bluuebunny/crossref_metadata_2025_split huggingface dataset:
Priapism in sickle‐cell disease; incidence, risk factors and complications – an international multicentre study
Authors: Adeyoju A.B. , Olujohungbe A.B.K. , Morris J. , Yardumian A. , Bareford D. , Akenova A. , Akinyanju O. , Cinkotai K. , O'Reilly P.H. 
Published: March 2003

Objective  To define the incidence, risk factors and complications of priapism in a large population of patients with sickle‐cell anaemia in five centres in the UK and Nigeria, as priapism is common among these patients, but the precise characteristics of the condition in this population are poorly documented.Patients and methods  A questionnaire was developed and administered to patients with sickle‐cell disease. Questions were designed to define the incidence, nature, precipitants, duration, treatment and complications of priapism. A distinction was made between acute (severe) priapism and the recurrent, ‘stuttering’ type.Results  The questionnaire was completed by 130 patients (mean age 25 years, sd 11, range 4–66) from the five centres; 102 (78%) were homozygous Hb SS genotype, 19 (15%) were Hb SC genotype and two (1.5%) were Hb Sα−thalassaemia. Of the patients, 46 (35%) reported a history of priapism, and of these, 33 (72%) had a history of stuttering priapism, while 24 (52%) had had an acute episode of priapism. The mean age of onset of priapism was 15 years, with 75% of patients having the first episode before their 20th birthday. Sexual activity was the most frequent precipitating factor, with fever and/or dehydration being the next most common. Of the 46 patients, 10 (21%) with a history of priapism reported having erectile dysfunction. A similar proportion reported dissatisfaction with sexual intercourse, including a fear of engaging in sexual activity.Conclusion  The incidence of priapism among patients with sickle‐cell anaemia is high (35%). The implications of priapism for erectile and sexual function are significant and documented in this large series. The treatment of this condition in these patients remains unstandardised. This study highlights the need for an increased awareness of the problems associated with priapism among patients, families and medical professionals.
Histopathological evaluation of the urethra after the Snodgrass operation: an experimental study in rabbits
Authors: Genç A. , TanelI. C. , Günşar C. , Türkdoğan P. , Yilmaz Ö. , Arslan O.A. , Mir E. 
Published: March 2003

Objective  To investigate the histopathological outcome of the incised urethral plate after tubularized incised‐plate urethroplasty (the Snodgrass procedure to repair hypospadias) in a hypospadiac rabbit model, as it can produce meatal and neourethral strictures, and healing with scarring.Materials and methods  The study comprised 10 male New Zealand White rabbits (2.2–2.4 kg); under general anaesthesia the ventral urethra was completely excised 1 cm from the meatus proximally and a model of hypospadias formed. A full‐thickness incision was then made in the distal dorsal urethra and the two sides of the incision marked by Indian ink tattooing. After placing a feeding tube (5 F) as a urethral catheter, both urethral wings were sutured ventrally by a 7/0 polydioxanone running suture, and the penile skin approximated by 5/0 chromic catgut. At 21 days and 3 months after surgery the penises were harvested, assessed histopathologically, and compared with those from control untreated rabbits of the same age and weight.Results  In the study group the incised area of the dorsal urethra was re‐epithelialized; the regional tissue and vascularity were normal.Conclusion  In this rabbit model the dorsal urethral incisions healed with no scar tissue; only the ventral suture lines had minimal fibrosis and inflammatory reaction.
Sildenafil influences lower urinary tract symptoms
Authors: Sairam K. , Kulinskaya E. , McNicholas T.A. , Boustead G.B. , Hanbury D.C. 
Published: March 2003

Objective  To assess the possible relationship between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) in men, and whether treatment of their ED with sildenafil influences their LUTS.Patients and methods  In all, 112 men with ED attending the andrology outpatient clinic were offered oral sildenafil and reviewed 1 and 3 months after treatment. They completed the International Index of Erectile Function and the International Prostate Symptom Score (IPSS) questionnaires at baseline and each review. Scores were designated to indicate the visit number and differences between the visits calculated.Results  A third of the men had an initial IPSS of > 7; there was no relationship between baseline urinary and sexual function scores. After treatment with sildenafil, the urinary scores at 3 months correlated strongly with the sexual function scores. There was a significant inverse relationship between the baseline IPSS and sexual function scores after treatment. The overall trend in the IPSS was towards improvement after treatment with sildenafil.Conclusions  In men with ED there is no relationship between sexual function scores and urinary symptom scores before treating ED. Treatment with sildenafil appears to improve urinary symptom scores. A lower IPSS at baseline appears to predict a better response to ED therapy with sildenafil.
A radiation perspective for treating loin pain in pregnancy by double‐pigtail stents
Authors: Hellawell G.O. , Cowan N.C. , Holt S.J. , Mutch S.J. 
Published: March 2003

Objective:  To review the risks of placing double‐pigtail stents during pregnancy in women presenting with loin pain associated with hydronephrosis.Patients and methods  A consecutive series of women presenting with loin pain and hydronephrosis in pregnancy were treated with double‐pigtail ureteric stents. A flexible cystoscope was used to identify the ureteric orifice and to pass a guidewire into the renal pelvis under fluoroscopic guidance. Stents were placed using the exchange technique over a stiff guidewire. Procedures were carried out under none or limited sedoanalgesia. Screening times and radiation dose were recorded. Data were collected for the average uterine radiation dose from a variety of radiological procedures. Previous publications were reviewed to determine the lethal, teratogenic and carcinogenic risk to the developing fetus from radiation exposure.Results  Seven patients referred with symptomatic hydronephrosis during pregnancy were treated. The screening time during placement was minimized. The mean (range) uterus (i.e. fetal) dose was 0.40 (0.03–0.79) mGy. Most radiological procedures involve uterine doses of < 20 mGy, far below the 100 mGy that may result in fetal damage during periods of maximum radiosensitivity.Conclusion  Minimized radiation exposure from a range of uroradiological procedures in pregnant women has limited fetal risk. The use of fluoroscopy for symptomatic hydronephrosis during pregnancy allows ureteric stents to be placed safely and reliably. The average excess risk to the fetus from this procedure is 1 in 43 000 of cancer induction and 1 in 100 000 of heritable disease, i.e. very small when compared with the natural incidence. Pregnancy should not exclude the use of appropriate diagnostic radiation exposure and urologists may conduct appropriate diagnostic and therapeutic procedures, taking care to limit X‐ray exposure without fear of risk to the developing fetus.
Knowledge of female bladder care among medical staff, nurses and midwives: results of a questionnaire survey
Authors: Williams A. , Taylor K. , Bates C. , Tincello D.G. , Richmond D.H. 
Published: March 2003

OBJECTIVETo determine knowledge about bladder care among junior medical staff and allied health professionals, and to examine any difference in knowledge among the subgroups.SUBJECTS AND METHODSUsing a single‐questionnaire survey in a large obstetrics and gynaecology Hospital Trust in an inner city setting, midwives, nurses and medical staff (not consultants) were asked eight questions about different aspects of female bladder physiology and care. The differences in responses among the professional groups were assessed.RESULTSIn all, 120 completed questionnaires were returned (32 doctors, 40 nurses, and 48 midwives). Knowledge was similar on urethral length, bladder capacity, daily fluid intake, ideal size of catheter, catheter balloon size, and the maximum time of use of a short‐term catheter. Correct responses for normal daily fluid intake, duration of both short and long‐term catheterization were given by fewer than half the respondents. There were significant differences among the professional groups in the correct response rate for long‐term catheter duration (P = 0.031) and the normal time interval between voids (P = 0.038).CONCLUSIONThere were significant differences in the knowledge of all subgroups about bladder care, and poor levels of knowledge in several areas. This is a potentially serious problem for women at risk of bladder complications after gynaecological surgery and childbirth. All staff involved in managing women after childbirth and gynaecological surgery should have formal training in bladder care, to optimize patient care.
A prospective evaluation of detrusor ultrastructural changes in bladder outlet obstruction
Authors: Brierly R.D. , Hindley R.G. , McLarty E. , Harding D.M. , Thomas P.J. 
Published: March 2003

OBJECTIVESTo characterize the ultrastructure of detrusor smooth muscle from the bladders of symptomatic men with bladder outlet obstruction (BOO) caused by benign prostatic enlargement (BPE) and compare this with a matched control group; to determine how detrusor morphology relates to urodynamic findings and to develop a better understanding of the natural development of bladder dysfunction related to BOO.PATIENTS AND METHODSTwelve men (mean age 66 years, range 52–77) with urodynamically confirmed BOO caused by BPE and 12 age‐matched asymptomatic normally voiding controls (mean age 67.8 years, undergoing cystoscopy for other conditions) had detrusor biopsies taken endoscopically. The biopsies were processed for electron microscopy using standard methods. The specimens were randomized and examined at medium power (× 4000) by an examiner unaware of the urodynamic findings. Any ultrastructural patterns identified subjectively were noted.RESULTSIn the BOO group eight of the 12 men had a myohypertrophic pattern, half of which were associated with a degenerative pattern of hypocontractility. Of the remaining four patients, two had the degenerative pattern alone and two were normal. The six men whose biopsies had a degenerative pattern had consistent postvoid residual volumes of> 150 mL; the remainder all had volumes of < 150 mL. There were no ultrastructural abnormalities in the control patients.CONCLUSIONSThere are interesting qualitative ultrastructural changes in the obstructed detrusor, but they are not consistent enough to provide a reliable diagnostic tool. However, there may be an important relationship between the degenerative pattern and postvoid residual volume in BOO.
Improvements in the provision of hospital diabetes services in an English region 1988–98
Authors: Parr J. H. , Kelly W. F. , Large D. M. , Roberts S. H. 
Published: March 2003

AbstractAims To investigate the changes in provision of hospital‐based services for patients with diabetes in an English region over a 10‐year period.Methods Questionnaires were completed by lead clinicians in hospitals in the Northern region of England in 1988 and repeated in 1998. Information was sought on diabetes service provision including the staff and their working practices. Data are presented to demonstrate changes during the 10 years.Results During a 10‐year period the number of consultants providing specialized diabetes services increased from 16 to 25 (to become one per 126 240 population). Their outpatient sessions changed from 34 to 55.5 per week, with a decrease in nonspecialists providing diabetes services. Reductions occurred in registrar numbers providing sessions from 23 to 15 and senior house officers from 16 to 14. Increases occurred in other health care professionals: diabetes specialist nurses from 19 to 30.3 whole time equivalents (WTEs); dieticians from 16 to 32.3 WTEs and chiropodists from 8 to 23 WTEs. The numbers of specialized clinics and units providing services from diabetes care centres increased. Improved facilities in clinics and access to laboratory tests were available to all units. Diabetes registers came into use in 12 of 16 units, but there have been difficulties in providing funding. ‘Out‐of‐hours’ advice has moved towards advising their patients to see their general practitioners or the accident and emergency department of the hospitals.Conclusions The number of diabetes professional staff and the provision of specialized diabetes services have increased during a 10‐year period in the Northern region of England. However, they still fall far short of recommended staffing levels and services are far from comprehensive in most districts.
Comparison of effects of captopril used either alone or in combination with a thiazide diuretic on insulin action in hypertensive Type 2 diabetic patients: a double‐blind crossover study
Authors: Hunter S. J. , Wiggam M. I. , Ennis C. N. , Whitehead H. M. , Sheridan B. , Atkinson A. B. , Bell P. M. 
Published: March 2003

Summary Aims It has been suggested that the adverse metabolic effects of antihypertensive therapy offset some of the benefits of blood pressure reduction. It has also been suggested that angiotensin converting enzyme (ACE) inhibitors reduce insulin resistance and that, if used together with thiazide diuretics, the adverse effects of thiazides on insulin sensitivity may be eliminated. We examined the effects on insulin sensitivity of captopril either alone or in combination with bendrofluazide in 11 hypertensive Type 2 diabetic patients. Methods Insulin action was assessed using an isoglycaemic hyperinsulinaemic clamp in a double‐blind, randomized, crossover study after a 6‐week placebo run‐in and following two 12‐week treatment periods with captopril (C) (100 mg) alone or in combination with bendrofluazide (CB) (2.5 mg). Results Blood pressure was lower following CB compared to C (128/82 vs. 144/88 mmHg; P < 0.005) and both were lower than baseline (162/101 mmHg; P < 0.001). CB resulted in a significant increase in fasting plasma glucose compared to C (9.7 ± 0.8 vs. 8.5 ± 0.6 mmol/l; P < 0.05). Exogenous glucose infusion rates required to maintain isoglycaemia during hyperinsulinaemia were lower after CB compared to C (22.3 ± 2.4 vs. 27.4 ± 4.2 mol.kg‐1.min‐1; P < 0.05). Suppression of endogenous glucose production was reduced after CB compared to baseline (4.0 ± 0.6 vs. 2.4 ± 0.5 mol.kg‐1.min‐1; P < 0.05). Conclusions Combination of bendrofluazide with captopril lowered blood pressure but resulted in deleterious effects on insulin action compared to captopril alone.
Effect of oral vitamin E (α‐tocopherol) supplementation on vascular endothelial function in Type 2 diabetes mellitus
Authors: Gazis A. , White D. J. , Page S. R. , Cockcroft J. R. 
Published: March 2003

Summary Aims Vascular endothelial dysfunction, an early marker of atherosclerosis, has been demonstrated in Type 2 diabetes mellitus (DM). Vitamin E preserves endothelial function in animal models of diabetes and reduces cardiovascular risk. We examined endothelial function and the effect of vitamin E supplements in uncomplicated Type 2 DM. Methods Forty‐eight subjects with Type 2 DM and 21 controls had endothelial function assessed using forearm venous occlusion plethysmography with endothelium‐independent (sodium nitroprusside) and dependent (acetylcholine, bradykinin) vasodilators. Those with diabetes received 1600 iu daily oral α‐tocopherol or placebo, double‐blind for 8 weeks, and had endothelial function reassessed. Results The diabetic group had higher HbA1c (6.9 ± 1.4 vs 4.8 ± 0.6%; P < 0.01) and systolic (145 ± 15 vs 130 ± 16 mmHg; P < 0.01) but not diastolic blood pressure (79 ± 8 vs 76 ± 9 mmHg; P = 0.15). There was blunted vasodilation to acetylcholine (15 μg/min; P < 0.01) in subjects with diabetes. Vasodilation to sodium nitroprusside and bradykinin was similar (all P > 0.1). α‐tocopherol did not affect vasodilation to nitroprusside (P > 0.1), acetylcholine (P > 0.1) or bradykinin (P > 0.1). Conclusions There may be receptor‐specific endothelial dysfunction in subjects with uncomplicated Type 2 DM. This is not improved by treatment with α‐tocopherol.Diabet. Med. 16, 304–311 (1999)
Glycaemic control and familial factors determine hyperlipidaemia in early childhood diabetes
Authors: Abraha A. , Schultz C. , Konopelska‐Bahu T. , James T. , Watts A. , Stratton I. M. , Matthews D. R. , Dunger D. B. 
Published: March 2003

Summary Aims To determine whether abnormal lipid levels in children with Type 1 diabetes mellitus are the result of poor metabolic control or may in part be determined by genetic factors. Methods Non‐fasting lipid levels were measured in 141 children with Type 1 diabetes (age range 7.7–19 years) 3 years after diagnosis, and in 192 of their parents. Glycosylated haemoglobin and the urinary albumin–creatinine ratio (three urine samples) were estimated in each child annually. Results The children had a mean total cholesterol of 4.46 ± 1.25 mmol/l (± SD) and a median triacylglycerol of 1.18 mmol/l (range 0.32–4.7). A total of 15.3% of the population had a total cholesterol > 5.2 mmol/l and 17.9% had a triacylglycerol > 1.7 mmol/l; in 5.6% both total cholesterol and triacylglycerol were greater than these cut‐off points. Total cholesterol, triacylglycerol and very low density lipoprotein‐cholesterol were significantly correlated to glycaemic control. However, total cholesterol was also significantly related to parental total cholesterol either as analysed separately or as mean parental total cholesterol (r = 0.37, P = 0.0001). In stepwise multiple regression analysis both mean parental total cholesterol (P = 0.001) and HbA1c (P = 0.015) were significant determinants of the child’s total cholesterol. The children studied were being followed prospectively for the development of microalbuminuria and there was a weak association across tertiles of total cholesterol, linking higher levels to the development of microalbuminuria (P < 0.05). Conclusions We conclude that both glycaemic control and familial factors may be important determinants of lipid levels in young people with diabetes. Both may contribute to the subsequent risk of cardiovascular disease and possibly the development of incipient diabetic nephropathy.
Vascularized pancreas allotransplantation – clinical indications and outcome
Authors: White S. A. , Nicholson M. L. , London N. J. M. 
Published: March 2003

SummaryAimsThis review examines the status of vascularized pancreas transplantation as a treatment for Type 1 diabetes mellitus (DM).MethodsThe world literature, with a particular emphasis on data from the International Pancreas Transplant Registry (IPTR), is reviewed and interpreted particularly for clinical indications and outcome.ResultsOver 9000 cases of vascularized pancreas transplant (VPT) have been registered, with insulin dependence approaching 82% at 1 year with 94% patient survival. The majority of transplants are simultaneous pancreas and kidney (SPK) transplants, with far fewer pancreas after kidney (PAK) or pancreas transplants alone (PTA). The success rates differ between the procedures but are generally improving as technical advances, improvements in immunosupression and greater experience are gained. The most obvious advantage is an improved quality of life (QoL) but there are risks associated with the procedure and with the immunosuppression. There is some evidence coming to light of a very slow beneficial effect on microvascular complications.ConclusionsVPT is an attractive option to offer Type 1 DM patients who need or already have a renal allograft. Patients have to decide between the increased surgical risk and the risks of long‐term immunosuppression and the benefits of improved QoL. In the absense of end‐stage renal failure (ESRF) there is no justification for PTA, except where the diabetes itself poses a greater risk to life than the transplantation procedure.
Cross‐sectional but not longitudinal associations between non‐esterified fatty acid levels and glucose intolerance and other features of the metabolic syndrome
Authors: Byrne C. D. , Maison P. , Halsall D. , Martensz N. , Hales C. N. , Wareham N. J. 
Published: March 2003

Summary Aims Cross‐sectional studies have demonstrated an association between high non‐esterified fatty acid (NEFA) concentrations and glucose intolerance. However, the direction of causality in these studies is uncertain. The aim of this study was to examine whether NEFA levels predicted the development of glucose intolerance in a prospective population‐based cohort study. Methods Four hundred and eighty‐one women and 345 men participated in a prospective cohort study in which NEFA concentrations and glucose tolerance were measured at baseline and then repeated at follow‐up 4.5 years later. Results The data do not show longitudinal relationships between baseline NEFA levels and either glucose intolerance or other features of the metabolic syndrome at follow‐up. In contrast, strong cross‐sectional associations were observed between NEFA measures and glucose intolerance (and other features of the metabolic syndrome) in both baseline and follow‐up studies. At follow‐up, fasting NEFA levels and two measures of NEFA suppression were markedly different in subjects with features of the metabolic syndrome, compared to subjects with normal glucose tolerance (NGT) (NGT vs. metabolic syndrome for each NEFA value, P <  0.001). Conclusions These results support the hypothesis that plasma NEFA levels change as a consequence of the metabolic syndrome and do not support the notion that increased NEFA levels cause either the metabolic syndrome or diabetes.
Population‐based genetic screening for the estimation of Type 1 diabetes mellitus risk in Finland: selective genotyping of markers in the HLA‐DQB1, HLA‐DQA1 and HLA‐DRB1 loci
Authors: Nejentsev S. , Sjöroos M. , Soukka T. , Knip M. , Simell O. , Lövgren T. , Ilonen J. 
Published: March 2003

Summary Aims To improve sensitivity and specificity of the diabetes risk assessment of the population‐based genetic screening used in the Finnish Diabetes Prediction and Prevention (DIPP) trial. Methods One thousand consecutive newborns enrolled in the DIPP were compared with 316 samples from children with Type 1 diabetes mellitus. A modification of the previously described technique based on hybridization of relevant PCR products with five lanthanide‐labelled probes detected by time‐resolved fluorometry (TRF) was used. A new probe was designed and allowed discrimination between DQB1*0602 and *0603 alleles, in addition to DQB1*02, *0301 or *0302, each of which required specific probes. A new, added screening strategy was developed for individuals carrying low‐risk genotypes through specific typing of DQA1*05 and *0201 alleles in DQB1*02 positive, and DRB1 typing for DR4 subtypes in DQB1*0302 positive subjects, with a new specifically designed high‐resolution TRF‐based DR4 subtyping technique. Results This two‐step screening approach enhanced the sensitivity of the detection of genetic risk for Type 1 diabetes mellitus in this cohort up to 85.4%. In the general population cohort, 24.4% were identified for prospective follow‐up, 2.6% of these are expected to develop Type 1 diabetes mellitus before the age of 15 years. Exclusive typing for HLA‐DQB1 locus as an alternative screening strategy had sensitivities of 26.3–77.2% with general population cohorts of 2.3–23.1% identified for follow‐up. Conclusions The described strategy for genetic prediction of Type 1 diabetes mellitus relies on the convenient genotyping procedure and could be applied in large scale screening projects such as DIPP.