bluuebunny/crossref_metadata_2025 huggingface dataset:
Influenza vaccination: Changes in exhaled nitric oxide levels and sputum cytology
Authors: Thomas Paul S , Ng Clifford , Elsing Melissa , Yates Deborah H
Published: March 2003

Objective:

Influenza vaccination is routinely recommended for patients with chronic lung disease, but has been reported to cause a small increase in airway reactivity. The use of simple, non‐invasive methods of assessing changes in airway inflammation could potentially allow improved understanding of the cellular mechanisms underlying such changes.

Methodology: We studied a group of 44 hospital workers before and after routine influenza vaccination, using spirometry, and exhaled nitric oxide (eNO) as a marker of pulmonary inflammation (Group A). In addition, methacholine challenge and sputum induction were also performed in a subgroup (subgroup B, n = 7) at baseline and at 7 days after vaccination.

Results: Spirometry did not change in either group. In Group A there was a small but significant rise in mean peak eNO from 47.32 ± 4.5 (mean NO p.p.b. ± SEM) to 53.2 ± 4.9 between days 0 and 7 (P < 0.05). A non‐significant rise in eNO was seen in subgroup B. In subgroup B, when the differential cell counts in induced sputum were compared between baseline and sampling 1 week later, there was a significant rise in the percentage of lymphocytes, from 3.9 (1.8–9.8: median %total (range)) to 11.9 (6.0–18.5, P < 0.02) and a non‐significant increase in shed respiratory epithelial cells from 3.1 (0.6–5.8) to 13.0 (1–30.3, P = 0.06). There was a corresponding significant fall in the percentage of macrophages. Methacholine challenge in subgroup B showed no change in reactivity in these normal subjects.

Conclusion: Influenza vaccination causes a small increase in exhaled NO, and is accompanied by increased sputum lymphocytosis and respiratory epithelial shedding. An influx of inflammatory cells may help to explain the induction of increased airway reactivity that has been described in other studies.
Antigen uptake and subsequent cell kinetics in bronchus‐associated lymphoid tissue
Authors: Toyoshima Mikio , Chida Kingo , Sato Atsuhiko
Published: March 2003

Objective:

Bronchus‐associated lymphoid tissue (BALT) plays an important role in the immunological defence of airways. However, the mechanisms of BALT development, antigen sampling, and subsequent cell kinetics remain unclear. To clarify these chronological processes, we used a Pseudomonas aeruginosa‐exposed mouse model.

Methodology: In BALB/c and C57BL/6 mice, BALT development was induced by inhalation of heat‐killed P. aeruginosa after sensitization with subcutaneous injection of P. aeruginosa in the presence of Freund’s complete adjuvant. Subsequently, we chronologically killed these mice who had inhaled PKH26‐labelled P. aeruginosa and examined bacterial transport using fluorescence microscopy. The distribution of interleukin‐4‐positive cells and interferon‐γ‐positive cells was studied immunohistochemically.

Results: The degree of BALT hyperplasia was greater in sensitized mice than in non‐sensitized mice and in BALB/c mice than in C57BL/6 mice. PKH26‐labelled bacteria were found in BALT earlier in sensitized mice than in non‐sensitized mice. Immunohistochemical studies revealed that interleukin‐4‐positive cells predominated over interferon‐γ‐positive cells in the peripheral areas of lymphoid follicles.

Conclusion: These results indicate that administered antigens are actively transported into BALT and that sensitized Th2 lymphocytes play an important role in forming and maintaining BALT.
Composition of alveolar surfactant changes with training in humans
Authors: Doyle Ian R. , Morton Sharon , Crockett Alan J. , Barr Heather A. , Davidson Kate G. , Jones Meril J. , Jones Michael E. , Nicholas Terence E.
Published: March 2003

Objective:

We test the hypothesis that the changes we observed previously in the relative amounts of disaturated phospholipids (DSP), cholesterol (CHOL), and surfactant protein‐A (SP‐A) in human alveolar surfactant in response to acute exercise, and which were related to fitness, can be induced by training.

Methodology:

We examine the effect of 7 weeks' training on these major surfactant components, together with surfactant protein‐B (SP‐B), in bronchoalveolar lavage fluid harvested from 17 males, both at rest and after acute exercise. Fitness was assessed as workload/heart rate achieved during cycling for 30 min at 90% of theoretical maximal heart rate, and was increased in all subjects following training (mean increase 22.2 ± 3.91%; P = 0.001).

Results:

Training significantly increased the SP‐A/DSP, SP‐B/DSP, SP‐A/CHOL and SP‐A/SP‐B ratios in whole surfactant harvested from subjects both at rest and immediately following exercise. Training also increased the SP‐B/CHOL ratio at rest. Changes were particularly marked at rest in the SP‐A/DSP, SP‐A/CHOL, and SP‐B/CHOL ratios in the tubular myelin‐rich fraction, and after exercise in the SP‐A/DSP, SP‐A/CHOL, and SP‐A/SP‐B ratios in the tubular myelin‐poor fraction.

Conclusion:

We conclude that training markedly alters the composition of alveolar surfactant both at rest and with exercise; the physiological significance of these changes remains to be determined.
Tachykinin‐induced bronchoconstriction in sheep is NK‐1 receptor mediated and exhibits tachyphylaxis
Authors: Rice Anthony J. , Reynolds Paul N. , Reynolds Ann M. , Holmes Mark D. , Scicchitano Raffaele
Published: March 2003

Objective: Tachykinins are mediators of airway hyper‐reactivity and inflammation. There is in vitro evidence that ovine responses to tachykinins correlate closely to human responses. This study was designed to characterize the effect of intravenously administered tachykinins on sheep lung resistance in vivo to determine the effect of dose timing on reproducibility of responses and the induction of tachyphylaxis. We then used this information to help further characterize the response with several pharmacological agents.

Methodology: Substance P (SP) was administered by infusion to conscious merino ewes and lung resistance (RL) was measured. Infusions were given at 30, 60, 120 min and 24 h intervals. The effect of various agents on the response to SP was then assessed.

Results: Substance P led to a transient increase in RL, mean (± SEM) 754.8 (± 139)% of baseline, with marked tachyphylaxis at 30, 60 and 120 min. Phosphoramidon increased the peak response to 1151.5 ± 196%. Atropine and CP 96 345 abolished the response to SP, while indomethacin, sodium cromoglycate and pyrilamine had no significant effect. Substance P had a greater effect on RL than did neurokinin A.

Conclusions: Substance P increases RL in sheep via a cholinergic mechanism which is mediated by NK‐1 receptors, and is subject to tachyphylaxis. These findings have implications for the design of studies using the ovine model in the evaluation of tachykinin antagonists as potential therapeutic agents.
Primary pulmonary botryomycosis: An important differential diagnosis for lung cancer
Authors: KATHIR KRISHNA , DENNIS CHRISTOPHER
Published: March 2003

This is the sixteenth reported case of pulmonary botryomycosis, an uncommon suppurative bacterial infection of the lung. We describe the case of a 69‐year‐old man who presented with a chronic cough and intermittent haemoptysis and on subsequent chest computed tomographic scan imaging was found to have a right lower lobe mass. He underwent a right lower lobectomy for presumed lung cancer. Histological analysis however revealed a bacterial aetiology. The past literature is reviewed outlining the pathogenesis and difficulties of clinical and radiological diagnosis. Primary pulmonary botryomycosis forms an important curative differential diagnosis for lung cancer.
Diffuse alveolar haemorrhage: A rare reaction to insect sting
Authors: MUKHOPADHYAY AMARTYA , FONG KOK‐YONG , LIM TOW KEANG
Published: March 2003

Insect stings and subsequent reactions are common occurrences, but life‐threatening systemic reactions are rare. Herein, we describe the case of a young man who developed diffuse pulmonary haemorrhage following an insect sting. He had experienced urticarial reactions to insect stings previously. Diffuse pulmonary haemorrhage should be recognized as an uncommon manifestation of severe systemic reaction to insect sting.
Worldwide guidelines for chronic obstructive pulmonary disease: A comparison of diagnosis and treatment recommendations
Authors: IQBAL Ahmar , SCHLOSS Stella , GEORGE Dorothy , ISONAKA Sharon
Published: March 2003

Objective: Chronic obstructive pulmonary disease (COPD) is a leading cause of worldwide burden of disease, but is underdiagnosed and undertreated. We performed a systematic review of worldwide COPD clinical practice guidelines (CPG) to determine the degree of international consensus on major guideline recommendations.

Methods: The COPD CPG were identified from the medical literature and through contact with respiratory experts and organizations. An abstraction form was developed to collect information related to COPD diagnosis and management.

Results: Locally developed COPD CPG are based upon expert consensus, but do not explicitly rate the strength of the evidence for recommendations. The detail and clarity of the 41 CPG varied regarding the diagnosis and management of COPD. Key differences included the lung function parameters that define a diagnosis and severity assignment of COPD. The use of anticholinergics, alone or in combination, was listed as a consideration for first‐line therapy for persistent COPD in all 41 CPG. There was consensus regarding reserving corticosteroids for selected patients.

Conclusions: There is variation and ambiguity within COPD CPG regarding specific recommendations that can be applied by clinicians at a patient‐specific level. The variation in CPG for COPD may contribute to the underdiagnosis and suboptimal treatment of COPD. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) workshop report may help resolve some of the variation surrounding COPD diagnosis and treatment. However, local guideline implementation efforts must assist physicians in applying guideline recommendations to support patient‐specific management.
Fatal idiopathic acute eosinophilic pneumonia with acute lung injury
Authors: KAWAYAMA TOMOTAKA , FUJIKI REI , MORIMITSU YOSUKE , RIKIMARU TORU , AIZAWA HISAMICHI
Published: March 2003

A fatal case of idiopathic eosinophilic pneumonia with acute lung injury is described. The patient required treatment with mechanical ventilation and intravenous corticosteroids, however, she died on the third hospital day. At autopsy, both exudative and proliferative phases of diffuse alveolar damage were observed bilaterally. Marked eosinophilic infiltrate was noted in the alveolar wall and within the alveolar cavities with occasional abscess‐like features. To our knowledge, this is the first report of fatal acute eosinophilic pneumonia, and provides important information for the management of this condition.
On the ecological and evolutionary significance of storage in clonal plants
Authors: Suzuki Jun‐Ichirou , Stuefer Josef
Published: March 2003

Environmental heterogeneity has received wide attention in clonal plant research over the last decade. Most studies have focussed on the effects of spatial variation in environmental conditions on the performance of ramets and genets, while the effects of temporal heterogeneity have only occasionally been studied. As a consequence, our current knowledge about functional responses of clonal plants to habitat patchiness is biased towards spatial aspects of environmental heterogeneity. Nevertheless, temporal changes in biotic and abiotic conditions do occur in most natural habitats, and they are very likely to affect plant growth and performance, and to create positive selection pressures on traits that can buffer plants against unfavorable consequences of this variability. Storage of resources is a widespread phenomenon in clonal plant species. Typical clonal structures such as stolons, rhizomes and hibernacles serve as storage organs. However, the ecologic significance of storage in clonal plant structures remains partly unclear. We suggest that the lack of understanding with respect to resource storage in clonal plants be related to our poor knowledge of ecologic implications of temporal habitat heterogeneity in natural environments. Resource storage can be understood as a safety measure against temporal changes in the growing conditions of plants. This paper summarizes existing information about the ecologic relevance of storage in clonal plants and it tries to develop a framework for further investigation of resource storage as a strategy to enhance the performance of clonal plants in temporally variable environments.
Some thoughts on the evolution and ecology of recalcitrant seeds
Authors: Pammenter N. W. , Berjak Patricia
Published: March 2003

There are substantial scientific reports on the basic physiology and desiccation sensitivity of recalcitrant seeds, but ecological and evolutionary aspects of their biology have received scant attention. Recalcitrant seeds are shed hydrated, are desiccation sensitive and have a short lifespan. In vegetative tissue, desiccation sensitivity is probably the ancestral state, but tolerance is thought to have evolved early and a number of times independently. It is difficult to see evolutionary relationships among species producing recalcitrant seeds. However, it is suggested that early evolved seeds were desiccation sensitive and that desiccation tolerance is a derived characteristic. Desiccation sensitivity and short lifespan of recalcitrant seeds places constraints on the range of environmental conditions in which reproductive success can occur. Species producing recalcitrant seeds are common in humid tropical forests, where the seeds of climax species germinate and form a seedling bank, rather than contributing to the soil seed bank. However, there is a wide range in post‐shedding physiology among recalcitrant seed species, and recalcitrant seeds do occur in habitats with seasonal climates. Here, regeneration strategies may be more specialized.
Acute rheumatic fever in Konya, Turkey
Authors: Karaaslan Sevim , Oran Bülent , Reisli Ismail , Erkul Ibrahim
Published: March 2003

Abstract Background: Patients with acute rheumatic fever (ARF), who were admitted to Pediatric Cardiology Unit of Selçuk University Faculty of Medicine from July 1993 to 1998, were studied retrospectively to verify the clinical profile of the disease and to compare the results with those from other countries.

Methods
: All patients were examined by one of the two pediatric cardiologists in our study group. Every patient had a chest X‐ray, electrocardiogram and an echocardiographic investigation. Throat culture, antistreptolysin O test, C‐reactive protein and sedimentation rates were investigated for each patient.

Results
: During the study period, 274 cases with ARF were identified among patients admitted to the present institution. There were 8032 visits during the study period, giving an occurrence rate of 3.4%. Arthritis was the most common major manifestation (81.4%). It was followed by carditis (60.9%) and chorea (17.9%). Subcutaneous nodules (0.7%) and erythema marginatum (0.4%) were both seen in patients with carditis. The mitral valve was the most commonly affected valve (95.8%), followed by the aortic valve (40.1%). Two patients died and regurgitation disappeared in 21% of patients with mitral regurgitation. Fifteen patients (14%) with isolated arthritis and pure chorea had mitral regurgitation demonstrated by echocardiographic investigation but without any significant murmur.

Conclusion
: The present study indicates that ARF is still a significant problem in Konya and that recurrences can be prevented by administering a 3‐week benzathine penicillin G regimen.
Rotavirus infection among infants with diarrhea in Vietnam
Authors: Nishio Osamu , Matsui Kiyohiko , Lan Doan Thi Phoung , Ushijima Hiroshi , Isomura Sin
Published: March 2003

Abstract Rotavirus was examined from diarrheal stool samples of 158 infants in rural area near Ho Chi Minh City, Vietnam, from 1994 to 1996. Group A rotavirus was detected in 50%. G1 and G4 were the predominant serotypes. G3 was not detected. The most predominant type changed from year to year. Rotavirus was found in all seasons, especially in winter and autumn. Infants younger than 2 years of age were those mostly infected and the virus was suspected to invade high concentration in this area.
Bone mineral density in children with cerebral palsy
Authors: Tasdemir Haydar Ali , Buyukavci Mustafa , Akcay Fatih , Polat Pinar , Yildiran Alisan , Karakelleoglu Cahit
Published: March 2003

Abstract

Background
: The purpose of the present study was to evaluate the severity of and factors related to osteopenia in children with cerebral palsy (CP).

Methods
: Bone mineral density (BMD), calcium (Ca), phosphate (P), alkaline phosphatase (ALP), creatinine, parathyroid hormone (PTH) and 25‐hydroxy vitamin D3 (25OHD3) concentrations were determined in 24 children with CP (15 ambulant, nine non‐ambulant), aged between 10 months and 12 years (mean (±SD) 4.1±2.9 years). These vaules were compared with data obtained from a control group.

Results
: Adjusted mean BMD values were lower in the patient group than in controls (P<0.05). However, there was no difference between BMD values of ambulant and non‐ambulant patients. The Ca and P levels of the patient group were significantly higher than those of controls (P<0.05).

Conclusions
: The present study showed that BMD was decreased in all children with CP, but to a greater extent in non‐ambulant children with CP, and immobilization is the major effective factor on bone mineralization.
Characteristics of suicide among children and adolescents in Budapest
Authors: Töero Klára , Nagy Ágnes , Sawaguchi Toshiko , Sawaguchi Akiko , Sótonyi Péter
Published: March 2003

Abstract

Background
: In Europe, the suicide rate among children and adolescents is the highest in Hungary. In the young age group (10–14 and 15–19 years), the suicide mortality rate had not showed a decrease.

Methods
: This study examined suicide cases committed by children and adolescents highlighted from the extraordinary death cases in Budapest between 1994 and 1998. The 72 suicide cases, which included 59 males and 13 females, were processed by sex, age, method and time of commitment, and distribution by districts.

Results
: Leaping off high places or hanging was the highest frequency among the methods of commitment. Accurate data about the frequency, type, time and location of death cases are indispensable to decrease the number of children’s and adolescents’ suicides.

Conclusions
: Studies of epidemiology and risk factors may provide a basis of development of a specific suicide prevention programme including educational, health and welfare elements.
Increase of cord blood cytokine‐producing T cells in intrauterine infection
Authors: Matsuoka Takashi , Matsubara Tomoyo , Katayama Kumiko , Takeda Kanae , Koga Mayumi , Furukawa Susumu
Published: March 2003

Abstract

Background
: Although infection is a frequent and important cause of morbidity and mortality in the neonatal period, evaluation of the immune system in cases of intrauterine infection is not easy. The subsets of T helper (Th) 1, which produce mainly interferon gamma (IFN‐γ), and Th2, which produce interleukin (IL) ‐4, have been implicated in the regulation of many immune responses. In this study, we investigated Th1 and Th2 subsets in the cord blood (CB) to evaluate the role of CB T cells in the intrauterine infections.

Methods
: We used an intracellular cytokine‐staining technique with determination by flow cytometry to study IFN‐γ‐producing T cells and IL‐4‐producing T cells in the CB of six neonates with perinatal intrauterine infection and 17 uninfected neonates.

Results
: The CB from neonates with intrauterine infections had more IFN‐γ‐producing CD3+T cells than that from uninfected neonates. The percentage of CB IFN‐γ‐producing CD3+T cells in the infected neonates correlated with the duration of membrane rupture before the onset of labor, but not with the level of C‐reactive protein. The infected neonate born after the longest duration of membrane rupture showed an increased percentage of IL‐4‐producing CD3+T cells.

Conclusions
: Our results suggest that the increase of CB IFN‐γ and IL‐4‐ producing T cells is part of the immune system directed against perinatal intrauterine infections.
Diagnostic significance of increased serum hyaluronic acid in juvenile rheumatoid arthritis
Authors: Shigemori Masahiko , Takei Syuji , Imanaka Hiroyuki , Maeno Nobuaki , Hokonohara Masashi , Miyata Koichiro
Published: March 2003

Background
: We have previously reported that serum levels of hyaluronic acid (HA) objectively reflect the severity of arthritis in juvenile rheumatoid arthritis (JRA). However, clear diagnostic standards do not exist for JRA; it is difficult to evaluate arthritis in children, particularly in small children and the diagnostic criteria for JRA requires an exclusion of several diseases. Therefore, if a specific test finding associated with JRA could be established, it would enable general pediatricians to make an objective diagnosis.

Methods
: We measured the serum HA levels in children with joint symptoms as a chief complaint. The total number of subjects were 197 children; of these 89 had JRA, 39 had rheumatic diseases other than JRA, and 69 had non‐rheumatic diseases (including systemic 31, polyarticular 40 and pauci‐articular in 17), rheumatic diseases other than JRA in 39 subjects, and non‐rheumatic diseases in 69 subjects. Sandwich enzyme‐linked immunosorbent assay measured HA by using the HA binding protein.

Results
: The serum level of HA was significantly higher in systemic and polyarticular JRA patients than in patients with pauci‐articular JRA, with rheumatic diseases other than JRA, and non‐rheumatic patients. With a cut‐off value of 100 ng/mL, a diagnostic value of HA in all JRA patients was 48.3% sensitivity and 98.1% specificity.

Conclusions
: In children presenting with joint symptoms, serum HA measurement is useful for diagnosing systemic and polyarticular JRA.
Characteristics of the daily lives of elderly women at various facilities for the elderly
Authors: Tada Toshiko , Yamamoto Sumiko , Morimoto Tadaoki
Published: March 2003

A number of studies have been conducted about support for the daily lives of elderly individuals that will elevate their quality of life (QOL). Services provided to support these individuals have also become more diverse. This study will attempt to add to the understanding of QOL for the elderly by comparing levels of dependence and QOL of elderly women in four different types of institution. Individuals who were over 65 years of age and who were able to participate in a 1 h interview were chosen for this study. The subjects were selected from the elderly population of a hospital for aged patients, health service facilities for the elderly, a nursing home and a general hospital. Levels of dependency of activities of daily living (ADL) were measured using the Kahoku Aging Longitudinal Study Scale. The scale qualitatively evaluates the cognition and activities of the elderly. Each measure is rated on a four point scale. Quality of life was measured using the visual analogue scale. Elderly women living at the nursing home differed from those living in the other facilities in regard to their degree of independence in ADL and QOL. These findings indicate that there were differences in the characteristics of the daily lives of elderly women at different types of facilities.
Heart rate variability of preterm neonates quantified by energy entropy
Authors: Verklan M. Terese , Bickel David R. , Moon Jon
Published: March 2003

Abstract Identifying variables predictive of neurobehavioural sequelae is a key objective in the study of high‐risk neonates. Examination of heart rate variability (HRV) characteristics may be a finer discriminator of the neonate’s response to physiologic stressors than the mean heart rate. The energy entropy of the heart beat tachogram, computed in four different domains, was used to quantify the HRV in 13 preterm neonates. The entropies of energies were computed from 1024 interbeat time intervals obtained once per week from 26 to 35 weeks postconceptional age (PCA). The energy entropy computed in three of the domains, like the standard deviation of intervals, distinguished between the 10 neonates that were measured at 35 weeks PCA with 100% specificity and 67% sensitivity, but did not distinguish between healthy and unhealthy neonates at earlier ages. The findings suggest that energy entropy may be a discerning measure of physiologic stress in the preterm infant, although future research is needed to refine the test and determine statistical significance.
Baccalaureate nursing education curricula in the People’s Republic of China: Status, issues and reforms
Authors: Sun Jiemin , Xu Yu , Xu Zhaomin , Zhang Jianhui
Published: March 2003

This article examines baccalaureate nursing education curricula in the People’s Republic of China. Three 5‐year curricula and one 4‐year curriculum were content analyzed and contrasted. Findings of this study suggested that: (i) the biomedical model dominated the three 5‐year traditional curricula; (ii) political‐ideological content permeated all four curricula; and (iii) the reformed curriculum at Peking Union Medical College was a genuine effort toward building a new nursing curriculum model that intended to differentiate nursing education from medical education. In addition, major themes of recent curriculum reforms were highlighted. Recommendations were suggested to improve the outcomes of future curriculum endeavors. Explicit as well as implicit comparisons with an ideal–typical American generic baccalaureate nursing curriculum were made when appropriate.
The relationship between fear of falling, activities of daily living and quality of life among elderly individuals
Authors: Suzuki Mizue , Ohyama Naomi , Yamada Kiyomi , Kanamori Masao
Published: March 2003

Abstract The purpose of the present study was to examine the relationship between functional disability and fear of falling during daily activities. Also examined was the relationship between fear of falling and health‐related Quality of Life (QOL). Health‐related QOL concepts were measured using the Short Form 36 Health Survey (SF‐36) within an elderly day services sample. Eligible subjects were elderly persons using Day Service (type B) who were capable of independently answering a questionnaire and had no memory problems. Forty‐three males and 92 females were eligible for this study. Forty‐nine (36.3%) subjects expressed no fear of falling, whereas 22 (16.3%) reported that they were very fearful of falling. Among females, walking and bathing had a highly significant relationship with the fear of falling. The fear of falling can contribute to psychological conditions such as depression, and also impacts on the health‐related QOL of frail elderly people. Thus, it is critical to provide integrated health care activities for these individuals that address both psychological well‐being and physical functioning.
Research utilization among pediatric health professionals
Authors: McCleary Lynn , Brown G. Ted
Published: March 2003

Abstract The present study investigated research use and attitudes toward research among pediatric health professionals. All nurses and allied health professionals in a pediatric teaching hospital were surveyed using previously tested and published measures. Over half of the participants had some formal education in research but, for some participants, that education was many years ago. Most participants reported poor or very poor understanding of research design. Two variables were independently associated with a positive attitude towards research: (i) better understanding of how to conduct a literature search; and (ii) higher level of education. Five variables were independently associated with research use: better understanding of research design; having presented at a conference in the past two years; sense of calling to the profession; better understanding of how to conduct a literature search; and attending rounds. A small proportion of variance in both research use and a positive attitude towards research was explained by the independent predicator variables. Further research is required to identify characteristics of the workplace environment that support research use.
Role of knowledge and ability in student nurses' clinical decision‐making
Authors: Botti Mari , Reeve Robert
Published: March 2003

Abstract Little is known about the acquisition of decision‐making skills in nursing students as a function of experience and academic ability. Knowing how experience and academic skills interact may help inform clinical education programs and formulate ways of assessing students’ progress. The aims of the present study were to develop a problem‐solving task capable of measuring clinical decision‐making skills in novice nurses at different levels of domain‐specific knowledge; and to establish the relative impact on decision‐making of domain‐specific knowledge and general ability as determinants of the acquisition of decision‐making skills. Three types of clinical problems of increasing complexity were developed. Sixty second‐year and third‐year student nurses with high and low academic scores were studied in terms of their ability to generate hypotheses for a hypothetical case, recognize disconfirming information and the need to access additional information, and diagnostic accuracy. The results showed that general academic ability and knowledge function partly independently in the acquisition of expertise in nursing. Academic ability affects decision‐making in low complexity tasks, but as case complexity increases, domain‐specific knowledge and experience determines decision‐making skills. There are important differences in the way novices with different levels of knowledge and ability make clinical decisions and these can be studied by systematically increasing the complexity of the decision task. These results have implications for the way in which clinical education is structured and evaluated.
Ureteropyeloscopy in the diagnosis of patients with upper tract hematuria: An initial clinical study
Authors: Yazaki Tsunetada , Kamiyama Yutaka , Tomomasa Hiroshi , Shimizu Hirofumi , Okano Yoshinori , Iiyama Tetsuro , Iizumi Tatsuo , Umeda Takashi
Published: March 2003

Background: To study the usefulness and safety of ureteropyeloscopy in the diagnosis of upper tract hematuria of unknown etiology by standard diagnostic methods.

Methods: Fifteen patients with upper tract hematuria of unknown etiology were the subjects of the present study. Prior to ureteropyeloscopy, they underwent standard diagnostic methods, including cystourethroscopy, excretory urography and computed tomography scan. The upper tract (ureter, renal pelvis and calyces) was inspected systematically with a flexible ureteropyeloscope under epidural anesthesia. A biopsy specimen was obtained when neoplasm of a suspicious lesion was seen. Bleeding and hemangiomatous lesions were fulgurated at the time of ureteropyeloscopy.

Results: Unilateral gross hematuria was seen in 12 patients. Imaging studies revealed a filling defect in four patients, ureteral stenosis in one patient and nutcracker phenomenon in one patient. Urine cytology was positive in three patients and suspicious in four patients. Results of ureteropyeloscopy were papillary tumor in three patients, whitish encrustation in one patient, redness of the renal pelvis in one patient, bleeding from the renal calyx in two patients, hemangiomatous lesion in one patient, ureteral stenosis in two patients and no abnormalities in five patients. Biopsies were performed in five patients. The pathology results were transitional cell carcinoma in four patients and no abnormality in one patient. Although a ureteral stent catheter was placed in one patient, no serious complications were encountered during or after the procedures.

Conclusions: Ureteropyeloscopy was useful and relatively safe. This endoscopic examination can differentiate insignificant lesions from significant lesions by visual inspection of the lesions, in addition, pathological diagnosis by biopsy specimen can also be performed if deemed necessary. Ureteropyeloscopy is recommended in the diagnosis of upper tract hematuria of unknown etiology.
The usefulness of [131I]‐metaiodobenzylguanidine ([131I]‐MIBG) scintigraphy performed one week after administration in diagnosing pheochromocytoma
Authors: Takahashi Nobuyoshi , Suzuki Tadashi , Yamaya Kanemitsu , Funyu Tomihisa
Published: March 2003

Background: Imaging performed 36–48 h after metaiodobenzylguanidine (MIBG) injection is being widely used in the diagnosis of pheochromocytoma. However, there are some difficult cases to diagnose due to a high concentration of MIBG remaining in the background. We studied the significance of scans on the 7th day after MIBG injection when the concentration of MIBG in the background has declined.

Methods: Imaging was carried out on 11 cases before operation, five cases (eight times) after operation and 12 cases which had been strongly suspected of being pheochromocytoma, but later proved to be non‐pheochromocytoma.

Results: In all the cases of pheochromocytoma, except one, the tumor imaging was clear 24–72 h after MIBG injection. As for the images after operation and those of the 12 non‐pheochromocytoma cases, the scintigram made on the 7th day proved the negative pheochromocytoma.

Conclusion: This approach was very effective not only for finding early small pheochromocytomas and the remnants of tumors after resection, but also in diagnosing non‐pheochromocytoma.
Apoptosis and nuclear shapes in benign prostate hyperplasia and prostate adenocarcinoma: Comparison with and relation to Gleason score
Authors: Choi Nak, Gyeu , Sohn Jin, Hee , Park Hung, Won , Jung Tae, Young
Published: March 2003

Purpose: To compare differences in the number of apoptotic bodies and nuclear shapes (size and roundness) between untreated benign prostate hyperplasia (BPH) and untreated advanced prostate adenocarcinoma (PCA) and to elucidate differences in apoptosis number and nuclear shapes with increasing malignant potentiality, by Gleason score, in PCA.

Methods: A retrospective study was conducted on 40 patients with BPH and 12 patients with PCA I (Gleason score 2–4), 14 patients with PCA II (Gleason score 5–7) and 14 patients with PCA III (Gleason score 8–10). The frequency of apoptotic bodies (mean percentage calculated from 200 cells/high‐power field over 10 fields) was examined on immunostain. Nuclear shapes were determined by an automatic image analyzer. Over 100 hyperplastic cells or cancer cells were detected by the image analyzer.

Results: The mean number of apoptotic bodies in BPH and PCA I were not significantly different, but patients with PCA II and PCA III showed significantly higher numbers of apoptotic bodies than patients with BPH. Patients with PCA III had significantly more apoptotic bodies than patients with PCA I. Benign prostate hyperplasia nuclei had the smallest mean nuclear area and the largest mean nuclear peripheral ellipse among the four groups. The study showed that PCA I, II, III nuclei had significantly larger areas and a less circular shape than nuclei from patients with BPH. Nuclei from patients with PCA I were smaller in size and rounder than nuclei from patients with PCA III.

Conclusions: The present study clearly shows the presence of apoptosis in BPH and PCA and shows an increasing number of apoptotic bodies with higher cellular malignancy. The nuclear shapes in PCA were more irregular and larger in size with increasing cellular malignancy. As expected, nuclei in BPH were smaller in size and rounder than those of cancer nuclei.
Laparoscopic treatment of retroperitoneal benign schwannoma
Authors: OHIGASHI TAKASHI , NONAKA SHOICHI , NAKANOMA TAKASHI , UENO MUNEHISA , DEGUCHI NOBUHIRO
Published: March 2003

Purpose/Methods: We report on a case of retroperitoneal benign schwannoma treated by laparoscopic surgery.

Results/Discussion: The difficulties of diagnosis and the advantages of laparoscopic management are discussed.
A case of renal metanephric adenoma: Histologic, immunohistochemical and cytogenetic analyses
Authors: Tsuji Masahito , Murakami Yoshihide , Kanayama Hiro‐Omi , Sano Toshiaki , Kagawa Susumu
Published: March 2003

Background: A unique case of metanephric adenoma of the left kidney is reported in a 61‐year‐old woman presenting with an incidental renal mass on ultrasonography.

Methods/Results: On radiographic examination, the presence of hypovascular renal cell carcinoma was suspected and left radical nephrectomy was performed. The resected tumor, measuring 4.9 x 4.7 x 4.5 cm, was well‐circumscribed and solid and its cut surface was tan–pink with foci of focal hemorrhage and cystic change. Microscopically, the tumor was composed of uniformly small acini with hyperchromatic round nuclei. Some acini were dilated and occasionally contained glomeruloid‐like bodies and psamoma bodies. Immunohistochemically, tumor cells showed positive immunoreaction for vimentin, cytokeratin and Leu7. Cytogenetically, the tumor did not show numerical aberrations of chromosome 7 or 17 by fluorescence in situ hybridization.

Conclusions: The patient is alive without recurrence or metastasis 4 years after surgery. Metanephric adenoma must be differentiated from other renal tumors, particularly Wilms’ tumor or low‐grade renal cell carcinoma. Immunohistochemical and cytogenetic analysis may be helpful in difficult cases.
Long‐term results of Burch colposuspension
Authors: Akpinar Haluk , Cetinel Bulent , Demirkesen Oktay , Tufek Ilter , Yaycioglu Ozgur , Solok Vural
Published: March 2003

Background
: We aimed to determine the long‐term results of Burch colposuspension.

Methods
: Patients who had undergone Burch colposuspension due to stress urinary incontinence (SUI) in our department between 1991 and 1995 were asked to participate in the study by telephone or mail. Fifty of 78 patients (64%) responded and these formed the study group. Patients were evaluated by a detailed questionnaire, pelvic examination, uroflowmetry and postvoid residual urine determination. Provocative stress test and urodynamic evaluations were performed in those who claimed leakage. Additionally, follow‐up charts were retrospectively reviewed from the patients’ files.

Results
: Mean follow‐up time was 50.6 months. The subjective cure rate was 52% and the surgical success rate was 84%. The patient satisfaction rate in terms of incontinence was 86%. No correlation was found between pre‐operative patient characteristics (i.e. age, number of vaginal deliveries and pregnancies, menopause, previous anti‐incontinence surgery and presence of detrusor instability) and outcome of surgery. Although no patient was performing clean intermittent catheterization in the long term, two patients had significant residual urine and obstructive flows. Three patients had severe pelvic prolapse that required surgical correction.

Conclusions
: Our results indicate that Burch colposuspension operation is an effective and durable choice of treatment with low complication rates for the treatment of SUI.
The correlation of stage and pathology of prostate cancer in Japan
Authors: Kubota Yutaka , Imai Kyoichi , Yamanaka Hidetoshi
Published: March 2003

Background
: Few articles describe stage and pathology distribution of prostate cancer by age, yet understanding these topics may provide clues to the etiology of this disease. The present study describes the distribution of stage and pathology of prostate cancer in terms of age and considers effective detection of early stage cancer by mass screening (MS).

Methods
: Data presented in this study were based on patient’s files from MS and the Gunma Urological Oncology Study Group (GUOSG) registry from 1981 to 1996 in Gunma Prefecture, Japan.

Results
: Age did not significantly correlate with stage distribution among the GUOSG patients, whereas stage tended to advance with age among the MS patients. Stage B was detected more frequently than any other stage in all age groups of the MS patients, whereas stage C and stage D were detected at similar rates in all age groups. After prostate specific antigen (PSA) had been introduced in MS, the percentage of early stage cancer increased at an earlier age. Pathology distribution did not significantly differ in any group.

Conclusions
: The data obtained from MS cancer patients showed that tumor stage tends to advance with age. We believe that the younger age group should be examined by MS using PSA to effectively detect early prostate cancer.
Urothelial cytoprotective activity of Tamm–Horsfall protein isolated from the urine of healthy subjects and patients with interstitial cystitis
Authors: Akiyama Akihito , Stein Paul C , Houshiar Amir , Parsons C Lowell
Published: March 2003

Purpose
: Tamm–Horsfall protein (THP) is a ubiquitous urinary protein with essentially no known function. We propose that THP is a cytoprotective agent that protects the urothelium from cationic species. To test this hypothesis we isolated THP from normal and interstitial cystitis urine to see if it could protect cultured cells from damage induced by the polyamine, protamine sulfate (PS).

Methods
: Tamm–Horsfall protein was extracted from the urine of interstitial cystitis (IC) patients (N = 28) and normal volunteers (N = 5). Urothelial target cells (T24) were radiolabeled with 51Cr and then exposed to PS (0–1.0 mg/mL) for either 1.5 or 20 h. The resulting cytotoxicity data (dose–response curves) were then compared with the data obtained when PS was preincubated with 0–0.5 mg/mL of THP (IC vs normal), the semisynthetic polysaccharide, pentosan polysulfate (Elmiron), or human serum albumin.

Results
: Toxicity of PS was significantly reduced by incubation with THP (or Elmiron) prior to evaluation by the chromium release assay, but not reduced by incubating with another protein, albumin. Tamm–Horsfall protein from IC patients’ urine was less protective than an equal quantity of THP from normal urine.

Conclusions
: These experiments suggest that THP has an important role in bladder mucosal defense mechanisms, protecting the bladder surface from injury. Inability of THP to prevent cytotoxic damage by urinary polyamine or other urinary toxins (cationic species) may be relevant in the etiology of interstitial cystitis, as putative urinary toxic components have been described in the urine of some patients.
Epidermoid cyst arising from the spermatic cord area
Authors: Tanaka Tomoaki , Kawano Manabu
Published: March 2003

Purpose
: We report on an epidermoid cyst arising from the spermatic cord area that was confirmed histologically after local excision.

Methods/Results
: Radiologic studies demonstrated a well‐encapsulated solid mass in the left inguinal region, which was adjacent to the left spermatic cord. Tumor resection was then performed. Pathological examination revealed a epidermoid cyst lined with keratinized squamous epithelium.

Conclusion
: There was no recurrence observed 5 years after surgery.
Lymph nodal involvement by renal angiomyolipoma
Authors: Köksal Ismail Türker , Tunç Murat , Kiliçaslan Isin , Ander Haluk , Özcan Faruk , Kaplancan Tansel
Published: March 2003

Angiomyolipoma of the kidney is a clonal neoplasm, apparently part of a family of neoplasms derived from perivascular epithelial cells. A 40‐year‐old woman presented with right flank pain and an otherwise non‐significant medical history. An abdominal computed tomography scan revealed an 18 cm solid mass in the mid‐portion of the right kidney and multiple perihilar lymph nodes. Presumptive diagnosis was renal cell carcinoma. Right radical nephrectomy and a perihilar lymph node dissection was performed through a Chevron incision for the anticipated diagnosis of renal adenocarcinoma. The renal tumor was diagnosed as angiomyolipoma and a component was identified pathologically in a dissected lymph node. There was no evidence of tumor recurrence in the follow‐up period of eight years. The consensus from other studies suggests that this phenomenon is a manifestation of the multicentric nature of angiomyolipoma, rather than due to metastasis. Genetic studies may resolve this question in the future.
Comparative study of transurethral laser prostatectomy versus transurethral electroresection for benign prostatic hyperplasia
Authors: Wada Seiji , Yoshimura Rikio , Kyo Munenori , Hase Taro , Masuda Chikayoshi , Watanabe Yoshihiro , Ikemoto Shin‐Ichi , Kawashima Hidenori , Kishimoto Taketoshi
Published: March 2003

Background: Transurethral resection of the prostate (TURP) is the gold standard treatment for benign prostatic hyperplasia (BPH). Recently, less invasive transurethral laser prostatectomy, such as visual laser ablation (VLAP) or interstitial laser coagulation (ILCP), have been developed. Herein, we investigated the efficacy of VLAP and ILCP compared to TURP.

Methods: A total of 80 patients with BPH were treated: 20 patients by VLAP, 30 patients by ILCP and 30 patients by TURP. All patients were followed up for 12 months after their operations. Treatment outcomes were evaluated by four different criteria: (i) the International Prostatic Symptom Score (I‐PSS), (ii) the maximum flow rate (Qmax), (iii) postvoided residual urine volume before treatment and one, three, six and 12 months after treatment, and (iv) prostatic volume before operation and three and six months postoperatively.

Results: The I‐PSS, Qmax and residual urine volume were significantly improved compared to baseline levels and the improvement continued for 12 months in the three groups: for I‐PSS (P < 0.001 in the VLAP group and P < 0.0001 in the ILCP and TURP groups), Qmax (P < 0.001 in the VLAP and ILCP groups, and P < 0.0001 in the TURP group), residual urine volume (P < 0.01 in the VLAP group and P < 0.0001 in the ILCP and TURP groups). Significant reduction of the prostatic volume was recorded only in the ILCP and TURP groups (P < 0.001).

Conclusion: Visual laser ablation and ILCP can be good alternative treatments for BPH. Visual laser ablation provides good outcomes in patients with small‐sized BPH and with risk factors such as heart disease or anticoagulation therapy.
Parapelvic neurofibroma of the kidney
Authors: Nishiyama Tsutomu , Ikarashi Toshihiko , Terunuma Masahiro
Published: March 2003

Abstract We report the first case of neurofibroma causing obstruction by external compression of the upper renal pelvis. A 33‐year‐old woman reported a 1‐year history of dull lumbar pain on the right side. A right renal parapelvic cyst was suspected. The patient underwent retroperitoneoscopic exploration. The right renal parapelvic lesion was identified as a soft tissue tumor. The tumor was removed with a retroperitoneoscopic procedure. Histopathological findings revealed neurofibroma.