Brian R Lane

Summary

Publications

  1. doi request reprint 7-year oncological outcomes after laparoscopic and open partial nephrectomy
    Brian R Lane
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
    J Urol 183:473-9. 2010
  2. doi request reprint Response of the primary tumor to neoadjuvant sunitinib in patients with advanced renal cell carcinoma
    Anil A Thomas
    Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
    J Urol 181:518-23; discussion 523. 2009
  3. doi request reprint Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older
    Brian R Lane
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    Cancer 116:3119-26. 2010
  4. doi request reprint Inadequacy of biopsy for diagnosis of upper tract urothelial carcinoma: implications for conservative management
    Armine K Smith
    Glickman Urological and Kidney Institute, Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH 44195, USA
    Urology 78:82-6. 2011
  5. doi request reprint Elective partial nephrectomy in patients with clinical T1b renal tumors is associated with improved overall survival
    Christopher J Weight
    Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    Urology 76:631-7. 2010
  6. pmc Differential expression in clear cell renal cell carcinoma identified by gene expression profiling
    Brian R Lane
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    J Urol 181:849-60. 2009
  7. doi request reprint Comparison of cold and warm ischemia during partial nephrectomy in 660 solitary kidneys reveals predominant role of nonmodifiable factors in determining ultimate renal function
    Brian R Lane
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    J Urol 185:421-7. 2011
  8. doi request reprint Does transrectal ultrasound probe configuration really matter? End fire versus side fire probe prostate cancer detection rates
    Christina B Ching
    Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
    J Urol 181:2077-82; discussion 2082-3. 2009
  9. doi request reprint Prostate cancers diagnosed at repeat biopsy are smaller and less likely to be high grade
    Nelly Tan
    Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
    J Urol 180:1325-9; discussion 1329. 2008
  10. doi request reprint Clinical correlates of renal angiomyolipoma subtypes in 209 patients: classic, fat poor, tuberous sclerosis associated and epithelioid
    Brian R Lane
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    J Urol 180:836-43. 2008

Detail Information

Publications54

  1. doi request reprint 7-year oncological outcomes after laparoscopic and open partial nephrectomy
    Brian R Lane
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
    J Urol 183:473-9. 2010
    ..Long-term outcomes of laparoscopic partial nephrectomy are pending. We present the long-term outcomes of patients undergoing laparoscopic or open partial nephrectomy for a single cT1 renal cortical tumor 7 cm or less...
  2. doi request reprint Response of the primary tumor to neoadjuvant sunitinib in patients with advanced renal cell carcinoma
    Anil A Thomas
    Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
    J Urol 181:518-23; discussion 523. 2009
    ..We assessed the activity of neoadjuvant sunitinib on primary renal tumors in patients with advanced renal cell carcinoma as well as the feasibility and safety of subsequent surgical resection...
  3. doi request reprint Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older
    Brian R Lane
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    Cancer 116:3119-26. 2010
    ....
  4. doi request reprint Inadequacy of biopsy for diagnosis of upper tract urothelial carcinoma: implications for conservative management
    Armine K Smith
    Glickman Urological and Kidney Institute, Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH 44195, USA
    Urology 78:82-6. 2011
    ..However, concerns about potential understaging, inaccurate grading, incomplete resection, lack of effective tertiary chemoprevention, and need for ureteroscopic surveillance limits it appeal...
  5. doi request reprint Elective partial nephrectomy in patients with clinical T1b renal tumors is associated with improved overall survival
    Christopher J Weight
    Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    Urology 76:631-7. 2010
    ..PN may offer the perfect combination of cancer control and preservation of renal function; therefore we compared overall and cancer-specific survival in patients treated for cT1b renal masses...
  6. pmc Differential expression in clear cell renal cell carcinoma identified by gene expression profiling
    Brian R Lane
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    J Urol 181:849-60. 2009
    ..We present data using a custom kidney cancer cDNA array that can predict the outcome in patients with unilateral and bilateral renal cell carcinoma...
  7. doi request reprint Comparison of cold and warm ischemia during partial nephrectomy in 660 solitary kidneys reveals predominant role of nonmodifiable factors in determining ultimate renal function
    Brian R Lane
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    J Urol 185:421-7. 2011
    ..We studied these determinants in a large cohort of patients with a solitary functioning kidney undergoing partial nephrectomy...
  8. doi request reprint Does transrectal ultrasound probe configuration really matter? End fire versus side fire probe prostate cancer detection rates
    Christina B Ching
    Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
    J Urol 181:2077-82; discussion 2082-3. 2009
    ..We compared prostate cancer detection rates for the 2 most commonly used transrectal ultrasound prostate biopsy probes, end fire and side fire, to determine whether the probe configuration affects detection rates...
  9. doi request reprint Prostate cancers diagnosed at repeat biopsy are smaller and less likely to be high grade
    Nelly Tan
    Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
    J Urol 180:1325-9; discussion 1329. 2008
    ..We investigated whether prostate cancer diagnosed on initial prostate biopsy had worse pathological outcomes compared to that diagnosed on repeat prostate biopsy...
  10. doi request reprint Clinical correlates of renal angiomyolipoma subtypes in 209 patients: classic, fat poor, tuberous sclerosis associated and epithelioid
    Brian R Lane
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    J Urol 180:836-43. 2008
    ..We investigated the clinical, radiographic and histological characteristics of each angiomyolipoma subtype...
  11. doi request reprint Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses
    Christopher J Weight
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    J Urol 183:1317-23. 2010
    ..Therefore, we compared overall survival, cancer specific survival and cardiac specific survival in patients undergoing partial or radical nephrectomy for cT1b tumors...
  12. doi request reprint Partial nephrectomy is associated with improved overall survival compared to radical nephrectomy in patients with unanticipated benign renal tumours
    Christopher J Weight
    Glickman Urologic and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
    Eur Urol 58:293-8. 2010
    ..The driving forces behind these differences have been difficult to elucidate given the heterogeneity of previously compared cohorts...
  13. ncbi request reprint Chronic kidney disease after nephroureterectomy for upper tract urothelial carcinoma and implications for the administration of perioperative chemotherapy
    Brian R Lane
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
    Cancer 116:2967-73. 2010
    ..Although multimodal treatment paradigms for UTUC are under-developed, this has important implications on patients' ability to receive cisplatin-based combination chemotherapy (CBCC)...
  14. doi request reprint Association of percentage of tumour burden removed with debulking nephrectomy and progression-free survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted therapy
    Juan Barbastefano
    Department of Medicine, Cleveland Clinic, Cleveland, OH, USA
    BJU Int 106:1266-9. 2010
    ....
  15. doi request reprint Correlation of radiographic imaging and histopathology following cryoablation and radio frequency ablation for renal tumors
    Christopher J Weight
    Glickman Urologic Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    J Urol 179:1277-81; discussion 1281-3. 2008
    ..We hypothesized that adding post-ablation kidney biopsy would help confirm treatment success...
  16. ncbi request reprint Surgical salvage of renal cell carcinoma recurrence after thermal ablative therapy
    Carvell T Nguyen
    Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
    J Urol 180:104-9; discussion 109. 2008
    ..However, initial data have suggested higher local recurrence rates for ablation compared to partial nephrectomy. We evaluated options for salvage of ipsilateral tumor recurrence after previous ablation...
  17. doi request reprint Performance of the chronic kidney disease-epidemiology study equations for estimating glomerular filtration rate before and after nephrectomy
    Brian R Lane
    Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    J Urol 183:896-901. 2010
    ..We compared the estimated glomerular filtration rate using several serum creatinine based formulas against the measured rate based on (125)I-iothalamate clearance to determine which most accurately reflects the rate in this setting...
  18. doi request reprint Laparoscopic partial nephrectomy in octogenarians
    Anil A Thomas
    Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
    Urology 74:1042-6. 2009
    ..We present our experience with laparoscopic partial nephrectomy in octogenarians to determine the safety and technical feasibility of this procedure in an elderly population...
  19. doi request reprint Prognostic models and algorithms in renal cell carcinoma
    Brian R Lane
    Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH 44195, USA
    Urol Clin North Am 35:613-25; vii. 2008
    ..These RCC nomograms allow more accurate counseling of patients regarding their likely clinical course and facilitate treatment planning...
  20. doi request reprint Active surveillance of renal masses in elderly patients
    Robert Abouassaly
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
    J Urol 180:505-8; discussion 508-9. 2008
    ..We identify and report on a large number of patients treated with active surveillance for incidentally diagnosed renal masses at our institution...
  21. doi request reprint Management of the adrenal gland during partial nephrectomy
    Brian R Lane
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    J Urol 181:2430-6; discussion 2436-7. 2009
    ..We analyzed initial management and oncological outcomes of adrenal glands after open partial nephrectomy...
  22. doi request reprint Renal angiomyolipoma: clinicopathologic study of 194 cases with emphasis on the epithelioid histology and tuberous sclerosis association
    Hakan Aydin
    Department of Anatomic Pathology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
    Am J Surg Pathol 33:289-97. 2009
    ..Epithelioid component, epithelial cysts, and microscopic AML foci are strongly associated with TSC and the presence of all 3 features should raise strong suspicion for TSC...
  23. doi request reprint Adult cystic nephroma and mixed epithelial and stromal tumor of the kidney: clinical, radiographic, and pathologic characteristics
    Brian R Lane
    Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
    Urology 71:1142-8. 2008
    ..Clinical and radiographic data regarding these lesions are sparse, especially with respect to factors providing clinical suspicion for CN or MEST...
  24. ncbi request reprint Low testosterone and risk of biochemical recurrence and poorly differentiated prostate cancer at radical prostatectomy
    Brian R Lane
    Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
    Urology 72:1240-5. 2008
    ..The results from 3 retrospective studies have suggested that low pretreatment testosterone is an independent predictor of adverse pathologic features in patients with localized prostate cancer...
  25. ncbi request reprint Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors
    Inderbir S Gill
    Glickman Urological Institute, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio 44195, USA
    J Urol 178:41-6. 2007
    ..We compared early postoperative outcomes in 1,800 patients undergoing open partial nephrectomy by experienced surgeons with the initial experience with laparoscopic partial nephrectomy in patients with a single renal tumor 7 cm or less...
  26. doi request reprint Partial nephrectomy does not compromise survival in patients with pathologic upstaging to pT2/pT3 or high-grade renal tumors compared with radical nephrectomy
    Christopher J Weight
    Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA
    Urology 77:1142-6. 2011
    ....
  27. ncbi request reprint A preoperative prognostic nomogram for solid enhancing renal tumors 7 cm or less amenable to partial nephrectomy
    Brian R Lane
    Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    J Urol 178:429-34. 2007
    ..We present novel nomograms that predict the likelihood of benign, likely indolent or potentially aggressive pathological findings based only on readily identifiable preoperative factors...
  28. doi request reprint Factors predicting renal functional outcome after partial nephrectomy
    Brian R Lane
    Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    J Urol 180:2363-8; discussion 2368-9. 2008
    ..We evaluate independent factors predicting functional outcomes after partial nephrectomy...
  29. ncbi request reprint Laparoscopic partial nephrectomy for selected central tumours: omitting the bolster
    Christopher J Weight
    Section of Laparoscopic and Robotic Urology, Glickman Urologic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
    BJU Int 100:375-8. 2007
    ....
  30. doi request reprint Comparison of laparoscopic and open partial nephrectomy for tumor in a solitary kidney
    Brian R Lane
    Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    J Urol 179:847-51; discussion 852. 2008
    ..We compared the postoperative and renal functional outcomes of patients undergoing open or laparoscopic partial nephrectomy for tumor in a solitary functioning kidney...
  31. doi request reprint Staging saturation biopsy in patients with prostate cancer on active surveillance protocol
    Robert Abouassaly
    Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    Urology 71:573-7. 2008
    ..Office-based saturation prostate biopsy (SB) provides more accurate staging than traditional biopsy; therefore, we studied its role in patients on an AS protocol...
  32. ncbi request reprint Renal neuroendocrine tumours: a clinicopathological study
    Brian R Lane
    Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
    BJU Int 100:1030-5. 2007
    ....
  33. ncbi request reprint Renal mass biopsy--a renaissance?
    Brian R Lane
    Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    J Urol 179:20-7. 2008
    ....
  34. ncbi request reprint Laparoscopic cystoprostatectomy in a heart transplant recipient
    Brian R Lane
    Section of Laparoscopic and Minimally Invasive Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
    Surg Laparosc Endosc Percutan Tech 18:319-21. 2008
    ..Final pathology revealed SCC with perivesical fat invasion. This immunocompromised patient remains disease free 2 months after resection...
  35. ncbi request reprint Nephron-sparing surgery
    Brian R Lane
    Glickman Urological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
    BJU Int 99:1245-50. 2007
  36. doi request reprint Renal mass sampling: an enlightened perspective
    Mary K Samplaski
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    Int J Urol 18:5-19. 2011
    ..Incorporation of novel biomarkers and molecular fingerprinting into RMS protocols will likely allow for more rational management of patients with renal masses in the near future...
  37. ncbi request reprint The impact of minimally invasive techniques on open partial nephrectomy: a 10-year single institutional experience
    Christopher J Weight
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    J Urol 180:84-8. 2008
    ....
  38. ncbi request reprint 5-Year outcomes of laparoscopic partial nephrectomy
    Brian R Lane
    Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
    J Urol 177:70-4; discussion 74. 2007
    ..We present outcomes in 56 patients, each of whom has now completed a minimum of 5 years of followup after laparoscopic partial nephrectomy...
  39. ncbi request reprint Ejaculatory urine incontinence after radical prostatectomy
    Robert Abouassaly
    Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
    Urology 68:1248-52. 2006
    ..We attempt to further describe and assess the phenomenon of urinary incontinence with ejaculation in a series of patients...
  40. doi request reprint Renal function assessment in the era of chronic kidney disease: renewed emphasis on renal function centered patient care
    Brian R Lane
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    J Urol 182:435-43; discussion 443-4. 2009
    ....
  41. doi request reprint Acute kidney injury: novel biomarkers and potential utility for patient care in urology
    Anil A Thomas
    Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
    Urology 77:5-11. 2011
    ..These serum/urine markers may guide future therapy, facilitate research efforts to reduce the severity of AKI, such as after partial nephrectomy, and allow for more accurate prognostication for patients with AKI...
  42. doi request reprint Saturation technique does not decrease cancer detection during followup after initial prostate biopsy
    Brian R Lane
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
    J Urol 179:1746-50; discussion 1750. 2008
    ..At a median followup of 3.2 years we report the cancer detection rate on subsequent prostate biopsy in men who underwent initial saturation prostate biopsy...
  43. ncbi request reprint Nerve-sparing laparoscopic radical cystectomy: technique and initial outcomes
    Brian R Lane
    Section of Laparoscopic and Minimally Invasive Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
    Urology 68:778-83. 2006
    ..To report the technique and early outcomes of nerve-sparing laparoscopic radical cystectomy with continent orthotopic ileal neobladder in selected male and female patients with bladder cancer...
  44. doi request reprint Is all chronic kidney disease created equal?
    Brian R Lane
    aDivision of Urology, Spectrum Health, Michigan State University, Grand Rapids, Michigan bGlickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio cUniversity of California, San Diego, California, USA
    Curr Opin Urol 24:127-34. 2014
    ..Recently released guidelines define CKD as abnormalities of kidney structure or function, present for more than 3 months. We review the recent literature about CKD and its implications for renal surgery...
  45. ncbi request reprint Case report: simultaneous laparoscopic management of bilateral ureteropelvic junction obstruction in a horseshoe kidney
    Brian R Lane
    Section of Laparoscopic and Minimally Invasive Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
    J Endourol 20:21-3. 2006
    ..The total operative time was 5.7 hours, with a blood loss of <350 mL. There were no complications, and the hospital stay was 3 days. This appears to be the first such case reported...
  46. doi request reprint Functional and quality-of-life outcomes in patients undergoing transperineal repair with gracilis muscle interposition for complex rectourethral fistula
    Mary K Samplaski
    Center for Genitourinary Reconstruction, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
    Urology 77:736-41. 2011
    ..There is currently no widely accepted procedure for the treatment of complex RUF, such as those complicated by radiotherapy, previous attempts at repair, or large in size...
  47. ncbi request reprint Conservative management of giant symptomatic angiomyolipomas in patients with the tuberous sclerosis complex
    Teresa L Danforth
    Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
    BJU Int 100:794-7. 2007
    ....
  48. pmc Renal neuroendocrine tumors
    Brian R Lane
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
    Indian J Urol 25:155-60. 2009
    ..Primary NETs of the kidney, including carcinoid tumor, small cell carcinoma (SCC), and large cell neuroendocrine carcinoma (LCNEC) are exceedingly rare...
  49. ncbi request reprint Three-piece inflatable penile prostheses can be safely implanted after radical prostatectomy through a transverse scrotal incision
    Brian R Lane
    Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
    Urology 70:539-42. 2007
    ..Some surgeons will not offer a three-piece inflatable penile prosthesis (IPP) to patients who have undergone retropubic surgery because of a perceived increase in intraoperative risk during reservoir placement into the retropubic space...
  50. ncbi request reprint Targeted molecular therapy for renal cell carcinoma
    Brian R Lane
    Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
    Urology 69:3-10. 2007
  51. ncbi request reprint Mucinous adenocarcinoma of the prostate does not confer poor prognosis
    Brian R Lane
    Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
    Urology 68:825-30. 2006
    ..MC is a rare form of prostate cancer reported in some cases to have a more aggressive clinical course than conventional adenocarcinoma (AC)...
  52. ncbi request reprint Acute obstructive renal failure after laparoscopic cryoablation of multiple renal tumors in a solitary kidney
    Brian R Lane
    Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
    Urology 65:593. 2005
    ..Follow-up magnetic resonance imaging at 3 months did not demonstrate any new lesions or enhancement of the treated renal masses. His serum creatinine at 3 months was 3.7 ng/mL...
  53. ncbi request reprint Long-term efficacy of holmium laser endoureterotomy for benign ureteral strictures
    Brian R Lane
    Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
    Urology 67:894-7. 2006
    ..To determine the long-term clinical and radiographic success of holmium laser endoureterotomy for nonobliterative benign ureteral strictures...
  54. ncbi request reprint Emphysematous cystitis: a review of 135 cases
    Anil A Thomas
    Glickman Urological Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
    BJU Int 100:17-20. 2007
    ..To review recently published data on emphysematous cystitis (EC), a potentially life-threatening condition characterized by air within the bladder wall, and that most typically affects middle-aged diabetic women...