower urinary tract symptoms.
The role of neuromodulation in the management of urinary urge incontinence
Authors: Abrams P. , Blaivas J.G. , Fowler C.J. , Fourcroy J.L. , Macdiarmid S.A. , Siegel S.W. , Van Kerrebroeck P. 
Published: March 2003

Neuromodulation is increasingly becoming an important part of the treatment strategy for bladder dysfunction. In this issue a group of urologists have analysed outcome measures from all patients in pivotal clinical trials who have had this treatment, and have suggested that sacral nerve stimulation has an vital role in the management of refractory overactive bladder and retention problems. In a carefully performed study, authors from Mansoura and Scottsdale have evaluated high‐energy TUMT and found that although symptomatic improvement occurred in 82.5% of patients, and that the peak flow rate improved from a median of 9.2 to 15 mL/s, pressure‐flow improvement occurred in just 50% of the group. However, they found that younger patient age and higher grade of obstruction, are good predictors of urodynamic and symptomatic success respectively. In another study, Marshall's group from Adelaide emphasize the value of urodynamics and other factors in patients having TURP. The value of trans‐abdominal ultrasound is described by Foo and his colleagues from Singapore, who state that intravesical protrusion of the prostate is an important indicator of bladder outlet obstruction. OBJECTIVETo examine the benefit‐risk profile of neuromodulation in treating refractory urinary urge incontinence and other voiding disorders.PATIENTS AND METHODSThe outcome measures from all patients in pivotal clinical trials who had undergone sacral nerve stimulation were analysed retrospectively.RESULTSNeuromodulation was effective in several clinical studies; the response is durable and the benefit‐risk profile good.CONCLUSIONSacral nerve stimulation is becoming the standard of care for refractory overactive bladder and retention problems. The potential benefit of neuromodulation should be included in female urology and gynaecology training programmes.
The evolution of diabetes information systems
Authors: Young R. J. , Khong C. K. , Vaughan N. J. A. , New J. , Roxburgh M. 
Published: March 2003

AbstractDiabetes information systems have already evolved rapidly in recent years along a developmental pathway initiated by the St Vincent Declaration, fuelled by the rapid pace of IT development in the 1990s and now endorsed by the emerging NHS information strategy. They will be central to the delivery of ‘patient‐centred’ care and essential to supporting and monitoring the diabetes national service framework implementation. Widespread experience has identified three key principles. Firstly the need for a core data set that supports both service delivery and quality development. Secondly, because of the multiprofessional, multisector nature of diabetes care, there is a need to reconcile information from many diverse sources into unitary diabetes care records. Thirdly the crucial importance of making data collection a by‐product of every day care delivery (i.e. no duplicate data entry). The work of many local innovators, allied to the increasing experience of the Diabetes UK sponsored UKDIABS project has generated substantial expertise. With the aid of new extraction/analysis tools such as QUIDS and a consistent approach to assessment, this work has hopefully laid secure foundations for monitoring the implementation of the national service framework. Furthermore, parallel developments under the aegis of the National electronic Library for Health (NeLH) should enable those involved with diabetes care to access relevant knowledge and information with ease. Increasingly user friendly ways by which patients can interact with their electronic records and linked knowledge sources will create many new opportunities. Diabetes information systems are likely to be at the forefront of diabetes care delivery in the future, providing patients and professionals with timely and accurate data for the organization and delivery of care.
Reversal of corticosteroid‐induced diabetes mellitis with supplemental chromium
Authors: Ravina A. , Slezak L. , Mirsky N. , Bryden N. A. , Anderson R. A. 
Published: March 2003

Summary Aims To determine if the stress of corticosteroid treatment increases chromium (Cr) losses and if corticosteroid‐induced diabetes (steroid diabetes) can be reversed by supplemental chromium. Methods The effects of corticosteroid treatment on chromium losses of 13 patients 2 days prior to steroid administration and the first 3 days following treatment were determined. Since steroid‐induced diabetes was associated with increased chromium losses and insufficient dietary chromium is associated with glucose intolerance and diabetes, we treated three patients with steroid‐induced diabetes with 600 μg per day of chromium as chromium picolinate. Results Urinary chromium losses following corticosteroid treatment increased from 155 ± 28 ng/d before corticosteroid treatment to 244 ± 33 ng/d in the first 3 days following treatment. Chromium supplementation of patients with steroid‐induced diabetes resulted in decreases in fasting blood glucose values from greater than 13.9 mmol/l (250 mg/dl) to less than 8.3 mmol/l (150 mg/dl). Hypoglycaemic drugs were also reduced 50% in all patients when given supplemental chromium. Conclusions These data demonstrate that corticosteroid treatment increases chromium losses and that steroid‐induced diabetes can be reversed by chromium supplementation. Follow‐up, double‐blind studies are needed to confirm these observations.Diabet. Med. 16, 164–167 (1999)
Painful diabetic neuropathy
Authors: Benbow S. J. , Cossins L. , MacFarlane I. A. 
Published: March 2003

SummaryChronic painful diabetic neuropathy causes symptoms that can last for many years and severely impair the quality of life of affected patients. This review describes the epidemiology, pathophysiology and treatment of chronic neuropathic pain. Particular emphasis is placed on a comprehensive review of the management of painful symptoms through a detailed review of the published literature using a variety of databases particularly Medline and EMBASE.
Increased nerve growth factor mRNA in lateral calf skin biopsies from diabetic patients
Authors: Diemel L. T. , Cai F. , Anand P. , Warner G. , Kopelman P. G. , Fernyhough P. , Tomlinson D. R. 
Published: March 2003

Summary Aims This study set out to establish a novel procedure for the measurement of human nerve growth factor (NGF) messenger ribonucleic acid (mRNA) and to use this method to measure NGF expression in skin biopsies from control subjects and from patients with early neuropathies. NGF mRNA levels were related to functional measures of the competence of NGF‐responsive nerves. Methods mRNA levels were measured by competitive reverse transcription with polymerase chain reaction amplification (cRT‐PCR). Functional correlates of this observation were assessed by indices of thermal sensitivity – mediated by C‐fibres, whose phenotype is regulated by NGF. Results NGF mRNA was increased in skin biopsies from 19 diabetic patients (5.12 ± 3.88 (
sd)) compared with samples from eight controls (1.57 ± 0.95; P = 0.001). Diabetic patients showed significantly (P < 0.001) diminished detection of cool and warm stimuli compared to age matched control group (n = 24), but there were no differences in detection of heat as pain, or correlation with NGF mRNA levels. Conclusions These findings suggest abnormally increased expression of NGF in diabetic neuropathy, which may represent a compensatory mechanism for impaired phenotype in NGF‐responsive neurones.
Identification of new mutations in the hepatocyte nuclear factor 4a gene among families with early onset Type 2 diabetes mellitus
Authors: Malecki M. T. , Yang Y. , Antonellis A. , Curtis S. , Warram J. H. , Krolewski A. S. 
Published: March 2003

Summary Aims Mutations in hepatocyte nuclear factor (HNF)‐4α gene located on chromosome 20q have been found to be responsible for the development of early onset Type 2 diabetes mellitus (DM). Through a national campaign, 53 families with autosomal dominant, early onset Type 2 DM (n = 654) were assembled to determine the frequency of mutations in the HNF‐4α gene and their contribution to the development of diabetes. Methods Twelve exons and the promoter region of the HNF‐4α gene were screened in probands of the families by a double gradient, denaturing gradient gel electrophoresis (DG‐DGGE) protocol combined with automated bi‐directional sequencing of the PCR products of all heterozygous individuals. Results We detected two new mutations in the HNF‐4α gene that changed the amino‐acid sequence. The first mutation was a Gly→Ser substitution in codon 115 within a highly conserved DNA binding domain, and all six carriers of this mutation had diabetes and low insulin secretion. The second mutation was an Ile→Val substitution in codon 454 within the transactivation domain. It was carried by four family members, two of whom also carried a mutation in the HNF‐1α gene. Of those having only the mutation in HNF‐4α one had diabetes and the other had normal glucose tolerance and both were obese and hyperinsulinaemic. Thus, it is uncertain that this mutation is responsible for any of the diabetes in this family. Conclusion We have found that mutations in the HNF‐4α gene account for a small proportion, about 2–4%, of families with early onset, autosomal dominant, Type 2 DM in US Caucasians.Diabet. Med. 16, 193–200 (1999)
Twinning project: Israel and Georgia – the birth of a Diabetes‐in‐Pregnancy Centre in Georgia
Authors: Hod M. , Asatiani N. , Elphick A. , Kurashvili R. , Natsvlishvili M. , Chanturia T. , Bar J. , Peled Y. 
Published: March 2003

Summary Aims To determine the effectiveness of a joint Israeli–Georgian twinning project aimed at introducing modern methods of perinatal care to Georgian women with pregestational diabetes mellitus. Methods A Diabetes‐in‐Pregnancy Centre was established in Georgia (in the former USSR). Thirty‐two women with Type 1 diabetes mellitus participated in the first stage of the study (January 1997–June 1998). All were maintained under strict metabolic surveillance starting at least three months prior to conception and were given organized instruction in methods of self‐monitoring of glucose levels, insulin dose adjustment, dietary management and close fetal surveillance throughout pregnancy. A second stage of the project was started in January 1998 and aimed at the diagnosis of gestational diabetes mellitus (GDM). Results Of the 32 women, 20 had had a total of 44 prior pregnancies without proper perinatal care (1990–96); only five (11.3%) ended in the birth of a healthy infant. On entry to the study, all 32 patients had unsatisfactory metabolic indices. HbA1c levels decreased significantly from the pre‐conception period (P < 0.001) and were maintained at the lower level throughout pregnancy; insulin doses decreased significantly until the third trimester (P < 0.01) and then increased (P < 0.001). Since January 1997, 21 women have become pregnant. Eighteen have given birth, 12 (67%) by Caesarean section and six (33%) by vaginal delivery. Gestational age at birth was 36–39 weeks, and birth weight ranged from 2300 to 4100 g. The only neonatal complications were mild respiratory distress syndrome and hypoglycaemia. There were no significant maternal complications in the 236 women screened, eight were diagnosed as having GDM and 12 impaired glucose tolerance. They were actively managed to a successful outcome. Conclusions The establishment of the Diabetes‐in‐Pregnancy Centre in the Republic of Georgia has significantly reduced the prior high pre‐programme perinatal morbidity and mortality as well as the incidence of maternal complications in pre‐GDM as well as in GDM.