Search

Objectives: Quality of work life (QWL) is an important indicator of job-related satisfaction among nurses; however, there is little information regarding the QWL of nurses in Oman. Therefore, this study aimed to explore factors affecting QWL among nurses working in governmental health institutions in Ad Dakhiliyah Governorate, Oman. Methods: This descriptive cross-sectional study was conducted between September and November 2018 at 29 governmental health institutions in Ad Dakhiliyah Governorate. A total of 374 nurses employed at these institutions were recruited via stratified random sampling. A demographic questionnaire incorporating Brooks' Quality of Nursing Work scale was used to collect data. Results: A total of 345 nurses participated in the study (response rate: 92.2%). The mean age was 33.3 ± 5.1 years and the majority were female (90.7%), married (88.7%), of Omani nationality (70.1%) and had a diploma degree (70.7%). Overall, the nurses demonstrated moderate levels of QWL (mean total score: 179.99 ± 24.17). Both job designation and nationality were found to be significant predictors of QWL (P = 0.041 and <0.001, respectively). Conclusion: The findings of this study represent a baseline for further research on this important topic. As with all healthcare professionals, the QWL of nurses indirectly affects quality of patient care and associated health outcomes. As such, identifying areas of poor QWL among nurses can help in the development of initiatives to improve their professional satisfaction, thereby enhancing job performance and employee retention. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to examine the rate and factors associated with the publication of abstracts presented by residents at Oman Medical Specialty Board (OMSB) scientific meetings. Methods: This retrospective study was performed in February 2018. Two previous national OMSB scientific meetings at which resident abstracts were presented were identified, having taken place in January 2014 and December 2016, respectively. Independent searches of the MEDLINE® (National Library of Medicine, Bethesda, Maryland, USA) and Google Scholar (Google LLC, Menlo Park, California, USA) databases were conducted to determine subsequent publication of the abstracts. Results: A total of 68 resident abstracts were presented, of which most were clinical research (92.6%). Residents comprised 36.4% of the authors, of which 73.1% were senior residents. In 64 abstracts (94.1%), a resident was the first author. Overall, 15 abstracts (22.1%) resulted in articles published in 11 journals. Of these, 12 (80%) represented clinical research and 10 articles (66.7%) were published in MEDLINE®-indexed journals. Residents were the first authors of eight articles (53.3%). The median time to publication was 19 months. The presence of two or more resident authors per abstract was significantly associated with publication (odds ratio = 5.50, 95% confidence interval = 1.15–26.36; P = 0.03). Conclusion: The publication rate of resident abstracts presented at two OMSB research meetings was low; however, a higher number of resident authors per abstract significantly increased the likelihood of publication. These findings may influence policymakers to implement measures to support inter-resident collaboration so as to increase research productivity. [ABSTRACT FROM AUTHOR]

The article reports on difficulties faced by students engaged in measures designed to gain work experience in Nigeria. The central focus of the article is on those working in the library and information sciences and the use of information and communication technology. A number of topics are addressed including the nature and scope of the program of work experience, the creation of digital libraries and the use of information and communication technologies, and the challenges of bibliometrics and citation analysis.

The article examines the challenges of the Students' Industrial Work Experience Scheme (SIWES) in Nigeria in library and information science (LIS) in the information and communications technology (ICT) environment. It observes that ICT developments have put more pressure on the SIWES program to equip students with new skills. The article also suggests that LIS schools should revise their curricula to meet the needs of employers in the public and private sectors in Nigeria.

The three hydroxybenzodiazepines oxazepam, temazepam, and lorazepam used for their anxiolytic, sedative, and anticonvulsant properties are metabolized by glucuronidation, which is the predominant pathway in the clearance mechanism of exogenous and endogenous substances during phase II metabolism. The aim of this study was the synthesis of benzodiazepine-O-glucuronides as analytical reference substances. All benzodiazepines are prescribed clinically as racemic formulations. The resulting conjugates from the coupling reactions with glucuronic acid are epimeric pairs of glucuronides. Due to the importance of stereochemical factors in drug disposition it is necessary to separate the diastereomeric forms after synthesis. An enzyme-assisted synthesis was developed and optimized by using microsomal UGT from fresh swine liver to receive multimilligram amounts of the benzodiazepine glucuronides, which were not accessible by standard synthetic procedures, like the Koenigs–Knorr- and Williamson-ether-synthesis. Swine liver microsomes were prepared by homogenization and differential centrifugation of liver tissue. In the presence of liver microsomes the benzodiazepines and cofactor UDPGA were incubated for 24h. After incubation the microsomes were removed by protein precipitation and the residual benzodiazepines by liquid–liquid extraction (dichloromethane). The epimeric pairs of benzodiazepine glucuronides were separated by preparative high performance liquid chromatography (HPLC) followed by solid phase extraction (SPE) to obtain the pure benzodiazepine glucuronide epimers. The synthesis products were characterized by mass spectroscopy and nuclear magnetic resonance (NMR) spectroscopy. [Copyright &y& Elsevier]

SUMMARY Although the ureter is functionally simply a tube to transport urine, ureteric surgery requires detailed anatomical knowledge and advanced surgical skills, because the ureter has a delicate blood supply. Therefore, the urological surgeon must have distinct strategies available to bridge ureteric defects of various sites and lengths. Furthermore, handling during and after surgery should be individualized to the patient's pre- and intraoperative situation. In this review, the indications for reconstruction of a specific ureteric defect, the required techniques and postoperative recommendations are discussed. [ABSTRACT FROM AUTHOR]

Investigates the hypoalbuminemia in patients admitted to the hospital for community-acquired pneumonia. Inflammatory reaction as the main reason for depressed serum albumin levels in elderly patients with pneumonia; Regulation of the synthesis of plasma proteins in the acute-phase response by cytokines; Correlation between serum albumin with transthyretin and transferrin.

Numerous vibrational modes of spherical submicrometer particles in fabricated soft opals are experimentally detected by Brillouin light scattering and theoretically identified by their spherical harmonics by means of single-phonon scattering-cross-section calculations. The particle size polydispersity is reflected in the line shape of the low-frequency modes, whereas lattice vibrations are probably responsible for the observed overdamped transverse mode. [ABSTRACT FROM AUTHOR]

Presents a retrospective assessment of morbidity and mortality due to pneumonia after discharge in 573 consecutive patients admitted to the hospital for pneumonia, gastrointestinal infection, renal infection or erysipelas. States that pneumococcal vaccination after hospital treatment for an episode of pneumonia might be a cost-effective means of preventing disease in patients 50 years or older.

Neurogenic lower urinary tract dysfunction continues to represent a diagnostic and therapeutic challenge. Many different conditions affecting the vesicourethral system have their origins in the nervous system, and it is important to recognise that lower urinary tract symptoms (LUTS) may sometimes be one of the first signs of neurological disorders such as multiple sclerosis (MS). A sound urodynamic investigation forms the basis for both the diagnosis and the therapy of neurogenic voiding dysfunction, the treatment of which is usually symptomatic. [Copyright &y& Elsevier]

This article describes the evolution or revolution in the management of erectile dysfunction over the centuries. In recent history there has been a rapid movement away from a predominant role for the specialist towards the primary care physician. The physician is increasingly faced with the need to individualise therapy to meet patient expectations. [ABSTRACT FROM AUTHOR]

• New styrenic copolymers obtained by radical copolymerization of styrene, sulfur, and phosphorus comonomers. • The copolymers achieve excellent UL 94 V classifications without the use of additional flame retardant additives. • Halogen-free materials, which are suitable for applications with high environmental standards. Halogen-free, intrinsically flame retardant copolymers with glass transition temperatures in the range of 93 - 97 °C were synthesized from styrene, elemental sulfur, and organophosphorus comonomers in a facile radical bulk polymerization process. The copolymers were characterized using multidetector size exclusion chromatography (SEC), elemental analysis (EA), thin layer chromatography (TLC), UV/Vis spectroscopy, and 1H, 13C, and 31P nuclear magnetic resonance (NMR) spectroscopy. SEC revealed number average molar masses (M n) ranging from 14 - 18 kg/mol, and weight average molar masses (M w) from 41 - 62 kg/mol. The phosphorus contents ranged from 0.1 - 0.6 wt.%, while the sulfur contents were 0.4 - 0.7 wt.%, with covalently bound sulfur being predominantly present in the lower molar mass fractions. Structural details of the formed sulfur-containing moieties in the copolymers were elucidated with homonuclear correlation spectroscopy (COSY) and 1H/13C heteronuclear single-quantum correlation spectroscopy (HSQC) techniques, indicating the presence of PS-substituted 1-phenylethyl sulfanyl units with a mono-, di- or trisulfidic arrangement. Thermogravimetric analyses (TGA) showed slightly decreased decomposition onset temperatures for all copolymers compared to that for polystyrene, and no or only minimal formation of residual masses above 500 °C. Selected copolymers were extruded and injection molded on a laboratory scale. UL 94 vertical flame testing demonstrated a good flame retardant performance for most copolymer types, alongside with short after-flaming times and intensive melt dripping. Increased melt flow caused by polymer decomposition, probably initiated by the sulfur moieties in the copolymer structures, and cooling are considered the main condensed-phase flame retardant processes involved. Two copolymers of the set display a UL 94 V-0 classification. [ABSTRACT FROM AUTHOR]

Abstract: Introduction:: Solitary adrenal metastases occur in about 1.2–10% of renal cell cancer patients. Since the vast majority of intraadrenal lesions can be detected preoperatively, we and others have recently recommended to renounce a routine adrenalectomy during surgery of renal cell cancer. However, the impact of adrenalectomy on the patients’ clinical prognosis in case of a solitary metastatic lesion within the adrenal gland remains an issue of controversial discussion. Whereas some authors suggest adrenalectomy as a potentially curative treatment option in these cases, others compare its clinical value with that of a mere lymphadenectomy. Patients and method:: Between 1981 and 2000, 648 patients (440 males and 208 females) underwent nephrectomy in combination with adrenalectomy in our clinic for the diagnosis of renal cell cancer. The median age at first diagnosis was 59 (range 33–84) and 60 (range 20–85) years for male and female patients, respectively. The median postoperative follow - up was 2.4 years (0.2–18 years). According to the TNM – classification system (2003) tumor stages were classified as follows: T1, 228 pat. (37%); T2, 70 pat. (11%); T3, 287 pat. (46%); T4, 37 pat. (6%). In total, 339 patients revealed regional lymph node or distant metastases at the time of the surgical treatment. Although metastases of the adrenal gland were diagnosed in 48 patients, solitary intraadrenal metastases without further systemic spread were observed in only 13 cases. Several patients’ and tumor characteristics (age, tumor stage and size, the presence of regional lymph node metastases, the presence of metastatic lesions at different organ sites as well as the detection of solitary intraadrenal metastases) were correlated with the patients’ overall survival by univariate and multivariate statistical analysis (logistic Cox regression analysis). Results:: The median long – term survival was 4.8 years for the entire cohort of patients investigated. The median long – term survival was 13.8 years and 11.7 years for patients with no evidence of metastatic spread as well as for patients with a solitary intraadrenal metastatic lesion, respectively. Accordingly, the long – term survival rates at 5 and 10 years after surgery were 66%/50% and 51%/51% for patients with no evidence of metastatic spread or isolated intraadrenal metastases. This difference was not statistically significant. In contrast, for patients revealing lymph node or distant metastases at other organ sites, the median long – term survival was significantly decreased (lymph node metastases: 0.7 years; distant metastases: 1.2 years). Discussion:: For patients with a solitary intraadrenal metastatic lesion, adrenalectomy is a potentially curative treatment option. The observation that the long – term survival of the latter patients is comparable to that of patients with organ – confined disease might suggest the establishment of a separate TNM – category for patients revealing a solitary metastasis within the adrenal gland and no hint at further systemic metastatic spread. [Copyright &y& Elsevier]

The concerns about testosterone therapy in ageing men with late-onset hypogonadism mainly address the risk of prostatic disease, i.e. either benign prostatic hyperplasia (BPH) or prostate cancer (PCa). Both conditions are highly dependent on androgen action and recent clinical data on the cancer-preventive effect of the 5α-reductase inhibitor finasteride have supported the possible role of androgens in PCa. However, the clinical data especially on the long-term effects of exogenous androgen substitution in regard to prostate safety are nonconclusive in many respects. As sufficient clinical studies on these risks will not be available in the near future, the approach of testosterone therapy towards prostate complications should be kept on a safe but practical basis. This review includes some recommendations in regard to testosterone therapy and prostate monitoring in patients with BPH and bladder outlet obstruction, with previous history of curative treatment for PCa or with prostatic intraepithelial neoplasia. [ABSTRACT FROM AUTHOR]

Background: The objective of the present study was to examine the long-term safety, tolerability and efficacy of tolterodine extended-release (ER) in patients who had completed 12 weeks’ treatment in a randomised, double-blind study comparing tolterodine ER 4 mg once daily (qd), tolterodine immediate-release (IR) 2 mg twice daily and placebo.Methods: Of the 1377 patients completing the 12-week study, a total of 1077 (78%) chose to continue with 12 months’ open-label treatment with tolterodine ER 4 mg once daily, irrespective of their previous treatment. Safety was assessed after 3, 6, 9 and 12 months’ treatment in the study. Efficacy was evaluated from micturition diary variables and patients’ perception of bladder condition and urgency following 3 and 12 months’ treatment.Results: 71% of patients completed the 12-month study. Tolterodine ER was safe and well tolerated. Adverse events of the general (14.5%), autonomic (13.2%), gastrointestinal (11.4%), respiratory (9.8%) and urinary (9.1%) systems were the most frequently reported. Dry mouth was the most common event, occurring in 12.9% of patients, and was generally mild in severity. Other adverse events occurred in less than 5% of patients. There was no increase in the frequency of adverse events with long-term relative to short-term treatment. The efficacy of tolterodine was maintained over the 12-month treatment period; relative to baseline there were reductions in the number of incontinence episodes per week (median change −83%) and micturitions per 24 hours (median change −21%) and an increase in volume voided (median change +25%) after 12 months’ treatment. An improvement in patient perception of their bladder condition was found in 75% of patients completing the study, and 51% had an improvement in patient perception of urgency.Conclusions: Tolterodine ER 4 mg qd displayed a favourable safety, tolerability and efficacy profile during 12 months’ treatment of patients with overactive bladder. [ABSTRACT FROM AUTHOR]

The permeation and translational diffusion of antibodies through the porous matrix of hydrogel materials is of fundamental relevance for many biological systems in living nature, but equally important in medical and technological applications, such as implanted drug release systems and biosensors. In this respect the diffusion of fluorophore-labeled protein immunoglobulin G (IgG) in micrometer thick, grafted hydrogel layers based on thermoresponsive poly(N-isopropylacrylamide) (pNiPAAm) is studied here by fluorescence correlation spectroscopy (FCS). The pore size of the gel gradually changes with its swelling state, which is controlled by the cross-link density of the network, temperature, and pH value of the surrounding medium. Notably, IgG permeation in these hydrogel layers exhibits a much more complex dependence on these factors. This rich variability of IgG permeation is attributed to the varying balance of protein interactions with the polymer network through electrostatics, controlled pH-dependent protein ionization, excluded volume repulsion, and hydrophobic attraction. A combined analysis of the fluorescence intensity profiles and the dynamics monitored by FCS allows us to quantify the thermodynamically controlled partitioning of IgG as well as the slowdown of its diffusion. Contrary to the complex behavior of the permeation, the diffusion slowdown seems to be a universal function of polymer volume fraction, which is rather robust with respect to temperature or pH changes. The presented findings suggest a model approach to explore the synergy between crowding and thermodynamics with respect to the controlled protein transport in pNiPAAm-based hydrogels. [ABSTRACT FROM AUTHOR]

To investigate the symptomatic and quality of life (QoL) response to treatment with tolterodine extended release (ER) in subgroups of male patients with Overactive Bladder Syndrome (OAB) and LUTS suggestive of non-obstructive benign prostatic hyperplasia (BPH) according to age, symptom severity, diabetes mellitus status, and concomitant treatment for LUTS. Patients treated with tolterodine ER 4 mg/day for OAB symptoms, alone or added to unsuccessful alpha-blocker treatment of ≥6 weeks duration, and presumed non-obstructive BPH ( Qmax ≥ 15 ml/s) were observed for 12 weeks in a non-interventional study. Patients completed the International Prostate Symptom Score (IPSS) and Overactive Bladder Questionnaire (OAB-q) at baseline and after 12 weeks. 52.4% of 741 patients were aged ≤65 years; 4, 64, and 32% had mild, moderate, and severe symptoms, respectively, according to IPSS; 14% had diabetes mellitus, and in 42% tolterodine was added to alpha blockers. In the various subgroups, mean IPSS total scores improved by 2.8–11.1 points, IPSS QoL scores by 1.8–2.4 points, and all OAB-q subscores by more than 14 points. Only IPSS and OAB-q baseline scores had a relevant impact on changes during treatment, benefits were greatest in patients with more severe symptoms and bother. In men with symptoms of OAB and LUTS suggestive of non-obstructive BPH of all IPSS severity classes, aged ≤65 years or above, with or without concomitant diabetes or alpha-blockers, symptoms and QoL improved markedly during treatment with tolterodine ER. [ABSTRACT FROM AUTHOR]

Patients with presumed non-obstructive BPH ( Q max ≥ 15 ml/s) treated with tolterodine ER 4 mg/day for OAB symptoms, alone or added to unsuccessful alpha-blocker treatment of ≥6 weeks duration, were observed for 12 weeks in a non-interventional study to generate real-life efficacy and safety data. Patients completed the IPSS, the OAB-q and a 2-day micturition diary at baseline and 12 weeks. PVR was determined sonographically. Seven hundred and forty one patients were analysed. Mean PVR did not increase (25.4 ± 26.5 vs. 29.3 ± 30.9 ml at baseline). AUR requiring catheterization occurred in two patients, acute UTI in four patients. Median IPSS total scores decreased from 17 to 10, IPSS QoL scores from 4 to 2, OAB-q symptom bother scores from 50.0 to 22.5 and OAB-q HRQL scores increased from 59.2 to 81.6. In men with OAB symptoms and presumed non-obstructive BPH, tolterodine ER provided considerable symptomatic and QoL improvements with a low risk of AUR, acute UTI, or increased PVR. [ABSTRACT FROM AUTHOR]

Introduction: The expression of the negative cell cycle regulator p27Kip1 is frequently found to be deregulated in various human cancer types. Whether expression of p27Kip1 can be used as prognostically relevant biological variables for renal cell cancer patients still remains to be clarified. Therefore, in the present investigation the expression within different tissue areas obtained from renal cell carcinomas was determined. Patients and Methods: For analysis of p27Kip1 in 420 tumor nephrectomy specimens obtained from 420 consecutively included patients, tissue microarrays were used comprising of 1,260 tissue samples each obtained from the tumor itself, the invasive front as well as non-malignant surrounding parenchyma. A sufficient follow-up after surgical therapy was available in 251 cases. Results: In univariate survival analysis, decreased expression of p27Kip1 within tissue cores obtained from the invasion front was significantly correlated with the patients’ disease-specific long-term survival (p = 0.02, log-rank test). In contrast, expression of p27Kip1 protein within the primary tumors was not identified to reveal any prognostically important information. In Cox regression analysis, histological stage and grade (p < 0.01), the presence of regional lymph node (p < 0.01) or distant metastases at the time of surgery (p < 0.01) as well as decreased expression of p27Kip1 (p = 0.04) within the invasion front tissue samples independently predicted the disease-specific long-term survival following surgery. Conclusion: Our analysis demonstrated that p27Kip1 is heterogeneously expressed in renal cell carcinomas. Moreover, the result of the present study supports the prognostic value of p27Kip1 protein expression for patients diagnosed with renal cell carcinoma. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Investigations in healthy persons have shown that drinking mineral water containing HCO3 has a positive effect on urine supersaturated with calcium oxalate (SSCaOx). The present study evaluates in a common setting whether these effects are also relevant in patients with multiepisodic urinary stone formation. A total of 34 patients with evident multiepisodic CaOx-urolithiasis were included in the study. Patients with hyperparathyroidism, renal tubular acidosis, Wilson’s disease, Cushing disease, osteoporosis and malignant diseases were excluded. In a cross-over design and double-blinded the patients received 1.5 l of a mineral water with 2.673 mg HCO3/l (test water) or the same amount of water with a low mineral content (98 mg HCO3/l) (control water) daily for 3 days. During the study period the patients diet was recorded in a protocol, but not standardised. The main target parameter was SSCaOx in 24 h urine. In addition, urinary pH and the most important inhibiting and promoting factors were measured in 24 h urine (Ca, Ox, Mg, Cit). Both waters tested led to a highly significant increase in 24 h urine volume without a difference between each other. In the group, drinking the water containing HCO3 the urinary pH increased significantly and was within a range relevant for metaphylaxis of calcium oxalate stone formation ( x = 6.73). This change was highly significant compared to the control group. In addition, significantly increased magnesium and citrate concentration were also observed. Supersaturation with calcium oxalate decreased significantly and to a relevant extent; however, there was no difference between the waters tested. As expected, the risk of uric acid precipitation also decreased significantly under bicarbonate water intake. However, an increase of the risk of calcium phosphate stone formation was observed. It is evident that both waters tested are able to lower significantly and to a relevant extent the risk of urinary stone formation in patients with multiepisodic CaOx-urolithiasis. In addition, the bicarbonate water increases the inhibitory factors citrate and magnesium due to its content of HCO3 and Mg. Thus, it can be recommended for metaphylaxis of calcium oxalate and uric acid urinary stones. [ABSTRACT FROM AUTHOR]

The evolution of flexible ureteroscopes led to a widespread use for the management of upper urinary tract abnormalities. The cost of purchase, maintenance and the durability of these instruments has become a major issue. This work describes a new device to avoid damages due to incorrect use of the Holmium laser during insertion of the laser fibre. A laser fibre with an optical core of 271 and 430 μm outside diameter was slid inside the FlexGuardTM laser fibre insertion sheath (LISA laser products, Germany). The outside diameter of the sheath measures 2.7 F (0.9 mm) and 2.1 F (0.7 mm) luminal diameter. The distal fibre tip was brought up to a position app. 2 mm inside the distal end of the sheath. The loaded sheath was pushed through the working channel of various ureteroscopes which were in maximum deflection. With the insertion sheath protruding about 2 mm from the distal tip of the URS the fibre was effortless forwarded out of the sheath to approach the stone. Once the laser fibre was in position, the sheath was removed, to increase the volume of irrigation fluid during laser lithotripsy. The radius of curvature (ROC) of the URS in maximum deflection and the integrity of the working channel was investigated. Using the insertion sheath the laser fibre reached the working position without any recognition of scratching or resistance. The integrity of the ureterorenoscopes was checked thoroughly be manually operated manometry. No damage of the inner surface of the working channel occured. The ROC of the instrument did not change significantly during this procedure. After removal of the sheath the ROC remained stable. With the extended use of ureteroscopy, durability and repair costs are of concern. Damage resulting from incorrect use of laser fibres is a major issue in this respect. FlexGuardTM proved to avoid this damage in all flexible ureteroscopes investigated without limiting their mobility. [ABSTRACT FROM AUTHOR]

The treatment of prostate cancer has undergone a fundamental change in the last decade. New surgical and nonsurgical minimal invasive methods have evolved. As the methodology of the different treatments is commonly known to urologists, this article focuses on oncological and functional outcome of open retropubic (ORP), trans- or extraperitoneal endoscopical (LRP), and robot-assisted radical prostatectomy (RALP), based on personal experience and review of the literature. A MEDLINE search was performed to review the literature on LRP and RALP between 1982 and 2007 with special emphasis on oncological and functional results, technical considerations, comparison of LRP and RALP to ORP, laparoscopic training, historical aspects, and cost-efficiency of the techniques. Based on diligent training and proctoring programs, a continuous dissemination of laparoscopic techniques takes place. There is a trend towards the extraperitoneal access in most of the minimal invasive programs at least in the European community. Mid-term outcomes of LRP and short-term outcomes of RALP achieved equivalence to open surgery with regards to complications, oncologic and functional results. Distinct advantages of LRP include less postoperative pain, lower transfusion rates, shorter convalescence, and better cosmetics. In contrast to RALP, LRP reaches cost-equivalence with open surgery in selected centers. LRP and RALP reproduce the short-term results of open surgery while providing the advantages of a minimal access. Video-assisted teaching improves the transfer of anatomical knowledge and technical knowhow, but the discussion about the longer learning curve for laparoscopy handling remains. The future will show if European centers adopt the use of robots comparable to the United States. [ABSTRACT FROM AUTHOR]

Minimally invasive therapies for treatment of benign prostatic hyperplasia (BPH) compete with the gold standard transurethral resection of the prostate (TURP). Comparisons of efficacy and safety have broadened the knowledge of different treatment modalities. Concerns of quality of life such as unaltered sexual function as well as cost considerations drive the market to develop techniques of lower level invasiveness. Among the competitors the office based transurethral microwave thermotherapy (TUMT) provides the broadest scale of scientific data. Numerous manufacturers sell various modifications of this technology. According to different clinical studies TUMT proved to be an effective, safe, and durable therapy for the treatment of lower urinary tract symptoms (LUTS) secondary to BPH. However, TURP still holds the steadier long-term results and is more effective to reduce obstruction as well as other LUTS. [ABSTRACT FROM AUTHOR]

The introduction of cisplatin-based systemic chemotherapy into the clinical routine has resulted in a substantial improvement of the recurrence-free and long-term survival of patients with metastatic testicular germ cell tumors. Late relapses after the completion of first-line therapy, comprising systemic chemotherapeutic treatment in combination with a complete resection of residual tumor masses visible in about 25–50% of patients, have been reported to occur in 1–5% of patients later than 2 years following the initial treatment. It has been reported that the risk for the development of late recurrence is correlated to the tumor burden at first diagnosis and/or the presence of teratomatous components within the primary testicular cancer. Second-line chemotherapy in combination with surgery, although not very well standardized, has been recommended as the most effective therapeutic regimen during the treatment of patients suffering from late recurrent germ cell tumors. Herein, we report our single-center experience with 14 patients in different clinical stages who developed late relapse after successful first-line therapy. In the present series, the risk for late relapse was not correlated to the clinical stage at first diagnosis or the presence of teratomatous elements within the primary tumor. It became evident that in selected cases chemotherapy alone can be considered a curative treatment option. [ABSTRACT FROM AUTHOR]

Objectives To further clarify the need for routine adrenalectomy during the surgical treatment of renal cell cancer, as in the absence of clinically overt metastatic disease, tumorous lesions within the adrenal gland are found in only 2–10% of patients, with most being over-treated by adrenalectomy. Patients and methods The medical records of 819 patients undergoing adrenalectomy combined with nephrectomy, irrespective of the local extension of the primary tumour or the clinical stage at first diagnosis, were reviewed to determine the reliability of currently available imaging methods in predicting adrenal gland metastases. Several patient and tumour characteristics were correlated with the presence of intra-adrenal metastases, and their possible independent prognostic value was determined by a multivariate logistic regression model. Results There was metastatic spread into the adrenal gland in 27 of 819 (3.3%) patients. In only three of eight patients in whom the adrenal was identified as the only metastatic site were preoperative abdominal computed tomography scans interpreted as false-negative. On multivariate statistical analysis only the presence of distant metastases, vascular invasion within the primary tumour and multifocal growth of renal cell cancer within the tumour-bearing kidney were identified as independent predictors of the presence of intra-adrenal metastases. Conclusions None of the patient or tumour characteristics evaluated reliably predicted the likelihood of adrenal metastases in patients with no evidence of disseminated metastatic spread. However, previously published data indicate that the frequency of metachronous metastases within the contralateral kidney (1.8–3.8%) is significantly higher than the risk of a preoperatively undetected isolated intra-adrenal metastatic lesion when currently available imaging modalities are applied. Therefore, routine adrenalectomy should not be recommended if the preoperative radiological... [ABSTRACT FROM AUTHOR]

CONTEXT: Tolterodine is a bladder-selective antimuscarinic agent designed for the treatment of overactive bladder. Traditional antimuscarinic therapies are poorly tolerated due to a high incidence of anticholinergic adverse events and consequently few patients remain on long term therapy. OBJECTIVE: To evaluate the long term efficacy and tolerability of tolterodine in patients with symptoms of overactive bladder. DESIGN: Twelve-month open-label extension of 4 randomised, placebo-controlled, double-blind, multinational, multicentre trials of 4 weeks' duration. PATIENTS: 714 patients (aged 18 to 92 years) with symptoms of overactive bladder who completed the double-blind portion of the studies. INTERVENTION: Tolterodine 2 mg twice daily for up to 12 months. MAIN OUTCOME MEASURES: Micturition diary variables: number of micturitions per 24 hours, number of urge incontinence episodes per 24 hours, mean urine volume voided per micturition. Safety variables: adverse events, study discontinuation rate. RESULTS: A total of 441 patients (62%) completed 12 months' open-label treatment with tolterodine, which significantly reduced the number of micturitions per 24 hours [mean change -2.4, 95% confidence interval (CI) -2.7 to -2.2, median change -20%, p < 0.0001] and number of urge incontinence episodes per 24 hours (mean change -1.3, 95% CI -1.6 to -1.0, median change -74%, p < 0.0001), while the mean volume voided per micturition was significantly increased (+33 ml, 95% CI +28 to +38, median change +18%; p < 0.0001). 41% of patients reported dry mouth (27% mild, 10% moderate, 3% severe). Dosage reduction to 1 mg twice daily was required in 23% of patients. 15% of patients withdrew from the study due to adverse events, with 5% having associated dry mouth. CONCLUSIONS: The high percentage of patients completing 12 months' treatment indicates that tolterodine is an effective and well tolerated agent for long term treatment of overactive bladder. [ABSTRACT FROM AUTHOR]

The p27[SUPKip1]gene has been identified as inductor of cell cycle arrest at the G1 checkpoint to prevent entry of somatic cells into the S phase of the cell cycle when substantial DNA damage has occurred. It has been suggested that decreased expression of the p27[SUPKip1] protein may contribute to the development of human malignancies due to loss of critical antiproliferative mechanisms. In the present study, 95 specimens (T1-T4) from 95 randomly selected patients undergoing radical prostatectomy at the Urological Department of Hannover University (82 patients) as well as in the Josef Hospital Regensburg (13 patients) between 1981 and 1992 for whom tissue blocks for immunohistochemical investigation were available, were investigated for different biological and clinical characteristics as possible predictors for recurrence-free and long-term survival: age, depth of tumour infiltration, histological grade, lymph node status, as well as decreased expression of the p27[SUPKip1] protein. After a median follow-up up of 56 months (24-151 months), seven of 21 (33%) patients (Group 1) with loss of p27[SUPKip1] protein expression or a relative amount of <10% of positively stained tumour cells developed recurrent disease in contrast to 17 of 74 (23%) patients (Group 2) with retained p27[SUPKip1] protein expression (≥10% of positively stained tumour cells). The median recurrence-free survival was 14 months (5-40 months) for patients from Group 1 and 31 months (7-133 months) for Group 2 patients (P = 0.02). In multivariate analysis, loss of p27[SUPKip1] protein expression was identified as the only independent prognostic parameter for recurrence-free survival. In contrast, neither the univariate nor the multivariate analysis showed a correlation between loss of p27[SUPKip1] protein expression and the long-term survival of the patients. Prospective studies are urgently needed to confirm the independent prognostic value of decreased p27[SUPKip1] protein expression... [ABSTRACT FROM AUTHOR]

Provides treatment of the genitourinary system disorders. Use of the antimuscarinics; Application of the isoenzyme-selective phophodiesterase inhibitors; Mechanism of the filament-associated protein troponin.

One hundred and forty-seven patients who had dorsal penile vein ligation (DPVL) between 1987 and 1996 were re-investigated either during clinical consultation or by standardised telephone interview respectively questionnaire. One hundred and twenty-six patients were available for long-term follow-up. Postoperative outcome was classified into complete spontaneous erection, postoperative response to pharmacotherapy or no satisfactory improvement. The short-term success after 1-3 months according to this classification was 31 (24.6%), 25 (19.8%) and 70 (55.6%). These results were found to have deteriorated on long-term observation; with only 14 (11.2%), 24 (19.0%) and 88 (69.8%) respectively. Positive prognostic factors were preoperative duration of erectile dysfunction of ≤ 7 y, a normal CC-EMG and a maintenance flow of ≤ 45 ml/min. With all three parameters present, longterm success (spontaneous erection plus responder to intracavernous injection) rose from 30 to 67% in this selected group (P ≤ 0.001). Our study shows that long-term success for unselected patients undergoing DPVL is disappointing; however, careful patient selection significantly improves long-term results. [ABSTRACT FROM AUTHOR]