bluuebunny/crossref_metadata_2025_split huggingface dataset:
Site‐specific positive margins at radical prostatectomy: assessing cancer‐control benefits of wide excision of the neurovascular bundle on a side with cancer on biopsy
Authors: Park E.L. , Dalkin B. , Escobar C. , Nagle R.B. 
Published: March 2003

OBJECTIVETo determine the potential risk of biopsy‐selected nerve‐sparing surgery based on the findings of site‐specific extracapsular extension (ECE) and positive surgical margins (PSMs) in the area of the neurovascular bundle in radical prostatectomy specimens.PATIENTS AND METHODSControlling for surgical technique and pathological interpretation, 221 consecutive patients had their neurovascular bundles removed on the side with a positive biopsy. The surgical specimens were reviewed for ECE and PSM status, specifically in the area of the neurovascular bundle, from apex to base.RESULTSOf the 221 patients, 38% had ECE and 43 (20%) had a PSM in the area of the neurovascular bundle. This equates to a ratio of 51% for PSM/ECE. An additional 42 men (18%) had ECE with negative margins, but would have been at potential risk for PSMs if the neurovascular bundle had been preserved.CONCLUSIONPreserving the neurovascular bundle on the side with a positive biopsy could result in a significantly greater incidence of PSM than with wide excision. Optimizing cancer control may require excision of the neurovascular bundle on a side known to have cancer on biopsy. In future site‐specific analyses, the PSM/ECE ratio could be used as a marker comparing cancer‐control outcomes from studies with differing technical approaches and indications for nerve‐sparing surgery.
Use and misuse of the concept of quality of life in evaluating surgical treatments for lower urinary tract symptoms
Authors: Haltbakk J. , Hanestad B.R. , Hunskaar S. 
Published: March 2003

OBJECTIVETo investigate how quality of life (QoL) components measured by given instruments direct the QoL perspective in treatment studies of lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH).METHODSComputer searches were conducted in Medline, CINAHL and Psychinfo; MeSH terms covering QoL and surgical treatments for BPH and LUTS were combined for the search. The analysis was based on a framework linking components of QoL to patient outcome.RESULTSOf the 74 papers meeting the inclusion criteria, 48 were published in 1997–2001, showing the increase of interest of the topic. Most of the papers reported the change in QoL by a one‐item scale, whilst only a few reported results from several of the components in the QoL concept. Some papers regarded the change in general health status or parts of health status as changes in QoL. Functional status and symptoms, and the bother of symptoms, were often regarded as indicators of a change in QoL.CONCLUSIONThese analyses show an increasing interest in measuring QoL after surgery for LUTS and BPH. In most of the studies analysed, the batteries of instruments selected were too narrow in scope to study the complexity of QoL. Most papers are based on instruments sensitive to change, but the reports do not distinguish the basic assumptions for understanding relationships important in QoL research and as a result, the reason for change is open to question.
Diabetes care in childhood and adolescence
Authors: Betts P. R. , Jefferson I. G. , Swift P. G. F. 
Published: March 2003

AbstractThe presentation of diabetes in young people has changed significantly over recent years. Not only has there been a rising incidence of Type 1 diabetes, especially in young children, but also there is an increasing recognition of Type 2 diabetes. Young people are also increasingly being diagnosed with genetic defects of B‐cell function and with diabetes in association with cystic fibrosis and other chronic diseases. There have also been significant changes in the pattern of paediatric diabetes care. This is increasingly being provided by a specialized paediatric multidisciplinary team in each health district working to agreed national standards. Despite improvements, diabetes control is still suboptimal with a high incidence of complications being reported in young adults. The challenge over the next few years is the provision of a uniform, equitable and first class paediatric service throughout the UK together with the introduction of new approaches to care, aiming to improve individual diabetic control and reduce long‐term complications. Increased collaboration with adult colleagues is needed to enable the transition of care in adolescence to a service that young adults perceive to meet their needs, encourage their attendance and improve their diabetes control and quality of life. A national paediatric diabetes register together with regular audit will encourage these objectives.
Low prevalence of hepatitis C virus infection in Greek diabetic patients
Authors: Sotiropoulos A. , Peppas T. A. , Skliros E. , Apostolou O. , Kotsini V. , Pappas S. I. 
Published: March 2003

Summary Aim To assess the prevalence of hepatitis C virus (HCV) among Greek patients with Type 1 and 2 diabetes mellitus (DM), in view of the previous reports of high prevalence, particularly in patients with elevated aminotransferase. Methods We checked 423 diabetic patients (183 male, 240 female, mean age: 63 years) attending our unit, recording epidemiology data, diabetes history, treatment and classification. Patients were stratified by aminotransferase values (normal or elevated). HCV screening was performed using standard techniques. Statistical analysis was done by using the Student’s t‐test for continuous variables and chi‐square (χ2) for categorical data. Results Antibodies against HCV (anti‐HCV) were detected in seven out of 423 diabetic patients (prevalence 1.65%). There was no correlation between HCV titre and diabetes type, duration, treatment, obesity (body mass index, BMI) or glycaemic control (HbA1c). The only correlation was elevated aminotransferase values (P < 0.01) Among the established risk factors for HCV transmission, only history of previous transfusion was significant (P < 0.001). Conclusions It remains a strong hypothesis that diabetic patients are at increased HCV infection risk, yet our findings in Greek diabetic patients were rather low. Further studies, possibly multicentre, are needed to estimate prevalence and address the question of whether a direct effect of HCV in diabetes development does actually exist.Diabet. Med. 16, 250–252 (1999)
Digital imaging: an accurate and easy method of measuring foot ulcers
Authors: Rajbhandari S. M. , Harris N. D. , Sutton M. , Lockett C. , Eaton S. , Gadour M. , Tesfaye S. , Ward J. D. 
Published: March 2003

Summary Aims A progressive reduction in the area of foot ulcer on serial measurement is traditionally done by tracing the margin of the ulcer on a transparent film and counting the number of squares on a graph paper underneath. We set out to use and validate the measurement of foot ulcers using a digital imaging technique and compare this with the traditional method. Methods Thirty diabetic foot ulcers (18 patients) were studied over 10 weeks. Each ulcer was traced by three independent observers with a pen over a flexigrid Opsite film and digital photographs were taken. Each observer calculated the area of an ulcer first using a 1‐mm2 graph paper and then with the computer software. For each ulcer we calculated the mean area using measurements from all the observers. We then calculated the deviation from this mean for each observer. Results There was significantly less interobserver variation using the digital image than the traditional method with mean coefficient of variation (CV) 16% vs. 27%; P = 0.05. Conclusions The digital imaging method was faster and easier to use and the patients preferred it, as it was a noncontact method. In addition it also provides a photographic record for comparison.Diabet. Med. 16, 339–342 (1999)
Impact of ubiquinone (coenzyme Q10) treatment on glycaemic control, insulin requirement and well‐being in patients with Type 1 diabetes mellitus
Authors: Henriksen J. E. , Andersen C. Bruun , Hother‐Nielsen O. , Vaag A. , Mortensen S. Aage , Beck‐Nielsen H. 
Published: March 2003

Summary Aim To investigate the effect of ubiquinone (coenzyme Q10) on glycaemic control and insulin requirement in patients with Type 1 diabetes mellitus (DM). Methods We investigated 34 patients with Type 1 DM in a randomized, double‐blind, placebo‐controlled study. Patients received either 100 mg Q10 or placebo daily for 3 months. The insulin doses were adjusted according to patients’ home measurements of blood glucose concentrations and reported experience of hypoglycaemia. Results At randomization no differences existed between the Q10 and the placebo groups in age, body mass index (BMI), HbA1c, daily insulin dose or mean daily blood glucose concentration. Serum Q10 concentration increased in the Q10 group (mean ± sd: 0.9 ± 0.2 vs. 2.0 ± 1.0 μg/ml, P < 0.005), with no change in the placebo group (0.9 ± 0.3 vs. 0.9 ± 0.3 μg/ml, not significant (NS)). Following intervention no differences existed between the Q10 and the placebo groups regarding HbA1c (7.86 ± 0.88 vs. 7.84 ± 0.84%), mean daily blood glucose concentrations (8.06 ± 1.86 vs. 8.53 ± 1.88 m
m), mean insulin dose (52.1 ± 13.2 vs. 52.6 ± 21.4 U), hypoglycaemic episodes (2.0 ± 1.8 vs. 2.5 ± 2.1 episodes/week), or cholesterol concentrations (4.81 ± 0.91 vs. 4.78 ± 1.07 m
m). Furthermore, no differences existed in the well‐being of the patients reported from a visual analogue scale (physical: 0.67 ± 0.21 vs. 0.71 ± 0.18, psychological: 0.70 ± 0.25 vs. 0.73 ± 0.24). Conclusion Q10 treatment does not improve glycaemic control, nor does it reduce insulin requirement, and it can therefore be taken by patients with Type 1 DM without any obvious risk of hypoglycaemia. No major beneficial or unfavourable effects on the investigated parameters could be demonstrated and no major changes in the sense of well‐being occurred in the patients.Diabet. Med. 16, 312–318 (1999)
Episodic hyperglycaemia in pregnant women with well‐controlled Type 1 diabetes mellitus: a major potential factor underlying macrosomia
Authors: Kyne‐Grzebalski D. , Wood L. , Marshall S. M. , Taylor R. 
Published: March 2003

Summary Aims To test the common assumption that pregnant women who are sufficiently motivated to achieve very good HbA1c levels will record home blood glucose data accurately. Methods A new device was used to download information from electronic blood glucose meters to assess the extent of selectivity in patient glucose diary‐keeping. Results In an index case, a woman with excellent ambient HbA1c (5.9%; upper limit of normal 6.1%) was observed to have 68% of preprandial blood glucose readings above the target range of 3.5–6.5 mmol/l and a mean (± sd) level of 8.9 ± 3.9 mmol/l in the corresponding period. No such impression was conveyed by the home monitoring diary. Six pregnant women with well controlled Type 1 diabetes (mean HbA1c 6.6 ± 0.2%) exhibited between 42 and 68% of preprandial readings above the target range. Conclusions The frequency of hyperglycaemia has hitherto been underestimated in well controlled pregnant women whose near‐perfect home monitoring record is apparently corroborated by near‐normal HbA1c levels. These observations provide a hypothesis for understanding of the disappointing continuance of macrosomia despite excellent HbA1c levels throughout pregnancy.
Incidence of childhood‐onset Type 1 diabetes mellitus in Devon and Cornwall, England, 1975–1996
Authors: Zhao H. X. , Stenhouse E. , Soper C. , Hughes P. , Sanderson E. , Baumer J. H. , Demaine A. G. , Millward B. A. 
Published: March 2003

Summary Aims To determine the incidence of Type 1 diabetes mellitus (DM) in children aged 0–15 years in the far south‐west of England between 1975 and 1996. Methods Patient information was collected to set up the Cornwall and Plymouth Children’s Diabetes Register (CPCDR) through two main data sources; hospitals and the general practitioners in all surgeries in the study region. All children under 16 years living within Cornwall and the Isles of Scilly, and the former Plymouth Health Authorities and diagnosed as having Type 1 DM during the study period were included. The case ascertainment was estimated by a capture–recapture method. Trends and differences in incidence of sex, age, time period and district of diagnosis were analysed by Poisson regression analysis. Roger’s method was used to estimate the seasonal variations. Results A total of 522 subjects aged between 0 and 15 years were identified from 01/01/1975 to 31/12/1996, giving an overall crude incidence of 14.9/100 000 population/year. The case ascertainment was 94.4% (95% confidence interval (CI) 91.4– 97.6%) for the whole register. Poisson regression analysis showed that a significant increase of incidence (2.49% per year) was observed throughout the 22‐year study period, which was mainly a result of the significant increase in the 0–4 year age‐group (6.29% per year). The incidence significantly differed among the 22‐years (P=  0.007), the three age groups (0–4, 5–9 and 10–14 years, P <  0.001) and different sexes (P=  0.049). The significant seasonal variations were detected with peak incidence appearing in autumn and winter. Conclusions The first validated childhood‐onset diabetes register has been set up in the far south‐west of England. The incidence of childhood Type 1 DM in this region has increased significantly over the past two decades, especially in children under 5 years.
‘Numbness of the feet’ is a poor indicator for polyneuropathy in Type 2 diabetic patients
Authors: Franse L. V. , Valk G. D. , Dekker J. H. , Heine R. J. , Van Eijk J. T. M. 
Published: March 2003

Summary Aims To identify neuropathic sensory symptoms associated with a clinical neurological examination (CNE) and to investigate whether these symptoms could be used as a diagnostic or screening tool for diabetic polyneuropathy in general practice. Methods Five hundred and eighty‐eight patients with Type 2 diabetes, recruited from 26 general practices in the Netherlands, underwent a CNE and completed a diabetes symptom checklist that included 10 items on neuropathic sensory symptoms. Linear regression analyses were performed to assess the association between neuropathic symptoms and CNE. Receiver operating characteristic (ROC) curves were created to assess the diagnostic properties of neuropathic symptoms. Results In this population, with a mean age of 66.8 years, 32% were identified with diabetic polyneuropathy according to the CNE. Variables that showed the strongest association with CNE score were age (β = 0.41), symptoms of sensory alteration (β = 0.27), and the item ‘numbness of the feet’ (β = 0.35) in particular. ROC curves showed that prediction of diabetic polyneuropathy from these symptoms was unsatisfying. The sensitivity and specificity of daily symptoms of ‘numbness of the feet’ were 28% and 93%, respectively, in patients < 68 years, and 22% and 92%, respectively, in patients ≥ 68 years. Conclusions Identification of neuropathic sensory symptoms is not useful as a diagnostic or even a screening tool in the assessment of diabetic neuropathy in daily practice. Therefore, the results reported in this paper mandate an annual foot examination by the general practitioner.
Education integrated into structured general practice care for Type 2 diabetic patients results in sustained improvement of disease knowledge and self‐care
Authors: Van Den Arend I. J. M. , Stolk R. P. , Rutten G. E. H. M. , Schrijvers G. J. P. 
Published: March 2003

Summary Aims The objective of this study was to study the effectiveness of structured care with and without integrated education with regard to patients' knowledge, self‐care behaviour and disease perception. Methods Four diabetes care programmes implemented in a daily primary care setting were compared, two based on structured care and two on education integrated into structured care. Measurements were taken at baseline and after 6 and 12 months. Results The study included 243 patients with Type 2 diabetes mellitus treated by a general practitioner (mean age 64.0 years; diabetes duration 7.1 years). The level of patients' disease knowledge increased in all programmes, was preserved at follow‐up and differed between programmes with a specific educational component (37%) on one hand and the non‐educational programmes (11%) on the other (P < 0.001). The percentage of patients performing self‐care behaviour increased in all programmes, but more so in the programmes with an educational component. In addition, an increase in the frequency of self‐care behaviour was observed, whereas no change in disease perception was found. In cross sectional analyses disease knowledge and self‐care behaviour were positively related (partial correlation coefficient: 0.35; P < 0.001 adjusted for age, sex, level of education and duration of diabetes). Conclusions The results indicate that primary care programmes which integrated education into structured care are able to improve both Type 2 diabetic patients' disease knowledge and their self‐care behaviour. These improvements endured after the completion of the programmes, which suggests that they initiate lasting changes in the way patients handle their disease.
Sorbitol and myo‐inositol levels and morphology of sural nerve in relation to peripheral nerve function and clinical neuropathy in men with diabetic, impaired, and normal glucose tolerance
Authors: Sundkvist G. , Dahlin L. ‐B. , Nilsson H. , Eriksson K. ‐F. , Lindgärde F. , Rosén I. , Lattimer S. A. , Sima A. A. F. , Sullivan K. , Greene D. A. 
Published: March 2003

Abstracts Aims Sorbitol and myo‐inositol levels and morphology of sural nerve were compared with nerve function and clinical neuropathy in men with diabetic, impaired (IGT), and normal glucose tolerance. Methods After neurography of sural nerve and determinations of sensory thresholds for vibration, warm and cold on the foot, whole nerve sural nerve biopsy was performed in 10 men with Type 1 diabetes mellitus, 10 with IGT, and 10 with normal glucose tolerance. Polyol levels were assessed by gas–liquid chromatography/mass spectrometry. Results Sural nerve amplitudes were significantly lower and sorbitol levels significantly higher in diabetic patients (median (interquartile range)) (3.7 (3.5) μV and 643 (412) pmol/mg protein, respectively) both compared with IGT (11.3 (10.6) μV; P = 0.04 and 286 (83) pmol/mg protein; P = 0.0032, respectively) and normally glucose tolerant (10.0 (11.6); P = 0.0142 and 296 (250) pmol/mg protein; P = 0.0191, respectively) subjects. There were no differences in nerve morphology between the three groups. Nerve myo‐inositol levels correlated, however, positively with cluster density (rs = 0.56; P = 0.0054). In diabetic and IGT subjects, sural nerve amplitudes (2.6 (3.8) vs. 12.1 (10.6) μV; P = 0.0246) and myelinated nerve fibre density (MNFD; 4076 (1091) vs. 5219 (668) nerve fibres/mm2; P = 0.0021) were significantly lower in nine subjects with clinical neuropathy than in 10 without. Conclusions Nerve degeneration (i.e. MNFD) correlated with clinical neuropathy but not with glucose tolerance status whereas nerve myo‐inositol levels positively correlated with signs of nerve regeneration (i.e. increased cluster density).
Increased left ventricular mass index and nocturnal systolic blood pressure in patients with Type 2 diabetes mellitus and microalbuminuria
Authors: Rutter M. K. , McComb J. M. , Forster J. , Brady S. , Marshall S. M. 
Published: March 2003

Abstract Aims To compare left ventricular mass (LVM) index and function in patients with Type 2 diabetes mellitus with and without microalbuminuria and to investigate the clinical determinants of left ventricular hypertrophy. Methods Echocardiography, electrocardiography and 24‐h ambulatory blood pressure monitoring were performed in microalbuminuric (n = 29) and normoalbuminuric (n = 29) patients with Type 2 diabetes and no clinical evidence of heart disease. Groups were individually matched for age, sex and diabetes duration and smoking status. Results LVM index (62 (34–87) vs. 52 (33–89) g/m2.7, P = 0.04) and LVH prevalence, using two out of three definitions, were greater in patients with microalbuminuria (LVM/height2.7: 72 vs. 59%, P = 0.27, LVM/height: 66 vs. 38%, P = 0.04, LVM/body surface area: 59 vs. 31%, P = 0.03). Night‐time systolic blood pressure (126 (99–163) vs. 120 (104–157) mmHg, P = 0.005) and the night/day systolic blood pressure ratio (0.92 (0.08) vs. 0.88 (0.06), P = 0.04) were higher in those with microalbuminuria. Systolic and diastolic function were similar in both groups. Linear regression analyses showed that body mass index (BMI) was significantly related to loge LVM index (R2 = 11.8%, P = 0.005) and a relationship with night/day systolic blood pressure was also suggested (R2 = 4.6%, P = 0.057). Conclusions In patients with Type 2 diabetes, LVH is more common and severe in those with microalbuminuria. Its presence may be related to raised night/day systolic blood pressure ratio and is significantly related to BMI. The high prevalence of LVH strengthens the case for echocardiographic screening in Type 2 diabetes to identify high risk patients who might benefit from aggressive cardiovascular risk factor intervention.
Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with a similar risk profile
Authors: Jensen D. M. , Sørensen B. , Feilberg‐Jørgensen N. , Westergaard J. G. , Beck‐Nielsen H. 
Published: March 2003

Abstract Aims To assess maternal and fetal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM) compared to non‐diabetic pregnancies with an otherwise similar risk profile and to study the association between different anti‐diabetic treatments and fetal outcomes. Methods The records of 143 consecutive GDM pregnancies and 143 non‐diabetic controls matched on the basis of age, parity and pre‐pregnancy body mass index (BMI) were studied. The GDM patients were treated with diet, tolbutamide and insulin. Data were collected from medical records and birth records. Results Despite treatment, the GDM group had a statistically significant higher frequency of maternal hypertension (20% vs. 11%), induction of labour (61% vs. 24%), Caesarean section (33% vs. 21%), macrosomia (14% vs. 6%), neonatal hypoglycaemia (24% vs. 0) and admission to a neonatal unit (46% vs. 12%). The risk of complications was similar in the different treatment groups. However, in the tolbutamide‐treated group, one case of long‐standing severe hypoglycaemia in a premature neonate occurred. Conclusions Pregnancies complicated by GDM are associated with a higher frequency of adverse maternal and fetal outcomes. The outcomes seem to be unaffected by treatment modality. However, because of the potential risk of hypoglycaemia in some neonates, tolbutamide treatment cannot be recommended in pregnancy.