bluuebunny/crossref_metadata_2025_split huggingface dataset:
A new core‐biopsy instrument with an end‐cut technique provides prostate biopsies with increased tissue yield
Authors: Häggarth L. , Ekman P. , Egevad L. 
Published: March 2003

Objective  To evaluate the tissue yield of a new core‐biopsy needle with an end‐cut mechanism when used for transrectal prostate biopsies. Patients and methods  The end‐cut instrument has an adjustable stroke length (13, 23 or 33 mm) and an inner and an outer cannula, but no trocar. It was compared with the conventional side‐notch needle (Biopty, Bard, Covington, GA, USA) with trocar and fixed stroke length (22 mm). In 60 men, octant biopsies were taken including the apex, mid‐medial, mid‐lateral and basal positions. At random, the left side of the prostate was biopsied with one of the instruments and the right side with the other. The length and weight of the biopsy specimens were measured. In 40 men, the stroke length of the end‐cut instrument was set to 23 mm, and in 20 men it was set to 33 mm. Results

The weight and the weight per length of the biopsies provided by the end‐cut instrument with a stroke length of 23 mm were 18.4% and 13.7%, respectively, greater than in the biopsies from the side‐notch instrument (
P <0.001). In 21.9% of the attempts no tissue was obtained by the end‐cut needle, compared with 1.9% with the side‐notch needle. With a 33 mm stroke length, the length and weight of the end‐cut biopsies were 38.4% and 33.0%, respectively, greater than in biopsies from the side‐notch instrument. Conclusion  The end‐cut instrument provided a greater tissue yield than the side‐notch needle, but a significant number of biopsies were lost.
Heat versus drugs in the treatment of benign prostatic hyperplasia
Authors: Djavan B. , Seitz C. , Marberger M. 
Published: March 2003

SUMMARYThe improvement in symptoms and voiding function is greater with transurethral microwave thermotherapy than with drug therapy, and the associated morbidity is low. Transient urinary retention necessitating catheterization is of short duration after targeted microwave thermotherapy. The short‐term effect of microwave thermotherapy can be improved by neoadjuvant and adjuvant α‐blockade. Microwave treatment offers greater versatility than drug therapy, allowing patients with severe baseline symptoms and small prostates to be treated successfully. Medical management improves symptoms to a more modest extent than does microwave treatment. Finasteride gives comparatively small symptom and flow rate improvements and requires several months for the maximum responses. With α‐blockers the onset of action is fast and side‐effects reversible, although they limit their utility. Finasteride or α‐blockers must be continued indefinitely to maintain improvements in patients with BPH, but they have a favourable safety and tolerability profile.
Simplified bladder training augments the effectiveness of tolterodine in patients with an overactive bladder
Authors: Mattiasson A. , Blaakaer J. , Høye K. , Wein A.J. ,   The Tolterodine Scandinavian Study Group
Published: March 2003

OBJECTIVESTo compare the efficacy of tolterodine plus simplified bladder training (BT) with tolterodine alone in patients with an overactive bladder.PATIENTS AND METHODSIn a multicentre, single‐blind study at 51 Scandinavian centres, 505 patients aged ≥ 18 years with symptoms of urinary frequency (≥ 8 micturitions/24 h) and urgency, with or without urge incontinence, were randomized to oral treatment with either tolterodine 2 mg twice daily plus simplified BT or tolterodine alone. Changes in voiding diary variables were evaluated after 2, 12 and 24 weeks of treatment. The patients' perceptions of their bladder symptoms and tolerability (adverse events) were also determined.RESULTSIn all, 501 patients (75% women) were evaluable on an intention‐to‐treat basis (244 on tolterodine + BT and 257 on tolterodine alone). Tolterodine significantly reduced the voiding frequency and increased the volume voided per void at all sample times; these effects were significantly increased by adding BT. At the end of the study the median percentage reduction in voiding frequency was greater with tolterodine + BT than with tolterodine alone (33% vs 25%, P < 0.001), while the median percentage increase in volume voided per void was 31% with tolterodine + BT and 20% with tolterodine alone (P < 0.001). There was a median of 81% fewer incontinence episodes than at baseline with tolterodine alone, which was not significantly different from that with tolterodine + BT (− 87%). The two groups had comparable median percentage reductions in urgency episodes. Some 76% of patients on tolterodine + BT reported an improvement in their bladder symptoms relative to baseline, compared with 71% on tolterodine alone. Tolterodine was well tolerated; the most common adverse event was mild dry mouth.CONCLUSIONTolterodine 2 mg twice daily is an effective and well tolerated treatment for an overactive bladder, the effectiveness of which can be augmented by a simplified BT regimen.
A posterior‐based omega‐shaped flap vaginoplasty in girls with congenital adrenal hyperplasia caused by 21‐hydroxylase deficiency
Authors: Freitas Filho L.G. , Carnevale J. , Melo C.E.R. , Laks M. , Calcagno Silva M. 
Published: March 2003

OBJECTIVETo describe a technical modification for constructing a vagina in girls with congenital adrenal hyperplasia caused by 21‐hydroxylase deficiency, using a narrower skin base but rich subcutaneous tissue, aiming to obtain both longer and larger vaginal segments with better cosmesis of the external genitalia.PATIENTS AND METHODSFrom August 1997 to February 2001, 28 girls (aged 5 months to 17 years) had a neovagina constructed using a posterior‐based omega‐shaped flap. Twenty‐six patients had a low vagina entering into the urogenital sinus and two had a high vagina that entered the urogenital sinus. In those with a high vagina the flap procedure was combined with the Passerini‐Glazel technique. All the patients were scheduled for vaginal ‘calibrations’ during the first year after surgery and, according to the result, would then undergo vaginal dilatation.RESULTSSix children were re‐operated; five had plastic surgery to correct genital folds that had regained a scrotal aspect, whereas one with a high vagina developed a urethral stricture, with urinary dribbling and infection, and had the urethra reconstructed. These six children are currently well. No hormone therapy was given to one child for 1 year who is scheduled for further surgery for a re‐virilized clitoris. Two patients were lost to follow‐up. Up to the last visit, 19 girls had not developed a vaginal stricture and the cosmesis of their external genitalia was deemed good.CONCLUSIONThe posterior‐based omega‐shaped flap enabled both the construction of wider vaginal segments with a low risk of developing stenosis in those with a low vagina, and increased vaginal dimension when associated with the Passerini‐Glazel technique for those with a high vagina. However, despite good cosmesis of the external genitalia, the follow‐up is too short to confirm whether this technique will meet all the expectations.
Rotoresect for bloodless transurethral resection of the prostate: a 4‐year follow‐up
Authors: Michel M.S. , Knoll T. , Trojan L. , Köhrmann K.U. , Alken P. 
Published: March 2003

OBJECTIVETo report the results and long‐term follow‐up of transurethral resection of the prostate (TURP) with a new resection device, the Rotoresect (Karl Storz, Tuttlingen, Germany).PATIENTS AND METHODSMost endoscopic resection techniques for benign prostatic tissue aim for high ablation rates and minimal bleeding. Available resection electrodes are effective, but cause high blood loss (loop electrode), or less bleeding but poorer ablation rates (electrovaporization). To resolve these conflicts the Rotoresect was developed in 1995; it consists of a specially designed rotating resection electrode, driven by a micromotor, and a high‐frequency current to enable simultaneous coagulation, vaporization and mechanical tissue removal during resection. To date, 84 patients with benign prostatic hyperplasia have had their prostate resected with this device (mean prostate size 46.0, sd 18.4 mL) and have been assessed for up to 4 years.RESULTSDuring resection there was very little bleeding, with no significant changes in haemoglobin or sodium levels. The mean (sd) duration of catheterization was 1.4 (1.1) days; the urinary peak flow rate was improved from 9.7 (3.2) to 24.2 (8.23) mL/s and the residual urine volume reduced from 187.3 (109.6) to 22.7 (19.5) mL. The International Prostate Symptom Score and quality‐of‐life index were both improved, from 24.0 (7.5) to 4.1 (2.7), and 4.2 (3.2) to 0.8 (0.9), respectively. Overall the results were stable during the 4 years of follow‐up.CONCLUSIONThe Rotoresect combines the advantages of standard resection (high ablation rate) by actively rotating the resection electrode, and the haemostatic effect of electrovaporization (minimal blood loss) by simultaneous tissue coagulation and vaporization.
High‐energy transurethral microwave thermotherapy: symptomatic vs urodynamic success
Authors: Osman Y. , Wadie B. , El‐Diasty T. , Larson T. 
Published: March 2003

OBJECTIVETo evaluate the subjective and objective treatment results of high‐energy transurethral microwave thermotherapy (TUMT) for symptomatic benign prostatic hyperplasia (BPH), and investigate the possible variables for predicting symptomatic and/or urodynamic success.PATIENTS AND METHODSBetween October 1998 and October 2000, 40 men with BPH underwent high‐energy TUMT using the Targis device (Urologix, Inc., Minneapolis, MN, USA). Evaluation after treatment included a clinical determination of the symptom score, a urodynamic assessment by peak flow rate and pressure‐flow, magnetic resonance imaging (MRI), transrectal ultrasonography and endoscopy. The objective and subjective success was correlated with several variables before, during and after treatment.RESULTSAll patients completed at least 1 year of follow‐up after TUMT as monotherapy. The symptom score improved from a median (range) of 20.5 (11–28) initially to 9 (0–28) (P < 0.001). Twenty‐two patients (55%) had a marked and 11 (28%) a moderate response, giving an overall subjective success rate of 83%. Similarly, there was a significant improvement in peak flow rate, from 9.2 (4.4–13.4) to 15 (3.3–22.9) mL/s (P < 0.001). Twenty‐one patients (53%) had a maximum flow rate of> 15 mL/s while in eight (20%) it was 10–15 mL/s. Only 20 patients changed from unobstructed on the pressure‐flow nomogram, i.e. an overall objective success rate of 50%. Gadolinium‐enhanced T1‐weighted MRI 1 week after treatment showed a median (range) perfusion defect of 20.7 (5.5–76.6)% of the total gland volume. Despite this persisting in all patients, a well‐defined cavity was apparent in only in seven (18%) at the final evaluation. Cystoscopy 1 month after therapy showed evidence of necrotic tissue occupying the prostatic fossa in all patients. Younger patients were more likely to be urodynamically successful, and a higher grade of obstruction predicted symptomatic success.CONCLUSIONHigh‐energy TUMT can induce considerable necrosis of the prostate, as shown by MRI and cystoscopy. Although there was an adequate improvement in most patients' symptoms, there was a successful urodynamic change to unobstructed in only half the patients. Younger patients and those with a higher grade of obstruction were more likely to have urodynamic and symptomatic success, respectively.
The Audit Commission review of diabetes services in England and Wales, 1998–2001
Authors: Fitzsimons B. , Wilton L. , Lamont T. , McCulloch L. , Boyce J. 
Published: March 2003

AbstractAims of the Audit Commission The Audit Commission has a statutory duty to promote the best use of public money. It does this through value for money studies, such as that reported in Testing Times[1]. This work has been followed with a review of innovative practice in commissioning. These initiatives aim to support the implementation of the diabetes national service framework. The Audit Commission also appoints external auditors to NHS organizations who assess probity and value for money in the NHS; the latter by applying national studies locally and by carrying out local studies.Methods Research for Testing Times consisted of structured visits to nine acute trusts, a telephone survey of 26 health authorities and a postal survey of 1400 people with diabetes and 250 general practitioners. Local audits used a subset of the original research tools. Case studies were identified through a cascade approach to contacts established during Testing Times and through self‐nomination.Results Rising numbers of people with diabetes are placing increasing pressure on hospital services. Some health authorities and primary care organizations have reviewed patterns of service provision in the light of the increasing demands. These reviews show wide variations in patterns of routine care. In addition, there is a widespread lack of data on the delivery of structured care to people with diabetes. People with diabetes report delays in gaining access to services, and insufficient time with staff. There are insufficient arrangements in place for providing information and learning opportunities to support self‐management.Conclusion As the number of people with diabetes continues to rise, the potential for providing more care in a primary care setting needs to be explored. This will enable specialist services to focus more effectively on those with the most complex needs.
Metformin‐associated lactic acidosis: a rare or very rare clinical entity?
Authors: Chan N. N. , Brain H. P. S. , Feher M. D. 
Published: March 2003

SummaryAims Lactic acidosis is a well recognized complication of biguanide therapy which is potentially serious. Although the prevalence of metformin‐associated lactic acidosis (MALA) is much lower than that associated with phenformin, it is still being reported sporadically which raises concerns for the practising clinicians. We review the currently available world‐wide data of the prevalence of MALA, the risk factors for its development and the current practical guidelines on the use of metformin to minimize the risk of this potential hazard. Methods An extensive literature search was conducted from both Medline and Ovid (1965–98) using the following keywords: ‘Type 2 diabetes mellitus’, ‘oral hypoglycaemic drugs’, ‘biguanides’, ‘metformin‐associated lactic acidosis’ and ‘renal impairment’.Results MALA was found to be a very rare clinical entity, being 20 times less common than phenformin‐associated lactic acidosis. Amongst all the risk factors, renal impairment appears to be the major precipitating factor for the development of MALA in metformin‐treated patients. We also found cases of MALA where no precipitating factors were identified and the underlying mechanism in these cases remains unclear. Practical recommendations of metformin use to minimize the risk of MALA have been listed based on previous reports. Conclusions The low prevalence of MALA is comparable to the prevalence of sulphonylurea‐induced hypoglycaemia. Metformin has many beneficial metabolic effects in the management of Type 2 diabetes mellitus. Provided that the recommended guidelines for metformin use are strictly adhered to, its widespread use would be safe and the incidence of MALA will be further reduced.Diabet. Med. 16, 273–281 (1999)
Denial of disease in Type 2 diabetes mellitus: its influence on metabolic control and associated factors
Authors: Garay‐Sevilla M. E. , Malacara J. M. , Gutiérrez‐Roa A. , González E. 
Published: March 2003

Summary Aims We have investigated denial of disease in patients with Type 2 diabetes mellitus (DM) and its possible association with metabolic control, and with psychosocial variables: satisfaction with medical care, perceived stress, social support, knowledge of diabetes and belief in conventional medicine. Methods We studied 160 patients in a cross‐sectional design, in two groups: with (70) and without social security coverage (90). The mean age for the total group was 53.6 years, with a known diabetes duration of 8.1 years. Results Denial of disease was similar in those with ≤ 5 years since diagnosis (73 patients) and with > 5 years (87). The group without social security had higher scores of perceived stress, and lower scores of social support, knowledge about diabetes and belief in conventional medicine; denial, however, was similar in the two groups with or without social security. Multiple regression analysis showed that denial of disease was positively associated with HbA1c in the total group (P < 0.001), in the groups with ≤ 5 and > 5 years since diagnosis, as well as in the groups with or without social security. Denial was also associated with years since diagnosis (P = 0.009) for the group with ≤ 5 years since diagnosis. Conclusions We concluded that, in patients with Type 2 DM denial of disease increases with time during the first 5 years of evolution of diabetes; is associated with poor metabolic control; but is not associated with knowledge of diabetes, belief in conventional medicine, social support or perceived stress.Diabet. Med. 16, 238–244 (1999)
Do diabetes clinic attendees stay out of hospital? A matched case–control study
Authors: Goyder E. C. , Spiers N. , McNally P. G. , Mdrucquer . , Botha J. L. 
Published: March 2003

Summary Aims To examine whether routine care for diabetes mellitus influences the risk of hospital admission. Methods All people with diabetes in five randomly selected general practices in the city of Leicester were identified from medical records and prescribing information. Cases with a hospital admission between 1992 and 1995 but no admission in the preceding 2 years were compared with age‐matched controls in a nested study. Results The variables significantly associated with an increased risk of admission were duration of diabetes in years (OR 1.07, 95% confidence interval (CI) 1.03–1.11) and number of non‐diabetic drugs prescribed (OR 1.51, 95% CI 1.27–1.79). Having attended a hospital clinic in the previous 2 years was associated with reduced risk of admission (OR 0.30, 95% CI 0.14–0.65), whilst having been seen for a diabetes review in general practice was not (OR 0.91, 95% CI 0.41–1.99). Similar results were found for both diabetes‐related and unrelated admissions. Conclusions Although general practice‐based review was not associated with a change in the risk of admission, attendance at a hospital clinic was associated with a decreased risk of admission. These results may be explained by the characteristics of those who attend hospital clinics, as well as by the possible effectiveness of access to specialist services in reducing admissions.
Is glycation of low density lipoproteins in patients with Type 2 diabetes mellitus a LDL pre‐oxidative condition?
Authors: Moro E. , Alessandrini P. , Zambon C. , Pianetti S. , Pais M. , Cazzolato G. , Bon G. Bittolo 
Published: March 2003

Summary Aims The study aimed to evaluate whether low density lipoprotein (LDL) in diabetic patients is more glycated and susceptible to oxidation than in non‐diabetic subjects and investigated the hypothesis that LDL glycation is associated with an increased plasma concentration of LDL– (a circulating electronegatively charged LDL), proposed as an index of in vivo oxidation. Methods LDL glycation was measured by a competitive enzyme immunoadsorbent assay, using a monoclonal antibody against glycated apoB in 24 Type 2 diabetic patients and 12 healthy controls. LDL– was separated by ion‐exchange HPLC in LDL samples obtained after sequential preparative ultracentrifugation (density range 1.019–1.063). In vitro LDL susceptibility to oxidation was evaluated by following the kinetics of conjugated diene formation and by measuring the lag‐phase time in the presence of copper (Cu2+) ions. Results The percentages of glycated apoB (3.33 ± 2.54% vs. 1.24 ± 0.71%) and of LDL– (3.88  ± 1.49% vs. 2.34 ± 1.03%) in total LDL were significantly higher in diabetic patients (P < 0.01 for both). LDL– was positively correlated with glycated apoB (r = 0.68, P < 0.001). LDL isolated from Type 2 diabetic patients showed a significant decrease (P < 0.001) in the resistance to oxidative stress, as indicated by the shorter lag‐phase time (91 ± 12.6 vs. 120 ± 24.5 min). The lag‐phase time was inversely correlated with glycated apoB (r = –0.65, P < 0.001) and LDL– concentrations (r = –0.69, P < 0.001). Conclusions In this population of Type 2 diabetic patients, LDL were more glycated, more susceptible to in vitro oxidation and had a higher percentage of electronegative LDL. The glycation of apoB is proposed to be associated with a significative increase of in vivo and in vitro LDL oxidation.
Insulin resistance alone does not explain the clustering of cardiovascular risk factors in southern India
Authors: Snehalatha C. , Sivasankari S. , Satyavani K. , Vijay V. , Ramachandran A. 
Published: March 2003

Summary Aims To determine whether insulin resistance (IR calculated using the HOMA model) has a dominant role in the clustering of cardiovascular risk factors in the Asian Indian population. Methods A total of 654 non‐diabetic subjects aged ≥ 40 years (male 396: female 258) were selected from a population survey. They had estimates of fasting and 2 h plasma glucose, insulin levels, body mass index (BMI), waist‐to‐hip ratio (WHR) and blood pressure. Factor analysis was carried out using the principle components analysis (PCA) with varimax orthogonal rotation of continuously distributed variables, considered to represent the components of insulin resistance syndrome including the calculated IR. Results There were three major clusters of cardiovascular disease (CVD) risk variables in men and four clusters in women. Insulin resistance, 2 h plasma glucose, insulin and obesity aggregated as the major domain. Insulin resistance was not linked with hypertension. BMI was a common link for all the three factors in men, and for three of the four in women. Conclusions Insulin resistance is not the only underlying factor for the clustering of CVD risk factors in south Indians. These findings are consistent with the presence of several distinct physiological domains, as shown in other ethnic groups.
Young Chinese adults with new onset of diabetic ketoacidosis – clinical course, autoimmune status and progression of pancreatic β‐cell function
Authors: Li J. K. Y. , Chan J. C. N. , Zimmet P. Z. , Rowley M. J. , Mackay I. R. , Cockram C. S. 
Published: March 2003

Abstract Aims To examine the clinical course, autoimmune status and pancreatic β cell function, over a 2‐year period, in young Chinese subjects newly presenting with diabetic ketoacidosis (DKA). Methods A prospective study involving 562 out of 27 893 patients who were admitted to the medical ward with a principal diagnosis of diabetes mellitus during the recruitment period of 1 year. Results Of these 562 patients, 27 were aged less than 35 years and admitted with a diagnosis of DKA and 11 (six males and five females) of these were newly diagnosed. Antibodies to glutamic acid decarboxylase (GAD) were present in five patients. Anti‐ICA 512 was not detected in any of the patients. Basal and post‐glucagon stimulated plasma C‐peptide remained in the insulin‐deficient range although showing improvement at 2 years. Conclusions These findings confirm the relative rarity of autoimmune Type 1 diabetes in young Chinese. Even when the clinical presentation takes the extreme form of acute DKA, less than 50% have positive autoimmune markers.