bluuebunny/crossref_metadata_2025_split huggingface dataset:
Altered cognitive function in men treated for prostate cancer with luteinizing hormone‐releasing hormone analogues and cyproterone acetate: a randomized controlled trial
Authors: Green H.J. , Pakenham K.I. , Headley B.C. , Yaxley J. , Nicol D.L. , Mactaggart P.N. , Swanson C. , Watson R.B. , Gardiner R.A. 
Published: March 2003

Objective  To report the first systematic investigation of the cognitive effects of luteinizing hormone‐releasing hormone (LHRH) analogues in male patients, as LHRH analogues have been associated with memory impairments in women using these drugs for gynaecological conditions. Patients and methods  Eighty‐two men with extraprostatic prostate cancer were randomly assigned to receive either continuous leuprorelin, goserelin (both LHRH analogues), cyproterone acetate (a steroidal antiandrogen) or close clinical monitoring. These patients underwent cognitive assessments at baseline and before starting treatment (77), and then 6 months later (65). Results  Compared with the baseline assessments, men receiving androgen suppression monotherapy performed worse in two of 12 tests of attention and memory; 24 of 50 men randomized to active treatment and assessed 6 months later had a clinically significant decline in one or more cognitive tests but not one patient randomized to close monitoring showed a decline in any test performance. Conclusion  Pharmacological androgen suppression monotherapy for prostate cancer may be associated with impaired memory, attention and executive functions.
Common skin disorders of the penis
Authors: Buechner S.A. 
Published: March 2003

SummaryDiseases of the male genitalia range from infectious lesions to inflammatory and neoplastic conditions, including many genital manifestations of more general skin diseases. This review highlights the clinical features, diagnosis and treatment of the most common dermatoses of the male genitalia. Herpes genitalis and infections caused by human papillomavirus (HPV) are increasing, particularly in young sexually active people. Herpes simplex virus infection is the commonest infectious cause of genital ulceration, with evidence that many infections are asymptomatic. HPV infection may be latent, subclinical and clinical. The most common causal agents for condyloma acuminatum are low‐risk HPV 6 and 11; high‐risk HPV types 16 and 18 are associated with premalignant and malignant lesions. Treatment for genital warts remains unsatisfactory; recurrences are common. Imiquimod, a new topical immunotherapeutic agent, which induces interferon and other cytokines, has the potential to be a first‐line therapy for genital warts. Scabies and pediculosis are transmitted by skin‐to‐skin contact and sexual transmission is common, with the penis and scrotum favourite locations for scabious lesions. Oral ivermectin, a highly active antiparasitic drug, is likely to be the treatment of choice, but until approval is granted it should be reserved for special forms of scabies. Common skin diseases, e.g. psoriasis and lichen planus, may have an atypical appearance in the genital area. The typical psoriatic scale is usually not apparent because of moisture and maceration. Allergic contact dermatitis of the genital area may result from condoms, lubricants, feminine hygiene deodorant spray and spermicides. More often, contact dermatitis is irritant, resulting from persistent moisture and maceration. Lichen sclerosus is a chronic inflammatory disease that occurs as atrophic white patches on the glans penis and foreskin. The penile form is a common cause of phimosis in uncircumcised men; involvement of the urethral meatus may lead to progressive meatal stenosis. Plasma cell balanitis is a benign, idiopathic condition presenting as a solitary, smooth, shiny, red‐orange plaque of the glans and prepuce of a middle‐aged to older man. Squamous cell carcinoma (SCC) in situ, e.g. erythroplasia of Queyrat and Bowen's disease, cannot be excluded clinically; their apparent clinical benignity may lead to lengthy periods of misdiagnosis and biopsy is required to confirm the diagnosis. SCC is the most common malignancy of the penis and the role of oncogenic HPV‐types has been also established in SCC of the penis. Prevention of SCC of the penis presupposes an identification of risk factors, early detection of all pre‐cancerous lesions and treatment of phimosis.
Banking of fresh‐frozen prostate tissue: methods, validation and use
Authors: Riddick A.C.P. , Barker C. , Sheriffs I. , Bass R. , Ellis V. , Sethia K.K. , Edwards D.R. , Ball R.Y. 
Published: March 2003

The question of banking of fresh frozen human prostatic tissue is addressed by a group of authors who have compared its value with what they call “pseudobanked” tissue. They then validate their methodology by a number of methods, including expression of hepsin, which they found to be significantly higher in malignant than in benign tissue. The theme of prostate cancer is continued by an English group looking at recent trends in the use of radical prostatectomy in England, and they make a number of interesting comments about this. Again in relation to prostate cancer, a group from Boston assess the use of steroids after prostate brachytherapy to reduce the risk of acute urinary retention. Authors from McGill University, Montreal and Beth Israel in Boston, comment on the controversial areas of insulin‐like growth factor and prostatic intraepithelial neoplasia and their role in the genesis of prostate cancer. Other interesting areas such as testicular sparing surgery in testis cancer, and a comparison of hand‐assisted laparoscopic versus open radical nephrectomy, are also described in this section. OBJECTIVETo describe the establishment, methods, validation and use of a bank of fresh‐frozen human prostate tissue.MATERIALS AND METHODSOn obtaining informed patient consent, protocols were followed for banking prostate tissue from any type of prostatectomy or cystoprostatectomy. A pseudobanking procedure was devised to determine the accuracy of assessing the histopathological status of the banked tissue. RNA was extracted, its quality assessed and used for quantitative real‐time reverse transcription‐polymerase chain reaction for the serine protease hepsin.RESULTSTo date prostate tissue from 112 patients has been banked, with pseudobanking in 58. The histopathological assessment showed pseudobanked tissue matched adjacent unbanked tissue in 98% of cases for benign vs malignant diagnoses, and in 92% of carcinomas for the Gleason score. Hepsin expression was significantly higher in malignant than in benign tissues (P < 0.0001).CONCLUSIONWe established a validated method for banking human fresh‐frozen prostate tissue and applied it successfully. Hepsin expression can be used to differentiate malignant and benign prostate tissue, and as an indicator of tissue heterogeneity.
Decisional regret and quality of life after participating in medical decision‐making for early‐stage prostate cancer
Authors: Davison B.J. , Goldenberg S.L. 
Published: March 2003

OBJECTIVETo determine the effect of men's reported levels of involvement in medical decision‐making and quality of life (QoL) on their levels of decisional regret after definitive treatment.PATIENTS AND METHODSMen referred to a hospital‐based resource centre completed QoL and decisional‐regret measures after definitive treatment for localized prostate cancer. Data from these questionnaires were linked with a previous study conducted to determine if providing individualized information to men newly diagnosed with prostate cancer would lower their levels of psychological distress and enable them to become more active participants in treatment decision‐making. The preferred role in medical decision‐making and QoL had previously been measured at the time of diagnosis and the assumed role at 4 months after the definitive treatment decision. This postal survey was conducted ≈ 18 months after diagnosis.RESULTSOf 74 men, 67 (91%) responded; the mean (sd) time since definitive treatment was 10.3 (4.7) months and the mean age of the men 62.5 (6.9) years. Radical prostatectomy was the most frequent treatment (72%). Most (94%) patients participated in medical decision‐making either actively or collaboratively and did not regret their treatment choice. The type of definitive treatment received had no effect on decisional regret; patients’ QoL scores were similar to the levels before treatment. Levels of sexual function were significantly lower after definitive treatment, but urinary incontinence was not significantly affected. Men who had neoadjuvant hormone therapy reported having significantly more treatment‐related symptoms.CONCLUSIONSThere is no evidence that providing information to facilitate participation in medical decision‐making causes decisional regret or psychological distress within the first year after definitive treatment. A longitudinal follow‐up of these patients is required to adequately assess the long‐term effects of treatment on QoL and decisional regret.
Transurethral electrovaporization of the prostate: is it any better than conventional transurethral resection of the prostate?
Authors: McAllister W.J. , Karim O. , Plail R.O. , Samra D.R. , Steggall M.J. , Yang Q. , Fowler C.G. 
Published: March 2003

OBJECTIVETo evaluate transurethral electrovaporization of the prostate (TUVP), compared with transurethral resection of the prostate (TURP), as a treatment for men with symptomatic benign prostatic enlargement (BPE).PATIENTS AND METHODSIn all, 235 men with symptomatic BPE in four hospitals in the South‐East of England were randomized to TUVP (115) and TURP (120). Patients were assessed using the International Prostate Symptom Score (IPSS), the Short Form‐36 (SF‐36), EuroQol and sexual function questionnaire, uroflowmetry, ultrasonographic measurement of residual urine volume, pressure‐flow urodynamics and transrectal ultrasonography.RESULTSThere was no statistically significant difference in the objective and subjective outcome after TURP and TUVP. The latter was associated with a lower transfusion rate than TURP but this did not result in an overall reduction in complications. There was no difference in the length of hospital stay. Overall, the two operations produced equivalent results and equivalent complication rates.CONCLUSIONTUVP is an effective treatment for symptomatic BPE, with results equivalent to TURP. TUVP has not led to the expected reduction in early postoperative morbidity or shorter hospital stays.
Testicular‐sparing surgery: a reasonable option in selected patients with testicular lesions
Authors: Passarella M. , Usta M.F. , Bivalacqua T.J. , Hellstrom W.J.G. , Davis R. 
Published: March 2003

OBJECTIVETo describe our experience of inguinal exploration in patients who had a reasonable chance of having a benign testicular lesion.PATIENTS AND METHODSFrom 1995 to 2002, 11 patients (mean age 43 years, range 27–63) with testicular masses that were suspected to be benign underwent inguinal exploration.RESULTSIn nine of the 11 patients, frozen‐section analysis and the final pathological results were similar, and two underwent inguinal orchidectomy. In seven patients the testicle was spared. Finally, because of an uncertain pathological diagnosis and patient age, two patients underwent orchidectomy.CONCLUSIONSInguinal exploration and testicular‐sparing surgery are reasonable options in patients with peripheral intratesticular lesions, on the basis of preoperative ultrasonographic characteristics, and if there is a possibility of the mass being benign because of age, race, physical examination and tumour markers.
The neuroanatomy of the human scrotum: surgical ramifications
Authors: Yucel S. , Baskin L.S. 
Published: March 2003

The developmental neuroanotomy of the human scrotum may not have been evaluated up to now, but the authors from San Francisco report here on an outstanding study in foetuses of this important area of interest. They have helped to define clearly the neuroanotomy of this region, which will be useful in planning surgery to the scrotum and penis in children. The group from the Hospital for Sick Children in Toronto have evaluated the safety and efficacy of toleterodine in children who have previously failed to tolerate oxybutinin. They found that toleterodine is well tolerated in children, and 77% of patients were able to continue this treatment without significant side effects in this subgroup who could not tolerate oxybutinin. OBJECTIVETo define the scrotal nerve origin and distribution with respect to surrounding structures in male human fetuses, by using neuronal‐specific markers and three‐dimensional (3D) imaging techniques, as the developmental neuroanatomy of the human scrotum has not been studied in detail and an explicit description of nerve derivation and distribution in the human scrotum is germane to genital reconstructive surgery.MATERIALS AND METHODSSixteen normal human fetal penile specimens at 17.5–38 weeks of gestation were studied. Specimens were fixed in formalin, embedded in paraffin wax, serially sectioned at 6 µm and stained with the neuronal marker S‐100. All of the specimens contained the whole penis and scrotum from glans to anal verge. The gestational age of the fetuses was determined by fetal heel‐to‐toe length. 3D‐computer reconstruction of serial sections allowed a detailed analysis of the neuroanatomy of the fetal penis and scrotum.RESULTSThe nerves innervating the ventral side of the proximal penis and scrotum originated mainly from the perineal nerves arising from pudendal nerves. The nerves travelling along the ventral side of penis coalesced at the penoscrotal area to be directed into the interscrotal septum. At the penoscrotal junction, nerves on both sides of the ventral penis shifted to the interscrotal septum in a triangular fashion. The interscrotal septum was densely occupied by nerve fibres. Nerves were distributed horizontally to both hemiscrotal walls through this interscrotal septum. Both hemiscrota seem primarily to be innervated separately.CONCLUSIONThe interscrotal septum has a dense innervation. Both hemiscrota were innervated mainly by horizontally distributed nerve fibres arising from the interscrotal septum. Any procedure violating the penoscrotal and interscrotal septal area may jeopardize scrotal innervation.
Efficacy and safety of acarbose in the treatment of Type 1 diabetes mellitus: a placebo‐controlled,double‐blind, multicentre study
Authors: Riccardi G. , Giacco R. , Parillo M. , Turco S. , Rivellese A. A. , Ventura M. R. , Contadini S. , Marra G. , Monteduro M. , Santeusanio F. , Brunetti P. , Librenti M. C. , Pontiroli A. E. , Vedani P. , Pozza G. , Bergamini L. , Bianchi C. 
Published: March 2003

SummaryAims The aim of the study was to evaluate the efficacy and safety of acarbose in patients with Type 1 diabetes mellitus (DM). Methods A multicentre double‐blind, randomized, placebo‐controlled study was performed. After a 6‐week run‐in, 121 patients were randomized to acarbose or placebo and to high‐ or low‐fibre diet for 24 weeks. Acarbose dose was 50 mg t.d.s. for the first 2 weeks and 100 mg t.d.s. for the subsequent weeks. Results At the end of 24 weeks of treatment the intention to treat analysis showed that acarbose compared with placebo decreased 2 h postprandial plasma glucose levels (12.23 ± 0.83 vs. 14.93 ± 0.87 mmol/l;F = 6.1, P < 0.02) (least square means ± sem). No significant effect of acarbose was recorded on HbA1c or on the number of hypoglycaemic episodes. The effect of acarbose on blood glucose control was not influenced by the amount of carbohydrate and/or fibre intake. The incidence of adverse events were 75% and 39% in acarbose and placebo groups, respectively; they were mild and confined to the gastrointestinal tract. Conclusions The use of acarbose in combination with insulin reduces postprandial plasma glucose levels in Type 1 diabetic patients who are not satisfactorily controlled with insulin alone but without significant effect on HbA1c.Diabet. Med. 16, 228–232 (1999)
Association of plasma fibrinogen level and blood pressure with diabetic retinopathy, and renal complications associated with proliferative diabetic retinopathy, in Type 2 diabetes mellitus
Authors: Fujisawa T. , Ikegami H. , Yamato E. , Kawaguchi Y. , Ueda H. , Shintani M. , Nojima K. , Kawabata Y. , Ono M. , Nishino T. , Noso S. , Yamada K. , Babaya N. , Okamoto N. , Ohguro N. , Fukuda M. , Ogihara T. 
Published: March 2003

Summary Aim To clarify the association of several clinical parameters, including plasma fibrinogen level, with diabetic retinopathy in patients with Type 2 diabetes mellitus (DM). Methods A total of 294 Japanese patients with Type 2 DM were studied; 53 patients with no diabetic retinopathy (NDR), 90 with background diabetic retinopathy (BDR), and 151 with proliferative diabetic retinopathy (PDR). Multiple logistic regression analysis was performed to assess variables independently associated with diabetic retinopathy in two settings: presence of retinopathy of any severity and presence of advanced retinopathy. Results The following parameters were identified as independent factors associated with the presence of diabetic retinopathy (NDR vs. BDR + PDR): type of therapy (P < 0.0005), log‐transformed plasma fibrinogen level (P < 0.05), mean blood pressure (P < 0.05), and duration of diabetes (P < 0.05). The independent variables associated with advanced retinopathy were type of therapy (P < 0.00005), age (P < 0.0005) and nephropathy (P < 0.05). Body mass index, smoking and hypertensive status, HbA1c and total cholesterol levels were not independently associated. Conclusions These data suggest that in patients with Type 2 DM, an increased blood viscosity due to high fibrinogen level as well as an elevated intravessel pressure play a role in the development of diabetic retinopathy, and that the progression to PDR is influenced or accompanied by the deterioration of renal status.
Effectiveness of screening and monitoring tests for diabetic retinopathy – a systematic review
Authors: Hutchinson A. , McIntosh A. , Peters J. , O'keeffe C. , Khunti K. , Baker R. , Booth A. 
Published: March 2003

SUMMARY Aims  To determine which screening and monitoring tests for diabetic retinopathy are most effective and under what circumstances.Methods  A systematic review of the English language literature, published from 1983 to April 1999.Results  Available studies are generally limited in their ability to answer the important questions on the effectiveness of tests for early detection of diabetic retinopathy. No randomized controlled trials were identified although primary studies exist for two screening tests: ophthalmoscopy, either direct or indirect, and retinal photography, using either mydriasis or non‐mydriasis. Retinal photography under mydriasis appears to be the most effective test, with the majority reporting levels of sensitivity in excess of 80%. However effectiveness is compromised when photographs are ungradable. Ophthalmoscopy can also reach acceptable standards of sensitivity and specificity.Conclusion  Based on an assessment of available cohort studies, the most effective strategy for testing is the use of mydriatic retinal photography with the additional use of ophthalmoscopy for cases where photographs are ungradable. This does not exclude the use of ophthalmoscopy alone for opportunistic case finding but there is evidence of considerable variation in effectiveness of this test.
A randomized, controlled trial comparing insulin lispro with human soluble insulin in patients with Type 1 diabetes on intensified insulin therapy
Authors: Group E. A. M. Gale for the U.K. Trial 
Published: March 2003

Summary Aims Despite considerable experience with insulin lispro, few blinded comparisons with soluble insulin are available. This study compared insulin lispro with human soluble insulin in patients with Type 1 diabetes mellitus on multiple injection therapy who inject shortly before meals. Methods Glucose control, frequency of hypoglycaemia and patient preference were examined in the course of a prospective, randomized, double‐blind, crossover comparison, with a 6‐week run‐in period and 12 weeks on each therapy. Ninety‐three patients took part, all on multiple daily doses of insulin, with soluble insulin before meals and NPH (isophane) insulin at night. The main outcome measures were self‐monitored blood glucose profiles, glycated haemoglobin, frequency of hypoglycaemic episodes, patient satisfaction and well‐being and patient preference. Results Blood glucose levels were significantly lower after breakfast and lunch, but higher before breakfast, lunch and supper, in patients taking insulin lispro. Levels of HbA1c were 7.4 ± 1.1% on Humulin S and 7.5 ± 1.1% on insulin lispro (P = 0.807). The overall frequency of symptomatic hypoglycaemia did not differ, but patients on insulin lispro were less likely to experience hypoglycaemia between midnight and 6 a.m., and more likely to experience episodes from 6 a.m. to midday. Questionnaires completed by 84/87 patients at the end of the study showed that 43 (51%) were able to identify each insulin correctly, nine (11%) were incorrect, and 32 (38%) were unable to tell the insulins apart. No significant preference emerged: 35 (42%) opted for insulin lispro, 24 (29%) opted for Humulin S, while the remainder had no clear preference. Conclusions Substitution of insulin lispro for soluble insulin in a multiple injection regimen improved post‐prandial glucose control at the expense of an increase in fasting and pre‐prandial glucose levels. Patients who already injected shortly before meals expressed no clear preference for the fast‐acting analogue, and did not improve their overall control as a result of using it. Nocturnal hypoglycaemia was however, less frequent on insulin lispro, and may emerge as a robust indication for its use.
Autoantibodies to tissue transglutaminase are sensitive serological parameters for detecting silent coeliac disease in patients with Type 1 diabetes mellitus
Authors: Kordonouri O. , Dieterich W. , Schuppan D. , Weber G. , Müller C. , Sarioglu N. , Becker M. , Danne T. 
Published: March 2003

Summary Aims To investigate the clinical significance of the determination of IgA antibodies to tissue transglutaminase (tTG) for the detection of silent coeliac disease in patients with Type 1 diabetes mellitus. Methods A total of 520 patients with diabetes (median age 14.2 years, range 1–27) were tested for IgA antibodies to tTG (IgA anti‐tTG, ELISA), endomysium (EmA, indirect immunofluoresence) and gliadin (IgA‐AGA, enzyme immunometric assay) after ruling out IgA deficiency. Results The prevalence of IgA anti‐tTG among patients with diabetes was 4.4% (23 of 520), and that of EmA and IgA‐AGA 3.5% (18 of 520, respectively). The coefficient of agreement between IgA antitTG and EmA was high (Cohen's kappa = 0.87, P < 0.001). Thirteen of the 23 IgA anti‐tTG‐positive patients underwent duodenal biopsy. Coeliac disease was confirmed in nine of 13 patients. One of them was negative for EmA and AGA, but positive for IgA anti‐tTG. Retrospective annual determinations up to 8 years in six IgA anti‐tTG‐positive patients showed both permanent and transient elevations of the serological markers. Conclusions These data show that a positive IgA antibody test to tTG is a more sensitive parameter than EmA for silent coeliac disease in patients with diabetes. Confirmatory small bowel biopsy, however, remains necessary for diagnosis as some patients with positive antibodies may be without histological changes.