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PubMed1999

Sperm viability in ram semen diluted and stored in three different extenders.

Semen was collected with an artificial vagina from 4 one-year-old rams, in order to study the changes in sperm motility and membrane integrity of spermatozoa split-diluted and stored at 5 degrees C during 7 days in sodium citrate, Tris, and milk-based extenders, respectively. Sperm motility was assessed subjectively and sperm membrane integrity was determined using the fluorescent probes Calcein-AM and Ethidium homodimer. Representative samples were studied using scanning electron microscopy (SEM). The average incidence of sperm motility decreased over time in all the extenders (p < 0.001). The incidence of spermatozoa showing progressive motility and intact plasma membrane was significantly higher in semen diluted with sodium citrate than in the other 2 extenders following 4 days of dilution until the end of the study. Evaluation with SEM confirmed the findings obtained with the supra vital fluorescent dyes. The results of the present study indicated that there were no differences between sodium citrate-, Tris- or milk-based extenders when ovine liquid semen was stored at 5 degrees C during a short period (2 days). However, when semen was stored for longer time, spermatozoa in the sodium citrate-based extender sustained its viability better.

Animals↗

PubMed1999

Substantial superiority of semiflexed (MTP) views in knee osteoarthritis: a comparative radiographic study, without fluoroscopy, of standing extended, semiflexed (MTP), and schuss views.

OBJECTIVE: To improve the radiographic assessment of cartilage loss, as measured by joint space width (JSW) in patients with osteoarthritis (OA) of the knees required to detect the effect of structure modifying drugs in OA trials. This was achieved by determining which of 3 nonfluoroscopic radiographic views--standing extended, semiflexed, and schuss--produced the most accurate radioanatomic positioning of the joint and greater reproducibility in joint repositioning and JSW measurement. METHODS: Knees from 74 patients with OA of the knees who had medial tibiofemoral compartment JSW > or =2 mm in all views were studied. For all 3 radiographic views, accuracy in the radioanatomic positioning of the knee was determined for both joint rotation and flexion. Reproducibility in joint repositioning and JSW measurement were determined from the difference between repeat examinations taken within 2 h. RESULTS: About 86% of knees in the 3 views had accurate rotational position of the joint at each visit. Radioanatomically, knees in the semiflexed view were significantly more accurately positioned in regard to knee flexion (p<0.0005) than in the schuss view, which in turn was better (p<0.014) than in the extended knee view. Joint repositioning was significantly more reproducible in the semiflexed (p<0.0001) than in the extended knee, which was better (p<0.013) than in the schuss position. JSW measurement was significantly more reproducible in the semiflexed (p<0.014) than both schuss and extended knee positions, which were not significantly different from each other. CONCLUSION: Protocols defining the nonfluoroscopic radiographic procedures for the semiflexed view provide the most accurate radioanatomic joint positioning, and the most reproducible joint repositioning and JSW measurement. Using this method significantly fewer knees would be required to detect significant JSW changes in a structure modifying drug trial compared to the schuss and the extended knee positions.

Adult↗

PubMedDate not supplied

Is extended lymphadenectomy valuable in palliatively gastrectomized patients with gastric cancer and simultaneous peritoneal metastasis?

BACKGROUND/AIMS: The optimal extent of lymphadenectomy in patients with gastric cancer and simultaneous peritoneal metastasis upon non-curative resection remains unclear. The aim of the present study was to evaluate the efficacy of extended lymphadenectomy in palliatively gastrectomized patients with gastric cancer and simultaneous peritoneal metastasis. METHODOLOGY: The significance and limit of extended lymphadenectomy according to the extent of peritoneal metastasis was analyzed retrospectively in 110 patients with gastric cancer and simultaneous peritoneal metastasis who had undergone palliative gastrectomy. RESULTS: Of the 47 patients with P1 metastasis, the median survival period of the 23 patients who underwent extended lymphadenectomy and the 24 patients who underwent limited lymphadenectomy was 21.7 months and 17.2 months, respectively. Of the 63 patients with P2 or P3 metastasis, the median survival period of the 16 patients who underwent extended lymphadenectomy and the 47 patients who underwent limited lymphadenectomy was 10.4 months and 12.8 months, respectively. No significant differences in survival time based on extent of lymphadenectomy were observed either in the patients with P2 or P3 metastasis (P = 0.262) or in those with P1 metastasis (P = 0.277). CONCLUSIONS: The results of the present study demonstrate that extended lymphadenectomy in gastric cancer yields no positive impact on survival upon non-curative resection either in patients with gastric cancer and simultaneous metastases to the adjacent peritoneum (P1) or to the distant peritoneum (P2 or P3).

Female↗

PubMed2001

Prospective randomized controlled trial of extended-release oxybutynin chloride and tolterodine tartrate in the treatment of overactive bladder: results of the OBJECT Study.

OBJECTIVE: To compare the efficacy and tolerability of extended-release oxybutynin chloride and tolterodine tartrate at 12 weeks in participants with overactive bladder. SUBJECTS AND METHODS: The OBJECT (Overactive Bladder: Judging Effective Control and Treatment) study was a prospective, randomized, double-blind, parallel-group study conducted between March and October 2000 at 37 US study sites. Participants who had between 7 and 50 episodes of urge incontinence per week and 10 or more voids in 24 hours received extended-release oxybutynin, 10 mg/d, or tolterodine, 2 mg twice daily. The outcome measures were the number of episodes of urge incontinence, total incontinence, and micturition frequency at 12 weeks adjusted for baseline. RESULTS: A total of 315 women and 63 men were randomized and treated, and 332 participants (276 women, 56 men) completed the study. At the end of the study, extended-release oxybutynin was significantly more effective than tolterodine in each of the main outcome measures: weekly urge incontinence (P=.03), total incontinence (P=.02), and micturition frequency episodes (P=.02) adjusted for baseline. Both drugs improved symptoms of overactive bladder significantly from baseline to the end of the study as assessed by the 3 main outcome measures (P<.001). Dry mouth, the most common adverse event, was reported by 28.1% and 33.2% of participants taking extended-release oxybutynin and tolterodine, respectively (P=.32). Rates of central nervous system and other adverse events were low and similar in both groups. CONCLUSIONS: Extended-release oxybutynin was more effective than tolterodine as measured by end-of-study urge incontinence, total incontinence, and micturition frequency episodes. Both groups had similar rates of dry mouth and other adverse events.

Aged↗

PubMed2001

Ventral mesopontine projections of the caudomedial shell of the nucleus accumbens and extended amygdala in the rat: double dissociation by organization and development.

The shell of the nucleus accumbens and central division of the extended amygdala are telencephalic structures that influence motor activity and lately have been regarded by some as components of a single functional-anatomic continuum. Each has a highly differentiated internal organization and output system and distinct pharmacologic responses however, and it is thus likely that each subserves distinct contributions to behavior. In this investigation, nucleus accumbens and extended amygdala outputs were compared by using retrograde tracing in adult and postnatal rats. Fluoro-Gold, when injected into the ventral tegmental area, produced substantial retrograde labeling in the adult nucleus accumbens shell, but only trivial amounts in the central division of the extended amygdala. Injection sites in the lateral mesopontine tegmentum produced robust labeling in the central extended amygdala but little in the nucleus accumbens. The projections of extended amygdala were substantially developed by postnatal day 1, whereas those of the caudomedial shell of the nucleus accumbens only reached the ventral tegmental area by approximately postnatal day 6. Few neurons projecting from the caudomedial shell of the accumbens to the ventral tegmental area were observed even at postnatal day 21. In consideration of the reported importance of the nucleus accumbens, particularly the caudomedial shell, in neural processing related to reward and motivation and the central nervous system response to antipsychotic drugs, it may be important to determine whether processes occurring during the protracted postnatal development of the caudomedial shell are vulnerable to destructive circumstances, such as drug intoxication, maternal separation, or social isolation.

Aging↗

PubMed2004

[Extended transsphenoidal approach to giant tumors in sellar and clival area].

OBJECTIVE: To explore the effects of extended transsphenoidal approach, a new approach for removing giant tumors in sellar and clival area. METHODS: Twenty-eight patients, 19 males and 9 females, aged 17 - 67 with a mean age of 47.8, with a mean history of 6.2 years, 13 with invasive giant pituitary adenoma, 10 with chordoma, 2 with giant cell tumor of bone, 2 with pituitary metastatic tumor, and 1 with pituitary endocrinal carcinoma underwent operation by extended transsphenoidal approach. The tumors were 3.0 - 5.5 cm in size. In 2 cases the tumor extended to the base of the frontal lobe, 7 tumors involved the cavernous sinus, and 19 extended to clivus. RESULTS: The tumor was totally removed in 19 patients, removed subtotally in 6 patients, and removed partially in 3 patients. Postoperative follow-up was performed for 6 months to 4 years. No recurrence occurred except for enlargement of 2 pituitary metastatic tumors and 1 chordoma. CONCLUSION: Extended transsphenoidal approach satisfactorily reaches and helps remove the giant tumors in sellar and clival area without severe complication.

Adenoma↗

PubMed2005

[Evaluation of surgical traumaticity of standard and extended surgical procedures in cancer of a proximal part of the stomach].

Analysis of the results and evaluation of surgical trauma of 454 various resections for cancer of a proximal part of the stomach were carried out. Proximal subtotal resection of the stomach with resection of the esophagus were performed in 151 patients (33.2% of all the resections). Gastrectomy was performed in 296 (65.2%) patients. Standard resection was carried out in 254 (55.9%) patients, extended -- in 72 (15.8%), combined -- in 64 (14,1%), extended-combined -- in 64 (14,1%). It is demonstrated that number of complications after surgical treatment of cancer of a proximal part of the stomach is high enough due to traumaticity of abdominal-thoracic surgical procedures. Surgical approach, duration of surgery, intraoperative blood loss have significant influence on short-term results. Duration of surgery more than 300 min is the main factor making worse short-term results of extended resection of the stomach. In such duration of surgery postoperative complications were seen in 45.0+/-11.4%, lethal outcome -- in 30.0+/-10.5% cases. Extended surgical procedures demonstrate better long-term results. Five-years survival of patients with cancer of proximal part of the stomach (stage II and III) after extended surgeries is 53.3+/-13.3 and 33.3+/-6.3%, respectively. Standard resection is recommended for elderly patients with low functional reserves.

Esophagus↗

PubMed2005

Atypical small acinar proliferation (ASAP) on extended prostatic biopsies: predictive factors of cancer detection on repeat biopsies.

OBJECTIVE: To evaluate the clinical and histopathologic factors that may help to predict cancer detection by means of extended repeated prostate needle biopsies in patients with Jumma atypical small acinar proliferation (ASAP) results on initial prostate biopsy. MATERIALS AND METHODS: From 1998 to September 2003, 105 out of 121 (86%) patients with a diagnosis of ASAP after a first set of 10 to 12 systematic biopsies, were rebiopsied using the same technique plus additional biopsies on the ASAP site (mean number of repeat biopsy samples, 12.6). The median time until a second and third biopsy was 7.04 months (95% confidence interval [CI], 5.5-8.5), and 13.3 months (95% CI, 8.8-17.7; 19 patients), respectively. Each histological slide was reviewed blindly by a single experienced pathologist (M.F) who differentiated highly suspicious (ASAPH) and not highly suspicious (ASAPB) lesions for cancer. RESULTS: On initial biopsy, a concomitant HGPIN was present in 18 patients (17%) with ASAP The overall cancer detection rate in those who underwent two or three sets of biopsies was 39% (41/105); it was 35% (37/105) and 21% (4/19) in second and third biopsies, respectively. The overall cancer detection rate was higher in patients who had ASAP associated with HGPIN (50%) compared with patients who had isolated ASAP (37%) (p = 0.3). Statistical analysis showed that levels of prostate-specific antigen (PSA), PSA density, prostatic volume, digital rectal examination results, transrectal ultrasound findings, time until rebiopsy (less vs. more than 6 months), and histological level of suspicion were not significant predictors of prostate cancer at the time of rebiopsy. In particular, the cancer detection rate was not significantly higher in patients with ASAPH than those with ASAPB (49% vs. 33%, respectively; p = 0.11). In a univariate analysis, the mean prostate volume was statistically different in patients with cancer compared with those without (56.4 +/- 6.3 and 78.9 +/- 5.3 respectively; p = 0.009), but only in the group of patients who had isolated ASAP In these patients, the rate of cancer detection was significantly higher in patients who had a prostatic volume less than 60 mL (56%) than in patients with a prostatic volume greater than or equal to 60 mL (27%) (p = 0.03). CONCLUSIONS: Patients with an initial ASAP diagnosis after extended biopsies had an overall cancer detection rate less than 40% after two sets of extended biopsy. ASAPH lesions did not indicate a significantly higher risk of cancer than ASAPB lesions on repeated extended biopsies. Despite the extended rebiopsy plus the additional biopsies targeted to the ASAP lesion, the detection rate was lower for patients with a larger prostate than those with a smaller prostate.

Aged↗

PubMedDate not supplied

[Response and remission in depressive patients with anxiety symptoms treated with venlafaxine extended release in primary care].

INTRODUCTION: The aim of this observational study was to evaluate the long term effect of treatment with venlafaxine extended release on response and remission in patients with depressive syndrome and associated anxiety symptoms, in primary health care. METHODS: Observational, naturalistic and prospective, open-label study. Inclusion criteria were as follows: age over 18 years, diagnosis of depressive syndrome with anxiety symptoms and minimum scores of 17 and 10 on Hamilton Depression Rating (HAM-D17) and Anxiety Rating (HAM-A) scales, respectively. Daily doses of 75-150 mg of venlafaxine extended release were administered for 24 weeks. Effectiveness on the depressive-anxious symptoms was assessed using the HAM-D17 and HAM-A scales. Response and remission criteria were considered. RESULTS: 6,719 patients were evaluable for effectiveness and safety - intention to treat population. Venlafaxine extended release treatment was associated with significant decreases in the scores in the HAM-D17 and HAM-A scales, as well as with significant increases in response and remission rates. At week 24, remission rates were: 74.62% (HAM-D17<or=7), 81.55% (HAM-A<or=7) and 72.63% (HAM-D17 <or=7/HAM-A<or=7). 81.8 % of patients completed 24 weeks of treatment. 6.4% of patients reported adverse events, of mild-moderate intensity in 94.9% of cases. CONCLUSION: In this study, venlafaxine extended release shows that it is an effective and safe drug in the treatment of the depressive-anxious symptoms of patients with depressive syndrome treated in primary care, both in remission and response rates. It would be of interest to compare data of venlafaxine extended release with that of other antidepressive drugs, such as SSRI.

Adolescent↗

PubMedDate not supplied

[Extended lymphadenectomy in radical cystectomy: margins, scope, methodology].

Radical cystectomy with pelvic lymphadenectomy is a gold standard for treatment of muscle-invasive urinary bladder cancer. However, therapeutic and prognostic value of pelvic lymphadenectomy is still controversial. Recent studies have demonstrated a better prognosis after extended lymphadenectomy. A multicenter study was made to standardize an extended lymphadenectomy procedure. We examined prospectively the total number of lymph nodes removed from various sites, number and location of positive nodes and its relation to location of primary tumors in the urinary bladder. Thirty five radical cystectomies with extended lymphadenectomy were performed for the treatment of invasive bladder cancer in National Urology Center in 1999-2004. The margins of extended lymphadenectomy were: cranial level of a.mesenterica inferior; lateral--n.n. genitofemoralis; caudal-fossa obturatoria. A total amount of removed lymph nodes comprised 1081, mean 34.2 +/- 8.1 lymph node per patient (range from 10 to 58). Fourteen patients (40.0%) were node positive (69 nodes). According to N category: N1--6 patients; N2--7 patients. Six patients had lymph node metastases up to the aortic bifurcation. In 6 cases a positive node was found on the contralateral side. Thus, we recommend extended radical lymphadenectomy for all patients undergoing radical cystectomy for bladder cancer.

Adult↗

PubMed2005

Costs and outcomes of extended-release vs. immediate-release clarithromycin for lower respiratory tract infections.

We used decision-analysis modeling to compare costs and outcomes of clarithromycin extended-release (Biaxin XL, Abbott Laboratories, Abbott Park, Illinois, USA) and clarithromycin immediate-release (Biaxin, Abbott Laboratories, Abbott Park, Illinois, USA) for outpatients with lower respiratory tract infections (LRTI). More patients achieved clinical cure with extended-release (83.9%) versus immediate-release (72.8%); fewer discontinued due to adverse events. Total costs with extended-release were $32 (16%) less; incorporating greater adherence for extended-release (once-daily) therapy resulted in greater savings. Results indicate that clarithromycin extended-release is cost-saving compared with immediate-release for LRTI.

Anti-Bacterial Agents↗

PubMed1991

Potential cost-avoidance with oral extended-release morphine sulfate tablets versus morphine sulfate solution.

The costs of acquiring, preparing, and administering morphine sulfate extended-release tablets and morphine sulfate solution were compared. Pharmacists at an acute-care community hospital timed the pharmacy and nursing components of the process of preparing and administering single doses of morphine sulfate extended-release tablets 60 mg and morphine sulfate solution 5 mg/mL. The labor cost of each step was determined by multiplying the mean time required to perform the task by the median of the wage scale for the person performing it. Acquisition costs and ancillary supply costs were determined, and the overall cost of each therapy was calculated. The total time required for providing single doses did not differ substantially. However, assuming a total daily morphine sulfate dosage of 120 mg, the time required for administering extended-release morphine sulfate tablets 60 mg twice daily was determined to be 8.90 minutes, compared with 23.44 minutes for solution (4 mL of 5-mg/mL solution) six times daily. Thus, although the cost of acquiring extended-release tablets was considerably higher than that of solution, the total daily cost of therapy with tablets was less than half that of therapy with solution. The potential for cost avoidance and the clinical advantages associated with extended-release morphine sulfate tablets make this formulation an attractive therapeutic alternative.

Administration, Oral↗

PubMed1991

[The use of extended family APGAR index in OPD].

The present study was designed to evaluate the clinical availability of extended family APGAR in OPD. Five hundred and twenty two patients were collected from three different out-patient departments were studied during a 6 month period. All 522 patients were over 12 years of age and asked to completed an extended family function questionnaire. The patient's age, sex, marital status, occupation, education, family role, socioeconomic status and religion were also recorded. The results showed that there were significant difference among the extended scores of patient's marital status and the socioeconomic status. We also found that patients suffering from family problems, psychosomatic problems and multiple problems have significantly lower extended scores. Because only 3 patients were diagnosed as having family problems by a chart reviewed in all 522 patients, we suggest further research on the extended family APGAR before widely using it in OPD.

Adult↗

PubMed1990

Promotion of extended-release niacin tablets at a Veterans Affairs medical center.

A program to modify the prescribing of antilipemic agents by promoting the use of extended-release niacin tablets is described. Between December 1987 and August 1988, pharmacists at a 1188-bed Veterans Affairs medical center observed a large increase in the number of outpatient prescriptions for antilipemic agents. In an attempt to control costs, a program to promote the use of extended-release niacin tablets for treating hyperlipemia was conducted during August and September 1988. Various educational materials on niacin were distributed to physicians. A display on therapy of hyperlipemia was featured at the monthly drug fair, and articles on niacin were presented during a journal club meeting of ambulatory-care clinicians. Pharmacists succeeded in having extended-release niacin tablets placed on the formulary in September. Data on the number of prescriptions filled for antilipemic agents were collected before and after the niacin promotional program. The number of prescriptions filled for extended-release niacin 500-mg tablets increased steadily during a six-month study period after the program ended; the number of prescriptions filled for regular niacin decreased by 50%. As prescribing of extended-release niacin increased, prescribing of colestipol, gemfibrozil, and probucol declined. The promotional program was well received by most of the medical staff. A program of education and formulary management successfully changed physician prescribing habits for antilipemic agents.

Cost Control↗

PubMedDate not supplied

The major histocompatibility complex: the value of extended haplotypes in the analysis of associated immune diseases and disorders.

Major histocompatibility complex antigens are critical to an animal's immune response. In most animals, the extreme polymorphism of MHC molecules complicates studies of the role of this complex in the immune response. In mice, however, MHC haplotype-homozygous inbred strains have been developed which are invaluable in the study of the immune system and the search for immune response genes. The human MHC bears many similarities to its murine equivalent with regard to antigen structure and polymorphism; furthermore, a number of combinations of specific MHC alleles between HLA-B and HLA-DR/DQ (extended haplotypes) are found in people more commonly than predicted by individual allele frequencies. Over 30 percent of Caucasian haplotypes are extended haplotypes, and over 55 percent of individuals have at least one extended haplotype. Examples of the same extended haplotype, even in unrelated individuals, should either all have or lack any gene within the MHC region. The value of considering extended haplotypes in searching for associations between the MHC and diseases, or immune response, is shown in three examples: congenital adrenal hyperplasia, hepatitis B immunization, and transfusion-associated graft-versus-host disease.

Animals↗

PubMed1989

Domains of medical practice: physicians' assessment of the role of physician extenders.

The relationship between physicians and physician extender occupations is considered in light of the stratification of medical care workers. Professional dominance between various medical occupations and professional competition among physicians are considered. Data from a national sample of physicians taken in 1981 are used to determine 1) under what conditions physicians are likely to consider the employment of physician extenders helpful for improving quality of care and 2) which characteristics and available resources are associated with the belief that the employment of physician extenders will improve medical care. Of four different service populations considered, physicians are most likely to think that the use of physician extenders to care for the urban poor will aid care and are least likely to think that their employment will improve care for obstetrics and pediatrics cases. The results indicate that physicians' beliefs regarding the employment of physician extenders are dependent on the clientele as well as on the relative position of the two occupational groups in the hierarchy of medical care occupations.

Attitude↗

PubMed1989

[The value and limit of extended surgery in colorectal cancer].

Since the majority of colorectal cancers are well differentiated adenocarcinomas and grow rather slowly and well limited, surgery is the most available and favored treatment. The cancer-related 5-year survival rates of patients having undergone an extended operation versus those undergoing the conventional operation in our hospital (1969-1983) were 86% and 70% for Dukes B stage, and 60% and 38% for Dukes C stage. The survival superiority of the extended operation was confirmed as statistically significant (p less than 0.05). However, this survival advantage not true for patients with lateral lymphnode metastasis. A more extended operation with lateral dissection cutting the iliac internal vessels was performed for patients suspected of having lateral metastasis. Reduction of the incidence of local recurrence is really observed by this procedure. Urine-voiding and sexual dysfunction were observed more frequently in patients with the extended operation than the conventional one. By selectively preserving only 4th pelvic nerve, it becomes possible to preserve the urine voiding function without losing the benefits of the extended operation. In cases of far advanced cancer invading to adjacent organs, value of combined resection was also confirmed. Metastatic lesions to the liver or the lung should be removed by enucleation or partial resection of these organs, unless a multiple case. The 5-year survival of patients were 35% for liver metastasis and 40% for pulmonary metastasis.

Colorectal Neoplasms↗

PubMedDate not supplied

The modified extended mastectomy using the trap-door method as a staging operation.

The choice of operation for breast cancer must be directed towards giving the best chance of local control of the disease. Extended radical mastectomy may be beneficial for patients with internal mammary lymph node metastases, although it has remained controversial. The anterior chest defect created by extended radical mastectomy should be avoided in patients with no metastasis in the internal mammary lymph nodes. This paper, proposes a new technique of modified extended mastectomy using the trap-door method as a staging operation and an intermediate operation between modified radical mastectomy and extended radical mastectomy. In this operation, the axillary dissection could be performed by reflecting the pectoralis major muscle and the internal mammary lymph nodes could be dissected by reflecting the parasternal chest wall in trap-door fashion. In cases in which the metastasis is histologically found in the internal mammary content, extended radical mastectomy by sternal splitting is preferred.

Breast Neoplasms↗