摘要:

Summary“But when the disease has spread also over the testicle and its cord the testicle sinks a little lower, and becomes smaller than its fellow, in as much as its nutrition has become defective.”Amelius Cornelius Celsus (42BC‐37 AD)“Varicocele is a compact pack of vessels quite filled with melancholic blood.”Ambroise P

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16167.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummarySerum immunosuppressive acidic protein (IAP) was measured serially in 69 patients with renal carcinoma who were treated surgically and followed up for more than 6 months after surgery. Elevated IAP levels>600 µg/ml were seen in 8 of 52 patients without evidence of recurrence and in 5 of 10 patients prior to clinical evidence of recurrence but in whom recurrence did eventually develop. The positive rate of IAP levels>600 µg/ml in recurrent cases was significantly higher than in non‐recurrent ones. In 7 patients with distant metastases, IAP levels rose to>500 µg/ml in 3 of 5 patients whose disease progressed despite therapy; levels fell to600 µg/ml, as these changes appear to correlate with the response of metastases to t

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16168.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryA cohort of 200 men over the age of 50 years was selected at random. Initially 112 men participated. After 5 years 61 were participating, and 2 years later 34 men still had no voiding problems, while 19 had had treatment for prostatism. A history was obtained and all 112 had symptom analysis and uroflow examination. The uroflow variables Qmax, Qave, Qmax‐time, Q“corrected”, volume and the ratio Qmax/Qmax‐time were recorded together with the symptom score and subjective evaluation. After 5 and 7 years all primary data were reviewed in the 61 and 34 men respectively, while a full history was obtained in the rest. The 3 sets of data were evaluated separately as 3 cross‐sectional investigations and as paired data sets by means of non‐parametrical statistical analysis. Comparing the 3 sets of data longitudinally, significant differences were found in Qmax, Qave, Qcor and Ace. A correlation analysis showed that Qmax, Qave, Q“corrected” and volume decreases significantly with advancing age in asymptomatic men, while no correlation with age was found in the 19 treated men. On the basis of the 93 men, untreated for 7 years, nomograms of Qmax, Volume and Ace were constructed using 2.5, 25, 50, 75 and 97.5% percentiles in 5‐year groups. Likewise, a nomogram on symptom score was constructed on the basis of the 82 men, asymptomatic and untreated for 7 years.In conclusion, uroflow in subjectively normal men over the age of 50 years shows increasing abnormality with advancing age. At the same time elderly men tolerate a considerable amount of symptoms of intravesical obstruction. The severity of symptoms increased with advancing age, but differently in persons likely and not likely

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16169.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryOne hundred and seventy women with genuine stress urinary incontinence participated in a pelvic floor exercise (PFE) programme (duration 4.7 ± 0.2 months, range 1–18). Twenty‐seven women awaiting surgery for genuine stress urinary incontinence constituted the control group. The women were evaluated using a provocation test, vaginal palpation and subjective assessment before and after treatment. After the PFE programme, 23% of the women considered themselves cured, 48% were improved and 29% unchanged. According to the provocation test used in this study 64% were cured or improved following PFE. The long‐term results of PFE were assessed by means of a postal questionnaire 2 to 7 years after completion of the supervised training period (response rate 152/170; 89%). During this time 38 women (25%) had undergone operative treatment. Of the remaining patients, 13 (11%) reported that they were still cured, 50 (44%) continued to be improved, 35 (31%) were unchanged and 16 (14%) had deteriorated. However, the frequency of PFE training during the follow‐up period was unsatisfactory, as only 15% were training several times a day. This indicates that continued guidance from a physiotherapist could improve the long‐term efficacy of PF

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16170.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryAn improved design of the recently developed urethral plug was evaluated for the treatment of women with genuine urinary stress incontinence. The plug consists of an oval meatal plate, a soft stalk and 1 or 2 spheres along the stalk with fixed distances between the meatal plate and the spheres. Inside the stalk is a removable semi‐rigid guide pin to ease insertion. Forty women were randomly allocated to treatment with either the 2‐sphere or the 1 ‐sphere plug during period 1 (2 weeks). In period 2 (2 weeks) the patients used the other plug. They then continued with what they judged to be the better plug in period 3 (2 months). Eighteen patients (45%) completed period 3 with the “preference” plug and 17 were subjectively and objectively continent or improved. Fourteen of these women preferred the 2‐sphere device. The plugs were equally effective in patients with mild or severe incontinence. To accommodate variations in urethral length and to avoid the loss of plugs, the devices are available in different lengths. Six women developed urinary tract infections and 2 of these had a plug in the bladder.The urethral plug is an effective treatment in a group of women with stress incontinence. Removal by hand is advisable in order to avoid retention of plugs in

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16171.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryTo investigate whether tumour recurrence or histological changes occur in the Kock pouch, periodic endoscopy with biopsy of the pouch was performed in 15 patients 6 to 66 months after radical cystectomy and urinary diversion for invasive bladder cancer. Endoscopy was undertaken 1 to 4 times in each patient (a total of 37 times in all patients). During endoscopy, random biopsies were taken from the pouch wall, and from the afferent and the efferent nipples. The histological changes were graded as: (1) villous atrophy (grade 0 to 3, 0: nearly normal; 1: shortening, villi/crypt of Lieberkuhn [length] between 1.5 and 4.0; 2: moderate flattening, villi/crypt<1.5; and 3: almost complete disappearance of villi); (2) fibrosis; and (3) chronic inflammation (grade 0 to 3, based on the amount of fibrous tissue and inflammatory cell infiltration in the lamina propria, respectively). There was no dysplasia or malignant tumour in the Kock pouch in any of the 15 patients. The histology of the ileum changed in terms of villous atrophy, fibrosis and chronic inflammation in the lamina propria and thickening of the muscularis mucosa. The same grade of villous atrophy of the pouch wall, the afferent and the efferent nipples was only found in 3 patients. More fibrosis and less chronic inflammation in the lamina propria were found at the efferent nipple than at the afferent nipple or pouch wall in 8 patients and 5 patients, respectively. Thickening of the muscularis mucosa was found in 13 of 15 patients (86.7%).In conclusion, there was no dysplasia or recurrent tumour in the Kock pouch in patients who were followed for up to 66 months. Various grades of histological changes of the ileum in terms of villous atrophy, fibrosis and chronic inflammation of the lamina propria, and thickening of the muscularis mucosa were found in the pouch wall, and in the afferent and efferent nipples. More fibrosis and less chronic inflammation were commonly observed at the efferent nipple than at the afferent nipple or pouch wall. The degree of histological changes varied even among patients followed over the same period after operation. The time to progression of villous atrophy also varied. The histological changes in some patients were dissimilar even at the same site of the Kock pouch.

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16172.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryA catheterised bladder model was developed to examine the design features of urinary drainage bags. The drainage bag of 4 commonly used products was inoculated with eitherEscherichia coliorProteus mirabilis.The speed of retrograde contamination towards the “bladder” was determined over 96 h. The effect of lifting the drainage bag above the level of the “bladder” was examined also. Within 4 days micro‐organisms were detected in the backflow valves/drip chambers of all products, but contamination had not progressed as far as the catheter.Ps. mirabilisappeared to migrate more rapidly thanEsch. coli.Lifting the drainage bag had no effect on the migration of either organism. The implications of these results for clinical practice are

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16173.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryWe report a prospective study of 141 patients presenting for the first time with a small, solitary, non‐invasive, moderately or well differentiated transitional cell carcinoma of the bladder. The pattern of recurrence in the first year was assessed and recurrence rates calculated; 80% of patients without recurrence at 3 months remained clear in the first year. There was a highly significant reduction in recurrence rates for those free of recurrence at 3 months. It has been suggested that this group should have the second check cystoscopy at 1 year and yearly cystoscopies thereafter. Our findings support that proposa

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16174.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThe first blind, prospective, randomised comparison of flexible cystoscopy with rod‐lens cystoscopy was carried out on 53 consecutive volunteers with bladder tumours or haematuria. Three patients' recurrences were missed on flexible cystoscopy and 3 others on rod‐lens examination. It was expected that the 9% rate of missed tumours would lessen with increased experience of flexible cystoscopy, as 2 of them occurred in the first 12 examinations and all of the lesions missed were<5 mm in diameter. Rod‐lens cystoscopy, the accuracy of which appears to have been measured for the first time, was no more sens

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16175.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryA cohort of 148 patients with papillary Ta‐T1 transitional cell carcinomas (TCCs) was followed up for over 10 years and flow cytometric (DNAploidy, S phase fraction) and morphometric variables (5 nuclear factors, volume corrected mitotic index) were related to prognosis during this period. Recurrence‐free survival was significantly related to DNAploidy, S phase fraction and M/V index. Progression in T‐category was predicted by M/V index, S phase fraction, DNA ploidy and WHO grade. The same variables predicted progression in N‐ and M‐categories. In a multivariate analysis only M/V index and S phase fraction were independent predictors of progression. Univariate analysis showed that M/V index, SPF, DNA ploidy and WHO grade predicted survival. In a multivariate survival analysis only M/V index and SPF were independent predictors. The results showed that proliferation indices had independent prognostic value in papillary Ta‐T1 TCCs and the grading of these tumours could be based on the proliferation indices. Papillary Ta‐T1 tumours with a M/V index value 10/mm2or SPF 10% had a favourable prognosis whereas tumours with M/V index>10/mm2or SPF>10% had a high malign

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16176.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY