bluuebunny/crossref_metadata_2025 huggingface dataset:
Coronary care nurses’ clinical decision making
Authors: Corcoran‐Perry Sheila , Narayan Suzanne , Cochrane Sally
Published: March 2003

Increasing acuity of hospitalized persons with cardiac disease places great demands on nurses’ decision‐making abilities. Yet nursing lags in knowledge‐based system development because of limited understanding about how nurses use knowledge to make decisions. The two research questions for this study were: how do the lines of reasoning used by experienced coronary care nurses compare with those used by new coronary care nurses in a representative sample of hypothetical patient cases, and are the predominant lines of reasoning used by coronary care nurses in hypothetical situations similar to those used for comparable situations in clinical practice? Line of reasoning was defined as a set of arguments in which knowledge is embedded within decision‐making processes that lead to a conclusion. Sixteen subjects (eight experienced and eight new nurses) from coronary care and coronary step‐down units in a large, private, teaching hospital in Minnesota, USA, were asked to think aloud while making clinical decisions about six hypothetical cases and comparable actual case. One finding was that most subjects in both groups used multiple lines of reasoning per case; but they used only one predominantly. This finding highlighted the non‐linear nature of clinical decision making. Subjects used 25 predominant lines of reasoning, with intergroup differences on six of them. Where there were differences, experienced nurses used lines of reasoning of lower quality than did new subjects. The type variability in lines of reasoning suggested that multiple pathways should be in‐corporated into knowledge‐system design. One implication of the variability in subjects’ line of reasoning quality is that nurses at all levels of expertise are fallible and could benefit from decision support. The finding that subjects tended to use similar lines of reasoning for comparable hypothetical and actual cases was modest validation of subjects’ performance on hypothetical cases as representing their decision making in practice. Consequently, there was support for using simulations and case studies in teaching and studying clinical decision making.
Japanese nurses’ perceptions about disclosure of information at the patients’ end of life
Authors: Konishi Emiko , Davis Anne J
Published: March 2003

Information disclosure at the end of life is one of the most debated ethical issues in Japan. This paper, using data from a larger questionnaire survey in which 147 Japanese nurses participated, describes nurses’ perceptions about this issue. The nurses perceived that non‐disclosure of impending death information to patients was the norm in Japan due to its traditional values. This non‐disclosure of information has various impacts on clinical nurses. Tension was evident between the Japanese traditional concepts supported by some nurses and the shift toward Western cultural and ethical values supported by other nurses. The nurses confronted uninformed patients who became suspicious, isolated, angry, or died unprepared for their life’s ending. The nurses were placed in the middle between the patient and the family, as nurses became keepers of family secrets, or between nurses’ ethical obligations to the patient and those of the institution. The nurses had the belief that at the patient’s end of life, it is important to change health professionals’ attitude from curing to caring.
Carl Rogers and postmodernism: Challenges in nursing and health sciences
Authors: Burnard Philip
Published: March 2003

Postmodernism, as an interpretation of the current cultural climate, has been widely discussed. This paper offers a summary of some of the points raised within the postmodern literature and the argument is raised that Carl Rogers, client‐centered therapist and advocate of student‐centered learning was postmodern in his viewpoint. Various tentative suggestions are offered as to how the postmodern mood may or may not affect counseling and psychotherapy. The analysis is, necessarily, partial given that postmodernism offers no obvious prescriptions and no ‘grand view’. This may be both its strength and its failing. Links are made to nursing and health sciences.
Teaching families to be caregivers for the elderly
Authors: Mulatilo Mesepi , Taupau Taipai , Enoka Iokapeta , Petrini Marcia A.
Published: March 2003

Abstract The number of elderly citizens in Samoa is increasing and caregivers are needed to meet the challenge of home care. Nurses provided a low‐cost and effective workshop for family caregivers of the elderly. The purposes of the study were to determine a relatively inexpensive method to educate many caregivers; to determine the impact of the workshops on the individual caregivers; to assess the impact on the care given to the elderly as a result of the workshops and to determine potential policy issues related to the elderly for Samoa. The results of this qualitative study indicate information sessions were effective, a support network for the caregivers developed, the quality of care of the elderly improved, community awareness about the needs of the elderly increased, and an interdisciplinary group met to formulate a policy for government action to provide needed services for the elderly.
Swedish nurses' experiences of being forced into part‐time employment
Authors: Kapborg Inez
Published: March 2003

Abstract Nurses being forced into part‐time work is a common occurrence in Sweden. A questionnaire was mailed to nurses who were registered with an unemployment agency, with the purpose to investigating how part‐time employment has affected their life situation and whether their attitudes to working as nurses had changed. The questionnaire was distributed via the unemployment agency, and 96 nurses responded. One in five nurses regretted their choice of profession and 30% considered retraining. Nurses forced into part‐time employment reported that their self‐confidence had decreased and their financial situation had deteriorated. The majority of nurses were not anxious about working as nurses within their area of competence, but some expressed a lack of sufficient practical professional experience. Nurses generally felt uncertain about their future and found it particularly difficult to plan their time because they did not know when they would be offered temporary work.
Korean nurses' perceptions of ethical problems: Toward a new code of ethics for nursing
Authors: Lee Won‐Hee , Pope Marion , Han Sung‐Suk , Yang Soon‐Ok
Published: March 2003

Abstract The Nursing Philosophy, Theory, History and Ethics Interest Group of the Alpha Lambda Chapter of Sigma Theta Tau in Seoul undertook a study of Korean nurses' perceptions of ethical problems in nursing practice, administration, education and research in 1993. The purposes of the study were to develop the ethical concerns of Korean nurses and to make suggestions for contents and guidelines for a new code. The data consisted of 329 descriptive items of ethical problems summarized into 221 descriptions and 57 nurses responded. To meet the study objectives, we analyzed the data according to content themes, comparing these data with the code of the Korean Nurses' Association (KNA), to the codes of the Canadian Nurses' Association and the College of Nurses of Ontario. In conclusion, the result showed that a new KNA code needs to include guidelines at different levels of abstractness, including standards at a concrete level reflecting the ethical problems faced by nurses in practice, administration, education, and research.
Knowledge, practice, and risk of breast cancer among rural women in Korea
Authors: Lee Chung Yul , Kim Hee Soon , Ham Okkyung
Published: March 2003

Abstract Breast cancer is the third leading cause of death among Korean women after stomach and cervical cancer. Furthermore, the incidence of breast cancer is increasing in contrast to decreasing trends of those two cancers described above. According to the Korean Ministry of Health and Welfare, in 1998, 6.1% of all cancers and 14.1% of cancers in women were breast cancers. Early detection of breast cancer can be achieved by performing periodic breast self‐examinations (BSE), clinical breast examinations, and/or mammography. Women should perform early detection procedures such as BSE or mammography on a regular basis to detect breast cancer earlier. For the cost effectiveness of the program, the identification of high‐risk groups should be conducted, and the provision of community programs for the early detection of breast cancers should be focused on high‐risk groups. The present study was designed to classify the high‐risk groups of breast cancer among rural women in Korea, to provide early detection of breast cancer programs. Breast cancer risk of each participant, aged 35–65 years and who reside in the Korean rural community including Kyungki‐Do and Chungchongbuk‐Do, was assessed utilizing the breast cancer risk appraisal instruments. The tool estimates the six risk factors including age, family history, personal breast disease history, breast‐feeding experience, number of children, and frequency of fat intakes. Breast cancer‐related knowledge and practices were also assessed. The study results identified a 1.5% high‐risk group, 3.8% moderate‐risk group, and 24.0% borderline‐risk group. Approximately 30% of the respondents were above the borderline‐risk groups, which indicate the need for systematic approach for breast cancer prevention and early detection in the community.
The prognostic factors for functional recovery in elders with hip fracture
Authors: Oh Heeyoung , Feldt Karen S
Published: March 2003

Abstract The purpose of the present study was to identify the factors that may have an impact on functional recovery in elder subjects with hip fracture. A prospective study design examined the impact of pain, negative emotions, and social support on functional outcome in a sample of 70 elderly subjects at two hospitals in a United States Midwestern metropolitan area. Data were collected at discharge and at 2 months following discharge, using the Verbal Descriptor Scale, depression and anxiety subscales on the Profile of Mood States, a modified Norbeck Social Support Questionnaire, and a modified Functional Status Index. Subjects who had less pain with movement (r = 0.29, P = 0.016), less anxiety (r = 0.31, P = 0.023), greater network size (r = −0.27, P = 0.045), more instrumental support (r = –0.28, P = 0.042) achieved better functional recovery. Pain, negative emotions, social support, age and mental status explained 56% of the variance in functional outcome.
Pain at the End of Life: The Experience of Elderly Hospice Patients with Cancer
Authors: Duggleby Wendy
Published: March 2003

28–29 March 2000 Yamaguchi University School of Medicine, Ube, Japan (Local Organizers: Junko Yoneda and Susumu Tomonaga, Yamaguchi University)
Burnout versus depression and sense of coherence: Study of Greek nursing staff
Authors: Tselebis Athanassios , Moulou Aikaterini , Ilias Ioannis
Published: March 2003

Abstract We assessed the relationships between burn out, depression and sense of coherence (SOC) using the Maslach Burnout Inventory, Beck's depression inventory and Antonovsky's SOC questionnaire in a large sample of 17 male and 62 female Greek nurses. Analysis showed that SOC in nursing staff was correlated with burnout (BO) and depression, while the latter was correlated to a lesser degree with BO. The relationship of BO with depression seems to be the result of the relationship between depression and SOC. Thus, we could hypothesize that the degree of SOC renders persons either vulnerable or resistant to both depression and BO, though further studies are warranted. In the hospital setting, the intervention by specialized personnel in order to assist nursing staff with BO may be an appealing option. Further, prevention programs aimed at helping individuals prone to BO could also be envisaged.
Self‐esteem and student nurses: A cross‐cultural study of nursing students in Thailand and the UK
Authors: Sasat Siriphan , Burnard Philip , Edwards Deborah , Naiyapatana Wassana , Hebden Una , Boonrod Wallapa , Arayathanitkul Bussarin , Wongmak Waraporn
Published: March 2003

Abstract Self‐esteem is a key feature in a person’s perception of their own worth.
This report is of a study of the reported self‐esteem levels of two groups of student
nurses: one in Thailand and one in the UK. Purposive samples of 120 Thai students
and 101 UK undergraduate nursing students were given the Culture‐Free Self‐Esteem
Inventory (CFSEI‐2). The CFSEI‐2 is a self‐reported inventory, which measures an
individual’s perception of self. The findings of the study indicate that the
perceptions of own self‐esteem in undergraduate student nurses in the UK and in Thailand
were comparable to the normal ranges of self‐esteem as assessed by the instrument.
An independent sample t‐test revealed that there were no significant differences in mean overall and subscale self‐esteem scores between UK and Thai nursing students. There were no indications of differences in levels of self‐esteem for UK and Thai nursing students experiencing different parts of their training.
Family support and self‐care behavior of Chinese chronic obstructive pulmonary disease patients
Authors: Xiaolian Jiang , Chaiwan Sombat , Panuthai Sirirat , Yijuan Cheng , Lei Yin , Jiping Li
Published: March 2003

Abstract A descriptive correlation study was conducted at the outpatient pulmonary clinic of a large medical center to describe family support and self‐care behavior and to ascertain the relationship of these two variables among Chinese chronic obstructive pulmonary disease (COPD) patients. A total of 98 COPD patients completed the questionnaires providing demographic data and information about perceived family support and self‐care behavior. Results showed that most subjects perceived that they had received a high level of family support, and the majority of the subjects perceived that they had initiated an adequate amount of self‐care behavior. A slightly statistically significant positive relationship between family support and self‐care behavior was ascertained.
Aging of the Population and the Subsequent Increase in the Mistreatment of the Elderly in Korea
Authors: Kim Han Gon
Published: March 2003

In 1999 there were 242 327 elderly people in Korea suffering from dementia. It is projected that the number of Korean elderly will grow to over 534 000 by 2020, and reach 1 961 575 by 2050. Facility‐based care will be required for those with more severe cases of dementia. The family‐oriented social welfare system for the elderly that now exists in Korea will not be adequate to meet the needs of the elderly in the coming years. This study was accomplished via questionnaires and face‐to‐face interviews. A total of 587 cases was analyzed. The results revealed that 58.6% of the respondents perceived that the elderly do not receive proper respect. Neglect was identified as the most serious type of mistreatment of the elderly, followed by verbal mistreatment. The findings revealed that abused persons were more likely to be impoverished, uneducated, physically or mentally frail women who also were socially, psychologically and economically dependent and who lived alone. Mistreatment of the elderly is recognized as a social problem that affects all of us, personally, as caring members of society. Abuse and neglect are not the major concern or responsibility of any one profession, individual, or group. Rather, all involved must address the issues, questions, and concerns raised in order to resolve the problem of mistreatment of the elderly.
Postoperative pain management: Study of patients’ level of pain and satisfaction with health care providers’ responsiveness to their reports of pain
Authors: Chung Joanne W. Y. , Lui Joseph C. Z.
Published: March 2003

Abstract The present prospective survey was conducted in a 1200‐bed hospital to examine postoperative patients’ current pain intensity, most intense pain experienced, satisfaction with postoperative pain management, and differences regarding pain and satisfaction levels. All adult patients admitted to a hospital in Hong Kong for surgery, except those receiving local anesthesia, were eligible to enter this study. The patient outcome questionnaire developed by the American Pain Society was used to solicit data about patients’ pain and satisfaction with pain relief. The subjects were 294 postoperative patients. Approximately 85% complained about varying degrees of pain during the 24 h prior to the assessment of their pain. When interviewed, most patients complained of mild to moderate pain (median = 2 on a 10‐point scale), while the median for ‘worst pain intensity’ was 5. Approximately 80% of the subjects indicated that both the nurses and physicians reminded them to report pain when it occurred. Only 143 (48.6%) agreed that the nurses and physicians sufficiently emphasized the importance of pain relief. Those who received acute pain services, provided by anesthetists, reported lower levels of current pain intensity. Over 65% of the subjects were satisfied with all levels of health care providers, regarding their postoperative pain management.
A case of pelvic arteriovenous malformation in a male
Authors: Tanaka Michio , Iida Katsuyuki , Matsumoto Shinichi , Takeuchi Takumi , Yamaguchi Kazumi , Nishimura Yoji , Tominaga Takashi
Published: March 2003

Background: Congenital pelvic arteriovenous malformation (AVM) is rare especially in males. We present a case of pelvic AVM in a 38‐year‐old male. He was admitted to our hospital with left flank abdominal pain and painless gross hematuria.

Methods/Discussion: Pelvic computed tomography demonstrated a homogeneous contrast‐enhanced mass, 6 cm in diameter. For diagnosis, non‐invasive magnetic resonance imaging (MRI) and color Doppler ultrasonography were very useful in our case. Though the treatment is controversial, we decided to monitor his clinical course.
Inhibition of urinary bladder tumors induced by N‐butyl‐N‐(4‐hydroxybutyl)‐nitrosamine in rats by green tea
Authors: SATO DAISUKE
Published: March 2003

Background: Recently, the anticarcinogenic effects of green tea have been studied in sites other than the urinary tract. The present study examined the inhibition by green tea of vesical tumors induced in rats by N‐butyl‐N‐(4‐hydroxybutyl) nitrosamine (BBN).

Methods: In the first series of experiments, 0.05% BBN was added to the drinking water of rats and remained present for 5 weeks. In one experiment, six groups of animals received either tap water, green tea, matcha, hojicha, oolong tea or black tea from week 6. In a second experiment, three groups of rats received either tap water, green tea extract or powdered green tea mixed into a pellet diet from week 6. In a third experiment, five groups of rats were fed a pellet diet with addition of either 0, 0.15, 1.5 or 3.0% powdered green tea from week 6. All rats were killed and examined at 40 weeks.

Results: Green tea, particularly green tea leaves, dose‐dependently inhibited the growth of BBN‐induced urinary bladder tumors when given after the carcinogen.

Conclusions: Green tea may inhibit bladder tumor growth.
Sarcomatoid renal cell carcinoma with scant carcinomatous components
Authors: Koga Fumitaka , Kawano Keizo , Honda Mikihiko , Sumi Shuhei , Horimi Hiroyuki , Kondo Shun , Yoshida Ken‐Ichiro
Published: March 2003

A 30‐year‐old male underwent radical nephrectomy for a right renal tumor 15 cm in diameter. On microscopic examination of initial 17 sections, the tumor consisted of pleomorphic giant cells and spindle neoplastic cells. There was no carcinomatous component. Immunohistochemically, the neoplastic cells were negative for keratin and epithelial membrane antigen but positive for vimentin. The giant cells were also scatteringly, weakly positive for myoglobin. At that time a diagnosis of rhabdomyosarcoma of the kidney was made. However, further microscopic examination of another eight sections revealed small areas of clear cell‐type renal cell carcinoma (RCC) which transited to sarcomatous components and led to a diagnosis of sarcomatoid RCC. The patient underwent three cycles of adjuvant chemotherapy. He has been free of the disease for 14 months after nephrectomy.
Comparative study of pulsed dye laser and pneumatic lithotripters for transurethral ureterolithotripsy
Authors: Nutahara Kikuo , Kato Moriaki , Miyata Akiomi , Murata Akihiro , Okegawa Takatsugu , Miura Ichiro , Kojima Miho , Higashihara Eiji
Published: March 2003

Background
: Clinical effectiveness and safety of the Swiss Lithoclast (Lithoclast) and the Candela MDL‐2000 (MDL) in the treatment of lower ureteral stone were examined retrospectively.

Methods
: Eighty‐six stones from 66 patients and 26 stones from 20 patients were treated by Lithoclast and MDL, respectively.

Results
: The stone‐free rate on 3‐month follow‐up was 97% and 95% for the Lithoclast and MDL, respectively (no significant difference). The operation time was significantly shorter for the Lithoclast than for the MDL (90.2 ± 50.2 vs 120.4 ± 55.1 min; P < 0.05). Postoperative analgesics were required significantly less frequently in Lithoclast (10/66 vs 11/20; P < 0.01). Postoperative hospital stay was significantly shorter for Lithoclast (8.7 ± 5.1 vs 12.1 ± 4.2 days; P < 0.01).

Conclusions
: Swiss Lithoclast is an effective and less invasive modality for endoscopic treatment of lower ureteral stones.
Comparison of prazosin, terazosin and tamsulosin in the treatment of symptomatic benign prostatic hyperplasia: A short‐term open, randomized multicenter study
Authors: Tsujii Toshihiko
Published: March 2003

Background
: The objective of this open randomized clinical study was to compare the short‐term efficacy and safety of three alpha‐1 blockers, prazosin, terazosin and tamsulosin, in the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH).

Methods
: The study comprised 121 patients with symptomatic BPH who were randomized to receive 0.5 mg of prazosin twice daily, 0.5 mg of terazosin twice daily or 0.1 mg of tamsulosin once daily for the initial 2 weeks. The doses were doubled for the next 2 weeks. The primary variables assessed were a symptom score, changes in maximum and average urinary flow rate (Qmax and Qave), postvoid resisual urine volume and blood pressure.

Results
: The percentage changes in the total symptom score from baseline were 38, 39 and 26% at 4 weeks by prazosin, terazosin and tamsulosin, respectively. Terazosin produced significantly higher improvement in four out of nine individual symptoms than tamsulosin (P < 0.05). A significant increase in Qmax or Qave in uroflowmetry was obtained in the prazosin and tamsulosin groups. Blood pressure remained unchanged in normotensive patients, but significantly decreased in hypertensive patients except for the tamsulosin group. Adverse events were minimal in all treatment groups.

Conclusions
: The efficacy and safety profiles were different among the alpha‐1 blockers at standard doses. Tamsulosin appears to be safer than the others for aged patients or patients with hypertension who have impaired blood pressure regulation, while terazosin is significantly effective in improving symptomatic score when compared with the others examined. It is recommended that the alpha‐1 blocking agent and its optimal dose are selected on the basis of the baseline characteristics of the patients with symptomatic BPH.
Subtypes of bladder mast cells in interstitial cystitis
Authors: Yamada Tetsuo , Murayama Tetsuo , Mita Haruhisa , Akiyama Kazuo
Published: March 2003

Background
: Because the types of mast cells present in the bladder of patients with interstitial cystitis (IC) have not been elucidated, we have used immunohistochemical techniques to determine which of the mast cell types is present in biopsy specimens.

Methods
: For all patients diagnosed with IC (n = 10; female) their symptoms satisfied the criteria proposed by the National Institutes of Health criteria of IC and six patients suffering from bladder tumors were selected as control patients. Adjacent sections of paraffin‐embedded tissues that had been fixed in Carnoy's solution were reacted with either antitryptase or antichymase antibodies.

Results
: In detrusor and in mucosa, the number of tryptase‐positive and chymase‐negative mast cells (MCT) was 146 ± 25 and 81 ± 31 cells/mm2, respectively, and the number of tryptase‐positive and chymase‐positive mast cells (MCTC) was 124 ± 50 and 54 ± 20 cells/mm2, respectively. These numbers were significantly greater than those of the control group. A significant negative correlation (P < 0.005; R = 0.943) was observed between the number of MCTC and the bladder capacity. The number of mast cells obtained by toluidine blue staining in detrusor and in mucosa was 95 ± 68 and 71 ± 39 cells/mm2, respectively, suggesting that staining with toluidine blue underestimated the number of mast cells.

Conclusions
: Mast cells were significantly increased in number in both the mucosa and detrusor of bladder specimens from IC patients compared with those from control. The MCTC may be the type of mast cell dominantly present in the bladder of IC patients. The MCTC in detrusor increased with the progression of contracted bladder.
Contractile properties of urethral smooth muscles of young and aged female dogs: Morphological and pharmacological aspects
Authors: Ahmed Helen , Moriyama Nobuo , Fukasawa Ritsu , Nishimatsu Hiroaki , Tanaka Yoshinori , Kitamura Tadaichi , Tatemichi Satoshi , Akiyama Katsuyoshi , Suzuki Yasunori , Aisaka Kazuo
Published: March 2003

Background
: α1‐Adrenoceptors are highly concentrated in the urethral smooth muscles and may play an important role in the contraction of this area. However, detailed examinations of age‐related changes of the properties of urethral smooth muscle have rarely been undertaken.

Methods
: The contractile properties of urethras from young non‐parous and old parous female beagles were determined with a urethral function study, macroscopic autoradiography for urethras using [3H]‐labeled tamsulosin and morphometry of the urethral muscles.

Results
: The antagonistic effect (pA2) of prazosin for norepinephrine was 7.76 ± 0.13 in young dogs and 7.62 ± 0.06 in aged dogs. The specific binding of [3H]‐tamsulosin (a relatively selective α1A‐adrenoceptor antagonist) was recognized diffusely in proximal urethras with in vitro autoradiography. The density of binding in smooth muscles was approximately 60 and 40% in circular longitudinal layers, respectively, for both dogs.

Conclusions
: The female canine urethra had α1A‐ and α1L‐adrenoceptors. No age‐related changes were seen in the function of the proximal urethra, distribution of α1‐adrenoceptor binding sites and smooth muscle densities.
Intrarenal varix mimicking a cystic renal tumor
Authors: Egawa Masayuki , Fukushima Masato , Hasegawa Toru , Komatsu Kazuto , Namiki Mikio
Published: March 2003

Abstract
Background
: A case of intrarenal varix in a 60‐year‐old woman is reported.

Methods/Results
: The preoperative diagnosis was cystic tumor in the central part of the left kidney. Retrospectively, gadolinium‐enhanced magnetic resonance (MR) imaging demonstrated a layered gadolinium sign, indicating the vascular nature of the mass.

Conclusions
: Our experience shows that urologists should be aware of the possible presence of a renal cystic mass of vascular origin and of the usefulness of gadolinium‐enhanced MR examination for making an identification.
Inflammatory pseudotumor of the bladder in neonates
Authors: Asanuma Hiroshi , Nakai Hideo , Shishido Seiichiro , Tajima Eiji , Kawamura Takeshi , Morikawa Yukihiko , Kawamura Takeshi
Published: March 2003

Abstract Inflammatorypseudotumors of the bladder are rare in children. We describe a 7‐day‐old male neonate with inflammatory pseudotumor of the bladder. He presented with a 3‐day history of macroscopic hematuria. Ultrasonography, computed tomography and cystoscopy showed an intravesical mass arising from the right lateral wall. Pathologic findings obtained by open excision revealed that the tumor had spindle‐shaped cells without significant atypia infiltrating into submucosal fibrous tissue. There has been no evidence of recurrent tumor 12 months post‐operatively. To our knowledge our case is the first presentation in a neonate among the reported pediatric cases.
Case of mesothelioma of the tunica vaginalis testis with characteristic findings on ultrasonography and magnetic resonance imaging
Authors: Fujisaki Masafumi , Tokuda Yuji , Sato Shinji , Fujiyama Chisato , Matsuo Yoshitomo , Sugihara Hajime , Masaki Zenjiro
Published: March 2003

Abstract A case of mesothelioma of the right tunica vaginalis testis in a 32‐year‐old man is reported. Trans‐scrotal ultrasonography revealed hydrocele and multiple nodular masses measuring 1.0–4.5 cm in size attached to the parietal vaginal layer. Magnetic resonance imaging demonstrated more clearly nodular masses with irregular surfaces lined on the hydrocele cavity. Histologic diagnosis of the tumor when orchiectomized was mesothelioma. The patient has been free of disease for approximately 3 years since the treatment.
Expression of Apg‐1, a member of the Hsp110 family, in the human testis and sperm
Authors: Nonoguchi Kohsuke , Tokuchi Hiromu , Okuno Hiroshi , Watanabe Hirohiko , Egawa Haruto , Saito Kaoru , Ogawa Osamu , Fujita Jun
Published: March 2003

Background:

Apg‐1 encodes a heat shock protein belonging to the Hsp110 family and is inducible by a 32°C to 39°C heat shock in somatic cells. In mouse testicular germ cells Apg‐1 mRNA is constitutively expressed depending on the developmental stage. As human Apg‐1 has recently been identified, the expression of Apg‐1 in the human testis and sperm was investigated.

Methods:

Expression and heat‐inducibility of Apg‐1 in the human testicular germ cell tumor cell line, NEC8, was analyzed. Using an antimouse Apg‐1 antibody, expression of Apg‐1 in the human testis and sperm was examined by western blotting after confirmation of the specificity of the antibody. The cells expressing Apg‐1 in the testis were further determined by immunohistochemistry.

Results:

Slight induction of Apg‐1 mRNA was detected in NEC8 cells after 32°C to 39°C temperature shift. In the human testis, the antibody specifically recognized Apg‐1, which was absent in the testis without germ cells (Sertoli‐cell‐only syndrome) or arrested at spermatogonia. Spermatocytes and spermatids, but not testicular somatic cells, were positively stained with the anti‐Apg‐1 antibody. By western blot analysis, Apg‐1 was detected in the preparation enriched for sperm from normal volunteers and infertile patients, but not from azoospermia patients.

Conclusion:

Apg‐1 is developmentally expressed in human testicular germ cells and sperm, suggesting its role in spermatogenesis and fertilization. Identification of substrates for Apg‐1 chaperone activity will help elucidate its function.
Autocrine expression of neurotrophins and their receptors in prostate cancer
Authors: Satoh Fuminori , Mimata Hiromitsu , Nomura Takeo , Fujita Yoshitsugu , Shin Toshitaka , Sakamoto Sadaaki , Hamada Yasuyuki , Nomura Yoshio
Published: March 2003

Abstract Previously, it has been demonstrated that the neurotrophins and their receptors are present in human prostate tissue, but neither their functional role nor localization is clearly understood. We studied the expression of neurotrophins and their receptors in prostate cancer. Between 1990 and 1999, 48 prostate cancer specimens were obtained from patients undergoing radical prostatectomy, of whom 25 received neoadjuvant hormonal therapy (NHT) and 23 were untreated. The specimens were analyzed immunohistochemically for neurotrophins (nerve growth factor, brain derived neurotrophic factor, neurotrophin 3, neurotrophin 4/5) and their receptors (TrkA, TrkB, TrkC, p75NTR). Immunohistochemical studies revealed that both benign and malignant prostate gland epithelial cells expressed the neurotrophins and their receptors to various degrees, but no obvious immunopositive reaction was observed in stromal cells. In benign epithelial cells, the neurotrophins were localized to secretory cells and the receptors were localized to basal cells. The neurotrophins, TrkA and TrkC were expressed to a similar extent in prostate cancer specimens obtained from patients both with and without NHT. In contrast, the expression of TrkB was down‐regulated and the expression of p75NTR was up‐regulated in prostate cancer after hormonal therapy. These findings suggest that neurotrophins are secreted by prostate cancer cells in an autocrine fashion. Neurotrophins may be involved, through their receptors, in the escape mechanism from cell death after androgen depletion found in prostate cancer.
Re‐evaluation of the latent period of bladder cancer in dyestuff‐plant workers in Japan
Authors: Miyakawa Michiko , Tachibana Masaaki , Miyakawa Ayako , Yoshida Katsumi , Shimada Naoki , Murai Masaru , Kondo Takefumi
Published: March 2003

Abstract Background: The carcinogenesis of benzidine (BZ) and beta‐naphthylamine (BNA) for bladder is well known. Although it was thought to be rare to develop occupational bladder cancer more than 20 years after the exposure to these chemicals, there are still new clinical cases even 30 years after exposure. The purpose of this study was to re‐evaluate the latent carcinogenic period of BZ and BNA, in order to set the safety period after exposure for the health surveillance system.

Methods: The subjects were 236 dyestuff‐plant workers in Tokyo, who had been exposed to these dyestuffs. The incidence of bladder cancer and its histopathology in this group was surveyed in the period from 1962 to 1996.

Results: Nineteen workers (8.1%) were found to have bladder cancers. The exposure period for these 19 patients was 82.0 ± 50.2 months. The mean ± SD latent period from the subjects’ initial and final exposure until tumor development was 29.5 ± 8.2 years and 20.1 ± 10.6 years, respectively. Significantly, a negative correlation (Pearson) was observed between the exposure period and the latent period from the end of exposure to cancer onset (R = –0.544, P < 0.05). All tumors except one were transitional cell carcinoma. Flow cytometric analysis was performed in 11 patients and all of these patients had DNA aneuploidy.

Conclusions: The latent periods of bladder cancer caused by BZ and BNA were longer than previously expected. It is necessary to survey the onset of bladder cancer in exposed workers more than 30 years after the initial exposure.
Orthotopic neobladder reconstruction in elderly bladder cancer patients
Authors: Saika Takashi , Suyama Bunzo , Murata Tadashi , Manabe Daisuke , Kurashige Takushi , Nasu Yasutomo , Tsushima Tomoyasu , Kumon Hiromi
Published: March 2003

Abstract Background: We compared the clinical results of orthotopic neobladder reconstruction in elderly patients and those in younger patients retrospectively in order to verify whether age is a critical factor in selecting a method of urinary diversion.

Methods: Following radical cystectomy for bladder cancer, 12 patients aged 75 or older and 17 patients under 75 who underwent orthotopic neobladder reconstruction between January 1992 and May 1999 were investigated in this study. The authors TS and BS were among the surgeons who performed operations for all cases. Of the 12 elderly patients, orthotopic neobladders were constructed according to Hautmann's method in nine cases, Studer's method in one case and Reddy's method in two cases. Of the 17 younger patients, these methods were employed in 12, one and four cases, respectively. Operative procedure, early and late complications, prognosis, continence and voiding pattern were investigated in these patients.

Results: The follow‐up periods for elderly and younger groups ranged from 21.3 to 82.7 months and from 8.8 to 94.2 months, respectively. No difference in operation time, amount of bleeding or postoperative length of hospitalization was observed between elderly and younger patients. The rates of early complications in elderly and younger patients were 41.7% and 35.3%, respectively. Late complication rates were 33.3% and 47.1%, respectively. The difference in these complication rates was not statistically significant. One of the elderly and two of the younger patients had local recurrence and metastasis postoperatively. Those three patients had died of their bladder cancer. No statistically significant difference between groups was recognized in either cause‐specific survival or overall survival, nor was there such a difference in relation to micturition/continence.

Conclusion: Based on these results, we believe that because age is not a critical factor in the selection of urinary diversion method, neobladder reconstruction following cystectomy for bladder cancer is indicated in elderly patients. As stoma management is difficult for the patients, we consider orthotopic neobladder reconstruction to be the method of choice if the patients' general physical condition allows.
Transitional cell carcinoma of the renal pelvis in a long‐term hemodialysis patient with autosomal dominant polycystic kidney
Authors: Miwa Sotaro , Fuse Haruki , Hirano Shoji , Masuda Shinji
Published: March 2003

Abstract We present a case of renal pelvic transitional cell carcinoma (TCC) accompanied by autosomal dominant polycystic kidney disease (ADPKD). An 81‐year‐old woman on long‐term hemodialysis for ADPKD visited the Department of Urology at Kouseiren Takaoko Hospital, complaining of asymptomatic macroscopic hematuria. Retrograde pyelogram showed an irregular filling defect in the right renal pelvis, which suggested the right renal pelvic tumor. We performed right nephrectomy and transurethral removal of the right ureter. Histological diagnosis demonstrated renal pelvic TCC.
Surface antigen expression on bladder tumor cells induced by bacillus Calmette‐Guérin (BCG): A role of BCG internalization into tumor cells
Authors: IKEDA NORIKO , TOIDA ICHIRO , IWASAKI AKIO , KAWAI KOJI , AKAZA HIDEYUKI
Published: March 2003

Abstract Background: The antitumor mechanisms of bacillus Calmette‐Guérin (BCG) against bladder

cancer is still unclear. We previously reported that BCG was internalized by and

survived within murine bladder tumor cells (MBT‐2) for at least 40 days. In the present

study, we investigated the effect of BCG on the surface antigen expression of bladder

tumor cells and the characteristics of these cells as antigen‐presenting cells in

vitro.

Methods: Surface antigen (major histocompatibility complex (MHC) Class II, CD1, CD80 and intercellular adhesion molecule‐1 (ICAM‐1)) expression on BCG‐treated murine (MBT‐2) and human (T‐24, J82) bladder tumor cells were analyzed using flow cytometry. The production of interleukin‐2 (IL‐2) and interferon‐γ (IFN‐γ) from murine lymphocytes sensitized with BCG or BCG‐treated tumor cells were also investigated.

Results: The expressions of MHC Class II, CD1, CD80 and ICAM‐1 were augmented in all of the bladder tumor cell lines used; however, they were augmented to varying degrees among the cell lines that were treated with live BCG. Heat‐killed BCG had little or no effect. When murine lymph node cells sensitized with BCG or BCG‐treated MBT‐2 cells were cocultured with BCG‐treated MBT‐2 cells, significant amounts of IL‐2 and IFN‐γ were produced in the culture medium.

Conclusions: BCG induced the augmented expression of surface antigens, such as MHC Class II, CD1, CD80 and ICAM‐1, of bladder tumor cells. Furthermore, BCG‐treated MBT‐2 cells could stimulate BCG‐sensitized lymphocytes to produce IL‐2 and IFN‐γ. These results strongly suggest that bladder tumor cells gained the characteristics and functions of antigen‐presenting cells (APC).
Tumor‐associated tissue eosinophilia of penile cancer
Authors: Ono Yoshihiro , Ozawa Masashi , Tamura Yoshimi , Suzuki Takanori , Suzuki Kazuhiro , Kurokawa Kohei , Fukabori Yoshitatsu , Yamanaka Hidetoshi
Published: March 2003

Abstract
Background: Tumor‐associated tissue eosinophilia (TATE) occurs in many kinds of cancer. This study analyzed whether TATE improves the survival of penile cancer patients.

Methods
: In 17 patients with penile cancer, survival was compared between the TATE‐positive group and the TATE‐negative group. Tissue eosinophils were observed by transmission electron microscopy.

Results
: In all cases, 5‐year survival was 72.9% in the TATE‐positive group (n = 8) and 38.9% in the TATE‐negative group (n = 9; P = 0.131). In stage III and IV, it was 60% in the TATE‐positive group (n = 5) and 0% in the TATE‐negative group (n = 5; P = 0.058). Transmission electron microscopy images revealed the vigorous infiltration of tissue eosinophils.

Conclusions: It is suggested that TATE improves the survival of patients with advanced penile cancer. However, a greater number of subjects is needed to prove statistical significance.
Clinical study of varicocele: Statistical analysis and the results of long‐term follow‐up
Authors: Onozawa Mizuki , Endo Fumiyasu , Suetomi Takahiro , Takeshima Hitoshi , Akaza Hideyuki
Published: March 2003

Background: The results of clinical examinations of varicocele and the clinical outcome of varicocelectomy conducted at Tsukuba University Hospital, Tsukuba City, Japan were analyzed.

Methods: The subjects of the present study were sixty‐four infertile male patients with varicocele who visited our hospital from 1991to 1999. A physical examination, semen analysis and hormonal evaluation were performed for each patient. Patients selected their preferred type of treatment (varicocelectomy or conservative treatment) after providing their informed consent.

Results: The age of the patients was 34.1 ± 5.1(mean ± standard deviation [s.d.]) years, and the infertile duration was 4.2 ± 3.0 (mean ± s.d.) years. Fifty‐one cases were left‐sided; 13 were bilateral. Mean sperm density (¥ 106/mL) was 37.2 for Grade I, 21.3 for Grade II and 9.4 for Grade III. Sperm density was significantly lower in the higher‐graded patients (P = 0.008). Varicocelectomy was performed in 31 cases; the postoperative/preoperative ratio of sperm density was significantly higher in the higher‐graded varicocele (P = 0.04), and the peak/base ratio of follicle‐stimulating hormone (FSH) after luteinizing hormone‐releasing hormone (LH‐RH) stimulation was significantly decreased after varicocelectomy (P = 0.007). The pregnancy rate in the partners of the varicocelectomized group (60%) was significantly higher than in the conservatively treated group (28%) P = 0.04; the mean follow‐up duration was 76.2 months.

Conclusion: These results show that varicocele should influence spermatogenesis, therefore altered spermatogenesis could be effectively treated by varicocelectomy, and varicocelectomy should induce a higher probability of pregnancy.
Symptom‐specific quality of life in patients with benign prostatic hyperplasia
Authors: YOSHIMURA KOJI , ARAI YOICHI , ICHIOKA KENTARO , TERADA NAOKI , MATSUTA YOSUKE , OKUBO KAZUTOSHI
Published: March 2003

Abstract Background: We investigated which factors are most bothersome to preoperative patients with benign prostatic hyperplasia (BPH).

Methods: A total of 423 newly diagnosed patients and 388 preoperative patients with symptomatic BPH were evaluated. International prostate symptom score (IPSS) and IPSS quality‐of‐life (QOL) assessment score were used for assessment of symptoms and symptom‐specific QOL of the patients with BPH. Uroflow variables were measured in all patients. Other objective variables such as prostate volume, transition zone volume, Schaefer's obstruction grade, and detrusor pressure at maximal urinary flow were evaluated in 209 preoperative patients. We analyzed the relationships between symptom‐specific QOL and other variables. Statistical analyses were performed using Spearman's correlation coefficient and a stepwise linear regression model.

Results: Symptom‐specific QOL scores had moderate to good correlation with IPSS (P < 0.0001; r = 0.525–0.560). Filling symptom subscore had a slightly greater impact on symptom‐specific QOL than voiding subscore in both groups of patients. Weak stream, feeling of incomplete emptying, and nocturia significantly decreased symptom‐specific QOL in both groups of patients. While newly diagnosed patients suffered from frequency as well, urgency had the strongest impact on symptom‐specific QOL of preoperative patients. Objectively measurable variables had no association with symptom‐specific QOL.

Conclusion: Japanese patients with BPH generally suffer from weak stream, feeling of incomplete emptying, and nocturia in all disease phases. Frequency is problematic for newly diagnosed patients and urgency is problematic for preoperative patients as well. Symptom‐specific QOL of BPH patients cannot be estimated by physically measurable variables.
Gamma‐knife radiosurgery for brain metastasis of renal cell carcinoma: Results in 42 patients
Authors: Hoshi Senji , Jokura Hidefumi , Nakamura Hiroyuki , Shintaku Ichiro , Ohyama Chikara , Satoh Makoto , Saito Seichi , Fukuzaki Atsushi , Orikasa Seiichi , Yoshimoto Takashi
Published: March 2003

Background: The present study provides data from clinical experience with gamma‐knife radiosurgery (GK) in patients with brain metastasis from renal cell carcinoma (RCC) and shows the value of this less invasive treatment modality.

Methods: Forty‐two patients received GK. Twenty of the 42 cases had multiple brain metastases. Extracranial metastases were observed in the lung (38 cases), bone (12 cases), liver (9 cases), lymph node (5 cases) and skin (6 cases).

Results: Neurological symptoms seen in 40 patients were rapidly improved after GK in 32 patients (80%). Magnetic resonance imaging (MRI) evaluation after GK in 32 patients showed the disappearance of brain tumor in 9 patients (28%). Complete response was obtained by GK in tumors up to 30 mm in diameter. Repeated GK for newly developed lesions was conducted in 11 patients. Extracranial tumor resection was conducted in 7 cases (lung: 3, skin: 2, liver: 1, adrenal: 1). Chemo‐radiotherapy or immunotherapy was effective in 8 cases (lung: 5, liver: 2, bone: 1). The actual one‐, two‐ and three‐year survival rates were 44.9%, 16.8%, and 11.2%, respectively. The median survival time was 12.5 months. In univariate analysis, the patients with successfully treated extracranial metastases had significantly better prognosis. In multivariate analysis, the patients with Karnofsky performance scale (KPS) ≥ 80%, who were treated by GK more than once and obtained complete response (CR) or partial response (PR) by GK, had significantly better prognosis.

Conclusion: Gamma‐knife radiosurgery for RCC is an effective non‐invasive modality of treatment. It offers a high local control rate and an improved quality of life and survival rate.