bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improved prognosis of patients with intermediate‐ and poor‐risk nonseminomatous germ cell tumours by optimizing combined treatment
Authors: Pentheroudakis G. , De Bono J.S. , Kaye S.B. , Simpson A. , Paul J. , Brown I. , Pamenter B. , Kirk A. , Vasey P. , Raby N. , Kirk D. 
Published: December 2004

OBJECTIVETo assess whether the optimal use of combined treatment with chemotherapy and appropriately timed surgical intervention by a specialized team might improve the outcome for patients with poor‐ and intermediate‐prognosis (International Germ Cell Consensus Classification, IGCCC) nonseminomatous germ cell tumours (NSGCTs).PATIENTS AND METHODSBetween 1984 and 1998, 47 patients with intermediate (16) and poor prognosis (31) NSGCT were treated; 43 had a testicular and four a retroperitoneal primary.RESULTSOf the 47 patients only seven (15%) had a complete radiological response after primary chemotherapy; 36 (77%) required surgery after chemotherapy (29 para‐aortic lymphadenectomy, 13 resection of pulmonary metastases, two each excision of supraclavicular and retrocrural lymph nodes and one resection of brain metastases; 13 required surgery at more than one site). There was no surgical mortality, with postoperative wound pain the commonest morbidity. On pathology, the resected masses were mature teratoma in 13, necrosis in 12 and malignant disease in 11 patients, the resection being complete in 30. There were microscopically positive margins in the other six patients, all but one having viable residual cancer. Of the 47 patients, 18 needed treatment for relapse, with four having surgery for growing mature teratoma, six chemotherapy plus surgery and eight salvage chemotherapy alone. Of 31 patients, 22 (71%) with a poor and 13 of 16 with an intermediate prognosis were alive at a median (range) follow‐up of 94 (41–171) months; of all 47, 34 (72%) remain in complete remission. Ten patients died from disease progression. The presence of residual malignant disease at the resection margin was significantly associated with poorer survival (hazard ratio 7.21, P = 0.0016). Prognostic factors, e.g. number of involved sites, IGCCC group and viable tumour in resected masses, were not significant. The 5‐year overall and relapse‐free survival (95% confidence interval) was 81 (69–93)% and 57 (43–71)%, respectively.CONCLUSIONThe optimal delivery and timing of chemotherapy and surgical resection by a specialist team of oncologists, urological and cardiothoracic surgeons is critical in treating poor‐risk NSGCT and might be responsible for improving the outcome of these patients. The detection of residual malignant disease after chemotherapy by positron emission tomography should be investigated to identify those who might benefit from further systemic treatment before complete surgical resection.
The effect of drotaverine hydrochloride in acute colicky pain caused by renal and ureteric stones
Authors: Romics I. , Molnár D.L. , Timberg G. , Mrklic B. , Jelakovic B. , Köszegi G. , Blaskó G. 
Published: December 2004

OBJECTIVETo assess the spasmolytic effect of drotaverine hydrochloride in colicky pain caused by renal and ureteric stones.PATIENTS AND METHODSIn a placebo‐controlled, multicentre, multinational, randomized, double‐blind study changes in the intensity of pain were recorded using a visual analogue scale (VAS), a four‐grade (five points) pain intensity (PI) scale and a pain‐relief scale. The primary endpoint was the evaluation of the antispasmodic effect of drotaverine during a 3‐h study period, to confirm that drotaverine abolished or significantly decreased the intensity of pain in renal colic. The painkilling effect was defined as a decrease by at least half in the PI scale, and/or a ≥ 40% decrease in the VAS 40 min after either the first or the second injection of 80 mg drotaverine or placebo (if necessary the dose could be repeated once). In all, 140 patients were enrolled but 38 withdrew, leaving 102 patients for analysis (48 drotaverine, 54 placebo; mean age 42.5 years, sd 11.25, and 41.7, sd 10.79).RESULTSDrotaverine was effective in 79% of patients and placebo in only 46% (P < 0.001). There were no serious adverse effects. There were 20 minor side‐effects in the drotaverine and four in the placebo group; none of the patients required treatment. The most frequent side‐effects were a transitory decrease in blood pressure, vertigo, nausea or vomiting.CONCLUSIONIntravenous drotaverine provides effective pain relief in more than two‐thirds of patients with renal colic, with no serious side‐effects.
Analysis of compartmental models of type 4 nuclear renograms with calculation of flow rate parameters and instantaneous drainage rates
Authors: Coffey J.P. 
Published: December 2004

The first of the two articles in this section examines the dynamic rates of arterial delivery and renal drainage in patients whose renogram showed a Homsy sign, using optimised computer compartmental modelling. The author found that the standard model was unlikely to be correct, and that the Homsy sign was probably an artefact seen in patients with impeded urinary drainage. In the second, the authors from Budapest studied the effect of drotaverine in patients with ureteric colic; it was of significant help in this condition. OBJECTIVETo estimate the dynamic rates of arterial delivery and renal drainage in renograms with the Homsy sign, using optimized computed compartmental modelling.METHODSEleven F−15 renograms and one F+15 renogram (using 99mTc‐mercaptoacetyltriglycine) with the Homsy sign were studied, with 26 controls. Compartmental models were constructed for each renogram using components (blood, renal, bladder) linked by variables (arterial rate, drainage rate). Each model was optimized using the Marquadt least‐squares method to numerical data from the time‐activity curves (TACs). The model renal component at sample points along the TAC was minimized and the corresponding drainage rates calculated.RESULTSThe models were optimized, with a mean (range) r2 of 0.811 (0.68–0.88). There were continuous low drainage rates for all type 4 renograms, with no quadrupling of the flow rate, as predicted by the standard model.CONCLUSIONThe standard model is unlikely to be correct and the Homsy sign is probably an artefact seen in patients with impeded urinary drainage. Computer modelling of individual renograms is feasible and can provide useful insights into the pathophysiology of renal uptake and drainage.
Lifestyle and behavioural interventions for men on watchful waiting with uncomplicated lower urinary tract symptoms: a national multidisciplinary survey
Authors: Brown C.T. , Van Der Meulen J. , Mundy A.R. , Emberton M. 
Published: December 2004

Authors from London sent a survey to British urologists, nurse practitioners and continence advisors to determine the use of lifestyle and behavioural interventions in the UK for symptom control in men with uncomplicated urinary tract symptoms in the event of a watchful waiting policy being adopted. There was an 83% response rate, and the results showed that these interventions are indeed advised by many in such circumstances; however, the wide variation in their use has lead to the suggestion by the authors that it is necessary to test their effectiveness. A further article from the same institution attempts to highlight the importance of methodological standards in diagnostic testing by reviewing the extent of compliance with these standards in report of evaluations of, in this case, uroflowmetry, in the medical literature. They found that the evaluations assessed showed poor compliance, and felt that this had a negative effect on cost‐effectiveness and health‐case resources OBJECTIVETo determine the use of lifestyle and behavioural interventions in the UK for symptom control in men with uncomplicated lower urinary tract symptoms (LUTS) on watchful waiting (WW).METHODSemi‐structured interviews with urologists, nurse practitioners and continence advisors were used to obtain a list of lifestyle and behavioural interventions used in men with LUTS. From the 18 interventions identified, a survey was constructed asking how often these interventions were used in routine practice. The survey was sent to 100 consultant urologists (British Association of Urological Surgeons), 100 nurse practitioners (British Association of Urological Nurses), and 100 continence advisors (International Continence Society) with an interest in male urology, all randomly selected.RESULTSOf 248 (83%) responses, 236 were suitable for analysis; 193 (82%) of the respondents reported using lifestyle or behavioural interventions in men on WW with uncomplicated LUTS. The most frequently used interventions were education about the prostate and bladder, avoiding caffeine, urethral milking and reassuring men that they do not have prostate cancer. The use of lifestyle and behavioural interventions showed an ‘all‐or‐none’ pattern. Respondents used either few or many of the 18 interventions identified. There was considerable variation in the extent to which these interventions were used among the survey groups (P < 0.01); urologists used these interventions the least and continence advisors the most.CONCLUSIONSLifestyle and behavioural interventions are advised by many medical professionals to men on WW with uncomplicated LUTS. However, the use varies considerably, with some medical professionals advising many of these interventions and some a few or none at all. Further research is required to define and test the effectiveness of these interventions in reducing LUTS.
Comparison of cadaveric pericardial, dermal, vein, and synthetic grafts for tunica albuginea substitution using a rat model
Authors: Leungwattanakij S. , Bivalacqua T.J. , Yang D.‐Y. , Hyun J.‐S. , Hellstrom W.J.G. 
Published: December 2004

OBJECTIVETo evaluate in an animal model the intermediate and long‐term efficacy of cadaveric pericardium, dermis, vein and Gore‐Tex‰ as grafting materials for tunica albuginea substitution after plaque excision for Peyronie's disease.MATERIALS AND METHODSThe study comprised 100 male Sprague‐Dawley rats (300–325 g) divided into five equal groups: group 1, sham‐operated controls; and groups 2–5 which underwent wedge excision of the tunica albuginea and replacement with either cadaveric pericardium, dermis, vein or Gore‐Tex grafts. Ten rats in each group had the cavernosal nerve stimulated electrically to assess erectile function at 4 months, and the remaining 10 rats at 6 months. After death the sampled tissues were fixed in 10% formalin, paraffin‐embedded, and stained with Masson's trichrome and Verhoff's van Giesen for collagen and elastic fibres.RESULTSErectile function, assessed by cavernosal nerve stimulation, did not differ significantly in any of the groups (P > 0.05). The histological assessment of penile cross‐sections showed minimal fibrosis surrounding the patch in the dermal and vein grafts, and moderate to severe fibrosis in the Gore‐Tex graft at 4 and 6 months. In the pericardial graft there was a moderate degree of fibrosis at 4 months with only minimal fibrosis at 6 months.CONCLUSIONSThese results show that cadaveric pericardium allows complete penile expansion and is strong enough to withstand normal intracorporal pressures. There was minimal fibrosis in the pericardial, dermal and vein grafts, and moderate fibrosis in the Gore‐Tex graft at 6 months. The pericardial graft is a satisfactory grafting material when used for tunica albuginea substitution, including the surgical management of Peyronie's disease.
Technical advances in radical retropubic prostatectomy techniques for avoiding complications. Part I: apical dissection
Authors: Gillitzer R. , Thüroff J.W. 
Published: December 2004

SUMMARYRadical retropubic prostatectomy is currently the most widely used surgical treatment for localized prostate cancer. This once cumbersome procedure has developed technically over the last 20 years, reducing dramatically the associated complications and morbidity, e.g. blood loss, incontinence and impotence. Currently the operation is safe and is the best choice for eradicating localized disease, with little loss in quality of life. However, differences in reported outcomes indicate that there is still a need for standardization and continued efforts for surgical excellence. This review focuses on the crucial steps of the procedure, in two parts: the first covers apical dissection and the second the steps related to vesico‐urethral anastomosis and the nerve‐sparing procedure. This evaluation of the technical modifications aims to offer a choice, to vary the procedure according to the individual situation and thus improve the results. Current trends in surgical technique are also presented.
Technical advances in radical retropubic prostatectomy techniques for avoiding complications. Part II: vesico‐urethral anastomosis and nerve‐sparing prostatectomy
Authors: Gillitzer R. , Thüroff J.W. 
Published: December 2004

SUMMARYWe previously reviewed different technical modifications and improvements in apical dissection in radical retropubic prostatectomy which have a considerable effect in optimizing the results. This second paper focuses on the vesico‐urethral anastomosis and aspects of nerve‐sparing prostatectomy.
Bilateral testicular cancer: a preventable problem? Experience from a large cancer centre
Authors: Pamenter B. , De Bono J.S. , Brown I.L. , Nandini M. , Kaye S.B. , Russell J.M. , Yates A.J. , Kirk D. 
Published: December 2004

OBJECTIVETo report a retrospective review of patients with a testicular germ cell tumour treated in a large cancer centre who developed a second tumour, as 1.8–5% of such patients will subsequently develop a new primary tumour in the contralateral testis.PATIENTS AND METHODSFrom a database of 570 men treated for testicular cancer in the West of Scotland between 1989 and 1998, all those who developed bilateral testicular tumours were identified.RESULTSNineteen men (3.3%) developed a second primary testicular malignancy; the mean age at diagnosis of the first tumour was 29.5 years, with the mean (range) interval to diagnosis of the second tumour of 76 (11–181) months (except for one man with synchronous tumours). The first tumour was teratoma in 11 and seminoma in seven; one patient had synchronous bilateral teratoma. The second primary was teratoma in 10 and seminoma in eight. Known risk factors for carcinoma in situ were present in nine patients, i.e. a small atrophic contralateral testis in five, a family history of testicular cancer in two, a history of infertility in two and unilateral undescended testis in one. Two patients had had contralateral testicular biopsies at the first diagnosis; both were negative for intratubular germ cell neoplasia (IGCN). Eight patients had chemotherapy to treat the first tumour and 14 for the second. All underwent bilateral orchidectomy. Overall, 18 of 19 men are alive and disease‐free, with a median follow‐up of 51 months. Pathology for 12 of the second testicular tumours was available for review; there was no IGCN in any of the slides from three patients, it was only present focally around the tumour in seven, and was diffuse in two patients.CONCLUSIONSChemotherapy for the first testicular tumour does not eliminate the risk of developing a contralateral tumour. Despite careful follow‐up, in most patients the second primary tumour was not diagnosed early enough to avoid chemotherapy. The focal nature of IGCN in the second testis in most patients questions the value of biopsy of the contralateral testis. Improved methods of detecting patients at risk of second testicular tumours are needed.
Hypospadias surgery: when, what and by whom?
Authors: Manzoni Gianantonio , Bracka Aivar , Palminteri Enzo , Marrocco Giacinto 
Published: December 2004

SummaryHypospadias is repaired by paediatric surgeons, paediatric urologists, adult reconstructive urologists and plastic surgeons. This review is unique in representing all four specialities, to provide a unified policy on the management of hypospadias. The surgeon of whichever speciality should have a dedicated interest in this challenging work, ideally having an annual volume of at least 40–50 cases. The ideal time for primary repair is at 6–12 months old, although when this is not practicable there is another opportunity at 3–4 years old. A surgical protocol is presented which emphasises both functional and cosmetic refinement. Using a logical progression of a very few related procedures allows the reliable correction of almost any hypospadias deformity. A one‐stage repair is used when the urethral plate does not require transection and its axial integrity can be maintained. Occasionally, when the plate is of adequate width and depth, it can be tubularized directly using the second stage of the two‐stage repair. When (usually) the urethral plate is not adequately developed and requires augmentation before it can be tubularized, then that second‐stage procedure is modified by adding a dorsal releasing incision ± a graft (alias Snodgrass and ‘Snodgraft’ procedures). The two‐stage repair offers the most reliable and refined solution for those patients who require transection of the urethral plate and a full circumferential substitution urethroplasty. From available evidence this protocol combines excellent function and cosmesis with optimum reliability. Nevertheless, it would be complacent to assume that these gratifying results will be maintained into adult life. We therefore recommend that there is still a need for active follow‐up through to genital maturity.
Randomised comparison of distension media for outpatient hysteroscopy
Authors: Shankar Meena , Davidson Allan , Taub Nick , Habiba Marwan 
Published: December 2004

Objective  To compare saline with and without added lignocaine and carbon dioxide distension for out patient hysteroscopy with regards to patient discomfort and hysteroscopic view.Design  Single blind prospective randomised controlled trial.Setting  Specialist out patient clinics in a large teaching hospital.Population  Women undergoing out patient hysteroscopy and endometrial biopsy for abnormal uterine bleeding.Method  Out patient hysteroscopy using carbon dioxide, saline or saline with lignocaine.Main outcome measures  Visual analogue score (VAS) for pain and present pain intensity (PPI) as assessed by patients and the quality of hysteroscopic view as assessed by the operator.Results  Of the 305 women approached, 300 women were randomised into the study. The mean [SD] VAS for pain in the carbon dioxide group was 2.9 [2.3] and in the saline group was 3.1 [2.6], the difference was not statistically significant (P= 0.49). The mean [SD] VAS for pain in the saline plus lignocaine group was 3.2 [2.4]. This was not significantly different from the saline group (P= 0.72). There was a statistically significant difference between the confidence rating for the hysteroscopic view for the carbon dioxide compared with the saline group; mean [SD] was 8.3 [2.1] and 9.6 [1.1], respectively (P= 0.001).Conclusion  Carbon dioxide and saline as distension media are comparable in terms of overall patient discomfort and satisfaction, but saline provides better views and increases confidence in diagnosis. Adding lignocaine to the saline distension medium does not confer any additional benefit.
Automated self‐initiated blood pressure or 24‐hour ambulatory blood pressure monitoring in pregnancy?
Authors: Brown M.A. , McHugh L. , Mangos G. , Davis G. 
Published: December 2004

Objective  To determine whether self‐initiated and recorded automated blood pressure measurement can provide an accurate estimate of ambulatory blood pressure in pregnant women suspected of having ‘white coat hypertension’.Design  A prospective observational study.Setting  Women's and Children's Health Unit, St George Hospital, a teaching hospital of the University of New South Wales.Population  Pregnant women being assessed for possible ‘white‐coat hypertension’.Methods  Sixty‐six pregnant women who were undergoing 24 hour ambulatory blood pressure monitoring (ABPM) in their home or work environment also measured their blood pressure six times during this interval using a self‐initiated automated blood pressure recorder (Omron HEM 705CP). Agreement between awake ABPM and Omron recorded blood pressures was tested by Bland–Altman analysis.Main outcome measure  Limits of agreement between blood pressures measured by each device.Results  Average blood pressures obtained by the two devices were identical (125/77 mmHg) but limits of agreement were wide, −20 to +23 mmHg for systolic blood pressure and −9 to +15 mmHg for diastolic blood pressure.Conclusion  The Omron HEM 705CP is a useful device for measuring group average blood pressures in pregnant women suspected of having white coat hypertension but cannot reliably replace ABPM for clinical management of individual pregnant women.
Monoamniotic twin pregnancies: antenatal management and perinatal results of 19 consecutive cases
Authors: Demaria Fabien , Goffinet François , Kayem Gilles , Tsatsaris Vassilis , Hessabi Madieh , Cabrol Dominique 
Published: December 2004

Objective  To describe the obstetric management and perinatal outcome of antenatally diagnosed monoamniotic twin pregnancies (MATP) in a tertiary level maternity unit.Setting  Port‐Royal Maternity Hospital, Paris, France.Population  MATP that progressed beyond 22 weeks seen from 1993 to 2001.Methods  A retrospective chart review of all twin pregnancies. Diagnosis of MATP was made by ultrasonography and confirmed by placental pathology.Main outcome measure  Perinatal mortality.Results  Among the 1242 twins pregnancies delivered during the study period, 19 were monoamniotic. Four fetuses (10% of all births) had malformations. Perinatal mortality was high (n= 12, 32%) because of fetal deaths (nine cases) and very preterm births (three neonatal deaths). No fetal deaths occurred after 29 weeks. Of the 15 women with at least one live fetus before labour, 6 gave birth by vaginal delivery (40%). No obstetric accidents occurred during vaginal deliveries.Conclusion  Perinatal mortality of MATP is still very high, even with accurate, early antenatal diagnosis, intensified surveillance and delivery provided in a tertiary level hospital. The main causes of perinatal deaths are cord accidents in utero, congenital anomalies and very preterm births.
A randomised trial comparing low dose vaginal misoprostol and dinoprostone for labour induction
Authors: van Gemund N. , Scherjon S. , Le Cessie S. , Schagen van Leeuwen J.H. , van Roosmalen J. , Kanhai H.H.H. 
Published: December 2004

Objective  To compare vaginal misoprostol with dinoprostone for induction of labour.Design  Randomised multicentre trial.Setting  Labour wards of one university hospital and two teaching hospitals.Population  Six hundred and eighty‐one women with indication for labour induction at ≥36 weeks of gestation, singleton pregnancy and no previous ceasarean section.Methods  Misoprostol (25 mcg, hospital‐prepared capsule) in the posterior vaginal fornix, every four hours, maximum three times daily or dinoprostone gel (1 mg) every four hours. Oxytocin was administered if necessary.Main outcome measures  Primary: ‘adverse neonatal outcome’ (5‐minute Apgar score <7 and/or umbilical cord pH <7.15). Secondary: labour duration, mode of delivery and patient satisfaction.Results  Three hundred and forty‐one women received misoprostol and 340 dinoprostone. The median induction–delivery interval was longer in the misoprostol group compared with the dinoprostone group (25 versus 19 hours, P= 0.008). The caesarean section rate was lower in the misoprostol group: 16.1%versus 21%, but this difference was not statistically significant RR = 0.8 (95% CI 0.6–1.04). ‘Adverse neonatal outcome’ was found to be similar in both groups: 21% in the misoprostol and 23% in the dinoprostone groups. Significantly fewer neonates were admitted to NICU in the misoprostol group compared with dinoprostone 19%versus 26% (RR = 0.7, 95% CI 0.5–0.98).Conclusions  Misoprostol in this dosing regimen is a safe method of labour induction. NICU admission rates were lower in the misoprostol group. No difference could be detected in patient satisfaction between groups.