bluuebunny/crossref_metadata_2025 huggingface dataset:
Identifying outstanding clinical nurses: The ‘Star’ shines in oncology
Authors: Kendall Sharon Frances
Published: March 2003

Abstract There are some oncology nurses who are special. They are ‘good’ nurses but they are more, somehow they ‘shine’. They are ‘stars’. Many nurses will identify the same nurse as a ‘star’ but what makes a nurse a ‘star’? Twelve semistructured interviews were conducted in which oncology nurses were asked to describe an oncology nurse who stood out in terms of clinical practice. The ‘star’ nurse was easily and readily recalled and described by participants. Analysis revealed 21 grouped themes relating to the ‘star’ nurse. Each theme was allocated to one of four headings: ‘Nurses’ ways of Being; Doing; Knowing; and Giving and Receiving’ (
Stiles, 1990). The ‘star’ nurse is professional, committed and caring; delivers excellent nursing care both basic and technical; is knowledgeable; has advanced communication skills, and establishes strong relationships with clients and peers. From this, it is clear that caring and psycho‐social aspects of care are only part of the make up of the ‘star’ nurse, and that the complexity of the ‘star’ nurse has not been highlighted in the literature.
Participation in change: Self‐reflection of staff in a psychiatric admission unit
Authors: Lepola Irja , Blom‐Lange Marja
Published: March 2003

This paper reports on a comprehensive nursing research and development project carried out in the psychiatric admission unit of The Mental Hospital, Keropudas, Finland. The purpose of the project was to plan, implement and evaluate the functioning of the ward in order to orient it more towards patient‐centered practices. This study was an action research project, the methodological foundations of which were based on the action theory and dialectics. This article reports on the staff’s written essays based on self‐reflection concerning the orientation of action towards change. The essays were analyzed using the method of continuous comparison. This analysis yielded a conceptual outline of how the orientation of action towards change manifested itself in the internal regulation of the ward staff. The main category of data to result from selective coding was participation in change. Participation was enthusiastic, hesitant or withdrawn.
Integrated quality improvement program in patient care
Authors: Navuluri Ramesh B.
Published: March 2003

Quality improvement in nursing is paramount among the factors contributing to an institution’s survival and growth. The demand by patients, families, insurance payers, and health professionals for quality in patient care is ever increasing. A review of the literature revealed that existing programs that ensure and monitor quality of care are group‐specific based on diagnosis‐related groups, time‐specific as in care maps and critical pathways, focused on outcomes only, or are not comprehensive by ignoring ‘little things’. Hence, there is a need for a comprehensive, continuous, individual patient‐specific, multidisciplinary quality improvement program. To fulfill the need, an integrated quality improvement program (IQIP) is formulated, and a quality monitor format (QMF) is devised. The QMF is planned by the staff nurses for each patient, and includes patient care standards, patient care by other departments, and ‘little things’ like ice water and noise control which have a significance to patients and families. The QMF is maintained from admission to discharge of each patient, non‐conformances are analyzed, and problem solving to improve quality is made continually at unit and institution levels. Committed implementation of IQIP ensures delivery of quality care, enhances satisfaction of patients and families, satisfies government regulations, and provides meaning to the efforts of nurses, education, management, and research.
Factors influencing the retention and turnover intentions of registered nurses in a Singapore hospital
Authors: Chan Ee‐Yuee , Morrison Paul
Published: March 2003

Abstract The rapid growth in Singapore's health‐care industry, coupled with an aging population has led to an acute shortage of nurses. Given the difficulty of recruiting new nurses, it is imperative to retain those already in the profession. This descriptive study explored some demographic and work‐related factors which influenced the retention and turnover intentions of Registered Nurses (RN) in a major hospital in Singapore. Using convenience sampling, 120 respondents were selected. An anonymous self‐reported questionnaire was used. Results showed that demographically, stayers and leavers differed in terms of experience as RN, specialty qualifications and practice area. A majority of the respondents gave reasons pertaining to nursing practice for both staying and leaving. Many leavers also mentioned reasons such as inadequacy of staffing, poor salary and welfare as primary influences on their intention to leave. Recommendations for management were made to assist in the retention of these RN in the future.
Nurses' support: Essential factor for the good compliance of adolescents with asthma
Authors: Kyngäs Helvi A.
Published: March 2003

Abstract The purpose of the present study was to identify the factors that predict compliance with health regimens by adolescents with asthma. The data were collected by using questionnaires. Three hundred individuals aged 13–17 years were randomly selected from the Finnish Social Insurance Institution's register. Every fifteenth person on the list was included in the sample. Eighty‐eight percent of the selected adolescents (n = 266) returned questionnaires. The data were analyzed using the SPSS (Statistical Package for the Social Sciences) for Windows software package. Logistic regression was used to find the factors that predict compliance with health regimens. The compliance of adolescents with asthma was predicted on the basis of support from nurses, motivation, energy and willpower as well as no fears of complications. The most powerful predictor was support from nurses. The likelihood of the adolescents supported by nurses to comply with health regimens was 56.88‐fold compared with the adolescents who did not receive support from nurses. Another powerful predictor was motivation. The adolescents who had motivation to take care of themselves complied with health regimens with a 10.7‐fold likelihood compared to the adolescents who did not have motivation. Also, the adolescents who had energy and willpower were 10.43‐fold more likely to comply than adolescents who did not have energy and willpower. No fear of complications also predicted good compliance with health regimens.
The Use of Interdisciplinary Teams and Evidence‐Based Practice
Authors: Verklan M. Terese
Published: March 2003

28–29 March 2000 Yamaguchi University School of Medicine, Ube, Japan (Local Organizers: Junko Yoneda and Susumu Tomonaga, Yamaguchi University)
Family Caregiver Research: Multidisciplinary Approaches to Reduce Family Stress
Authors: Ostwald Sharon K.
Published: March 2003

28–29 March 2000 Yamaguchi University School of Medicine, Ube, Japan (Local Organizers: Junko Yoneda and Susumu Tomonaga, Yamaguchi University)
Development of Health Promotion Program for Elderly in Rural Communities
Authors: Tantayotai Valla , Noonin Naiyana , Konggumnerd Roumporn , Suwanno Jom
Published: March 2003

28–29 March 2000 Yamaguchi University School of Medicine, Ube, Japan (Local Organizers: Junko Yoneda and Susumu Tomonaga, Yamaguchi University)
Comforting Touch Relieves Muscular Strain during Upper Gastrointestinal Endoscopy
Authors: Yoneda Junko , Yoshimura Mari , Harada Noriaki , Yamauchi Toyoaki
Published: March 2003

28–29 March 2000 Yamaguchi University School of Medicine, Ube, Japan (Local Organizers: Junko Yoneda and Susumu Tomonaga, Yamaguchi University)
Improving Quality of Life for Elders: Resident Satisfaction with Nursing Home
Authors: Oh Heeyoung Lee , Ryden Muriel , Snyder Mariah
Published: March 2003

28–29 March 2000 Yamaguchi University School of Medicine, Ube, Japan (Local Organizers: Junko Yoneda and Susumu Tomonaga, Yamaguchi University)
Complementary therapy use by nursing, pharmacy and biomedical science students
Authors: Wilkinson Jenny M. , Simpson Maree D.
Published: March 2003

Abstract Attitudes towards the use of complementary therapies by students of undergraduate Bachelor of Nursing, Pharmacy and Biomedical Sciences were determined using a self‐administered questionnaire. Overall, 78% of students had used a complementary therapy in the past year and 56% had visited a complementary therapy practitioner. The therapies most used were those involving vitamins, mineral and other supplements. Practitioners specializing in this area were the most visited, followed by chiropractors. Commonly used products included vitamin C, multivitamins, B group vitamins, garlic, iron and echinacea. Most students thought complementary therapies improved quality of life, with friends and family providing the main sources of information. There were few differences attributable to course or gender. The results suggest that these students have favorable attitudes towards complementary therapies and that many choose to use them as part of normal health care.
Australian hospital generalist and critical care nurses' perceptions of doctor–nurse collaboration
Authors: Chaboyer Wendy P. , Patterson Elizabeth
Published: March 2003

Abstract Previous researchers have indicated that collaborative practice between doctors and nurses results in positive effects on patient care, health‐care costs and provider satisfaction. Despite these benefits, collaborative practice appears to be the exception, rather than the dominant pattern, within health care. A collaborative relationship cannot evolve if individuals do not value and respect others' competencies. This study, a mailed survey, used the Collaboration with Medical Staff Scale to compare the perceptions of doctor–nurse collaboration held by critical care nurses and generalist hospital nurses. The hypothesis that critical care nurses perceive there to be greater collaboration with doctors than their generalist nurse colleagues was supported even after taking into consideration education and experience. These results suggest that critical care is an area that might be useful when trying to understand the dimensions and implications of collaboration among health professionals.
Genetic education in baccalaureate and associate degree nursing programs in Japan
Authors: Iino Hidechika , Tsukahara Masato , Murakami Kyoko , Lambert Vickie A. , Lambert Clinton E. , Tsujino Kumiko
Published: March 2003

Abstract The purpose of the present study was to ascertain the amount and type of genetic content in basic nursing education programs in Japan baccalaureate degree (BSN) and associate degree (ADN), and to describe the qualifications of faculty members teaching the genetics content. A questionnaire was used to examine these. The sample was derived from 66 basic nursing preparatory programs. Faculty members from 34 out of 75 (44.7%) of the BSN programs and 32 out of 52 (61.5%) of the ADN programs returned completed surveys, providing a total response rate of 52%. As a result of the analysis of the survey data, the researchers recommend increasing the amount of genetic content, related to nursing practice, in the curriculum of Japanese baccalaureate and associate degree nursing programs. In addition, the researchers recommend increasing the number of nursing faculty specialising in genetics. Japanese nursing education must incorporate genetic knowledge into the curricula to produce professionals who are prepared to practise in the current and future genetic health care arena.
Perception of Aging and Quality of Life in Modern Japanese Community
Authors: Hattori Keiko , Matsuda Masako , Yoneda Junko
Published: March 2003

The number of aged people in Japan has risen dramatically. There were 21 million elderly people in 1999, which accounted for 16.7% of the population. By comparison, the number of juveniles (0–14 years) has decreased by 316 000 annually and the working population (15–64 years) has decreased by 160 000 annually. It is estimated that 25% of the population in Japan will be over 65 years of age by 2020. Although the Japanese government has taken new measures (i.e. nursing care insurance) to address this rapid increase of elderly people, the rising number of aged has been perceived, by the younger generation, as being overwhelming. This study examined the modern Japanese perception of aging and quality of life (QOL). A semistructured interview was done with 22 healthy adults. Three men and three women were randomly selected from four age groups: 40–49 years, 50–59 years, 60–69 years, and 70 years and over. Keyword s were abstracted by way of interviews. The Short Form‐36 Health Survey (SF‐36) was used to assess QOL. The SF‐36 contains 36 questions that measure the health status for the eight parameters: physical functioning, mental health, role‐physical, role‐emotional, bodily pain, general health perception, vitality, and social functioning.
Study of Gerontological Nursing Curriculum
Authors: Chon S.J. , Ahn S.Y. , Cho M.O. , Cho N.O. , Choi K.S. , Kim C.H. , Kim C.K. , Kim H.K. , Kim G.B. , Kim N.C. , Kong E.S. , Lee K.J. , Lee Y.W. , Ro Y.J. , Shin K.R. , Song M.S.
Published: March 2003

The purpose of this study was: (i) to survey the present status of the gerontological nursing course in 3‐year diploma programs, baccalaureate degree programs (BSN), and graduate programs in Korea; and (ii) to analyze the contents of the syllabus, credits, clinical practise, and gerontological nursing textbooks used within these programs, so as to provide basic data for developing a standard model for a gerontological nursing curriculum. Primary data were collected from all the nursing programs in Korea, from November 2000 to February 2001, by way of mail and fax. Data on the detailed contents of the gerontological nursing curriculum were collected from those programs that had a gerontological nursing course. The results of the study revealed that 36 diploma programs (58%), 40 BSN (80%), and 17 graduate programs (63%) offered gerontological nursing courses. The credits of the gerontological nursing course offered, by program, were found to be: one credit (10 diploma programs, eight BSN programs), two credits (22 diploma programs, 29 BSN programs) and three credits (one BSN program). The gerontological nursing courses were found to be taught mostly by adult health nursing professors. The contents of gerontological nursing curricula were analyzed by comparison with the core curriculum of NGNA. The majority of the nursing schools were found to include the following: gerontological nursing in general; theory of aging; aging processes; care plan options; and common health problems. Legal/ethical issues; evaluation; regulatory and reimbursement issues; education issues; nursing research in gerontology; and environment issues of older adults were not covered in most of the programs. Differences were noted between ADN, BSN, and graduate school curricula. However, similar curriculum contents were found among the undergraduate programs, suggesting that these curricula used gerontological nursing textbooks as references.
Experience of Postmenopausal Women of Hormone Replacement Therapy
Authors: Lee Hea‐Sook , Choi Kyung‐Sook
Published: March 2003

Goal:  The purpose of this study was to examine and describe women's physical and psychological changes after a trial of hormone replacement therapy (HRT), so as to be able to provide accurate information about HRT to women who are preparing to undergo HRT.

Methods:  The study sample consisted of 10 women who were taking hormones for treatment of postmenopausal symptoms. Data were collected from September 2000 to March 2001. Interviews were recorded and transferred to written documents. The analysis of the data used the methodology described by Giogi.

Results:  The subjects reported that taking HRT was an excellent choice for enhancing their quality of life during menopause because they felt younger and healthier, although they expressed concern about unexpected side‐effects, after their HRT. They felt that such effects could be prevented through regular check‐ups. The participants recommended that all postmenopausal women take HRT because they believed the benefit of HRT was greater than its harmfulness. The subjects also suggested that postmenopausal women need to be educated about the physical and psychological symptoms that they feel during menopause and about how to manage the symptoms. It was concluded that accurate information about the relationship between HRT and the quality of life should be provided to postmenopausal women, in addition to providing educational programs on postmenopausal management to postmenopausal women.
Actual Conditions and Countermeasure of Yun‐bian Old Men's Health
Authors: Lee Chun‐Ok
Published: March 2003

The purpose of this study was to investigate how the aging problem in China was reflected in Yun‐bian, an area where the Korean‐Chinese converge, and to forecast future aging issues. The findings of this study revealed that 60% of the elderly identified themselves as healthy or normal, while 30.8% of them identified themselves as having a disease. Over 80% (80.6%) of the population who had an illness were elderly. The most prevalent diseases were hypertension, angina pectoris, arthritis, cerebral thrombosis, and digestive and respiratory disease. The leading causes of death were cerebrovascular disorders, accidents, malignant tumors, and heart disease. Among the Yun‐bian elderly, 68.8% were found to be cared for by their families, with 30.8% of them living with their offspring. Only 0.45% of the Yun‐bian elderly were found to be living in social welfare centers. The medical treatment services provided were either community‐centered or hospital‐centered. It was concluded that reinforcement for administration and organization of the health‐care services, policy development regarding medical insurance for the aged, professional health‐care provider education for the elderly, and health‐care program development for the elderly are needed.
Vesicoureteral reflux in a boy presenting with difficulty in walking
Authors: Matsumoto Seiji , Hara Yasushi , Esa Atsunobu , Matsuura Takeshi , Kurita Takashi
Published: March 2003

Background: We report an uncommon case who presented himself at our hospital with main complaints of high fever and difficulty in walking due to pain on extension of his right lower extremity.

Methods: He was diagnosed, through investigation of his urinary tract, as having secondary psoas pyomyositis spread from acute pyelonephritis caused by vesicoureteral reflux.

Results: He was successfully managed firstly by antibiotic therapy, followed by the correction of reflux by ureteroneovesicostomy.
Recurrent bladder adenocarcinoma in an ileal conduit stoma: A case report
Authors: Inobe Takuji , Kanda Kazuya , Murakami Yoshihide , Tsuji Masahito , Tamura Masato , Kagawa Susumu
Published: March 2003

Background
: The first case of a patient with recurrent adenocarcinoma in an ileal conduit stoma 7 months after radical cystectomy is reported.

Results/Discussion
: The most likely explanation of this case is hematogenous metastasis based on the clinical diagnosis and the pathological immunostaining examination of cytokeratin.
Common sheath reimplantation with ureteral plication: A useful technique for the management of ectopic ureterocele
Authors: Yamazaki Yuichiro , Setoguchi Kiyoshi , Yago Rie , Suzuki Mari , Toma Hiroshi
Published: March 2003

Abstract
Background
: When salvaging the upper pole kidney in duplex ectopic ureterocele, primary bladder level surgery with common sheath ureteral reimplantation has the definite advantage of allowing the reconstruction of the entire collecting system through a single lower abdominal incision. However, there are several complications associated with a common sheath reimplantation in a child with a very dilated upper pole ureter, such as vesicoureteral reflux or ureterovesical stenosis.

Methods/Results
: To avoid these complications, ureteral plication over the common ureteral sheath in two children with duplex ectopic ureterocele was used. Postoperatively, neither child showed reflux or recurrent urinary tract infection and both showed a marked improvement of the upper pole collecting system.

Conclusion
: This technique allows for a simple and definitive reconstruction in cases of duplex ectopic ureterocele, particularly with dilated upper pole ureter.
Urinary undiversion for pelvic actinomycosis: A long‐term follow up
Authors: MAEDA HIROSHI , SHICHIRI YASUMASA , KINOSHITA HIDEHUMI , OKUBO KAZUTOSHI , OKADA TAKASHI , AOKI YOSHITAKA , MAEKAWA SHINYA , ARAI YOICHI
Published: March 2003

Background: A 43‐year‐old woman who had been using intrauterine contraceptive devices for the past 10 years underwent an emergency operation for bowel and urinary obstruction.

Methods/Results: Frozen section analysis showed undifferentiated adenocarcinoma. Incomplete tumorectomy, ileal resection, partial cystectomy, colostomy and bilateral ureterocutaneostomy were palliatively performed. Postoperatively, periodic acid‐Schiff and Grocott–Gomori methenamine tests revealed Actinomyces and the final diagnosis was pelvic actinomycosis. Treatment with penicillin G administered intravenously relieved her symptoms and the lesion was dramatically improved. The patient underwent colostomy closure and urinary undiversion.

Conclusions: Five years after urinary undiversion, the patient’s renal function has been maintained and she can void without incontinence and dysuria.
Erectile function and nocturnal penile tumescence in patients with prostate cancer undergoing luteinizing hormone‐releasing hormone agonist therapy
Authors: Marumo Ken , Baba Shiro , Murai Masaru
Published: March 2003

Background: Luteinizing hormone‐releasing hormone (LHRH) agonists have been widely used as effective agents in endocrine therapy for prostate cancer. Continuous administration of the drug results in profound suppression of testicular androgen production. However, the side effects on erectile function have not been fully investigated.

Methods: We studied the influences of testosterone suppression on male sexual function and nocturnal penile tumescence in nine sexually active patients with prostate cancer who were treated with an LHRH agonist.

Results: Following reduction of serum testosterone concentrations to a castration level by the administration of the LHRH agonist, sexual desire, sexual interest and sexual intercourse were totally annulled, with significant changes in frequency, magnitude, duration and rigidity of nocturnal erections observed in all patients.

Conclusions: These results demonstrate that the LHRH agonist strongly suppresses erectile function and sexual activity. Taking into account the quality of sexual function for relatively young and sexually active patients and their partners, it is necessary to establish effective modalities that minimize the adverse effects on sexual function for the treatment of patients with prostate cancer.
Severe rhabdomyolysis as a complication of high‐dose chemotherapy in a patient with advanced testicular cancer
Authors: Hoshi Senji , Itoh Akihiro , Kato Shinnosuke , Suzuki Kenichi , Kawamura Sadafumi , Orikasa Seiichi
Published: March 2003

Background: A 38‐year‐old man was diagnosed with choriocarcinoma in the left testis, a 9 cm retroperitoneal tumor, left hydronephrosis, multiple lung metastasis and gynecomastia. His serum hCG level decreased but was still above the normal range after four courses of standard chemotherapy.

Methods: High‐dose chemotherapy was then given with ICE (ifosfamide, carboplatin, etoposide) from days −7 to −3.

Results/Discussion: On day −2 the patient became confused and hallucinated, so the sedatives haloperidol and flunitrazepam were administrated. His creatinine phosphokinase levels increased to 6150 IU/L (reference range <197 IU/L) on day 0. Myoglobinuria and myoglobinemia were noted and the renal dysfunction progressed. A peripheral blood stem cell transplantation was performed after hemodialysis on day 0. Although his bone marrow recovered, the patient died of respiratory failure on day 18. An autopsy revealed massive pulmonary bleeding. Pretreatment renal dysfunction, renal damage by high‐dose chemotherapy, ifosfamide‐induced hallucinations and the administration of sedatives, such as haloperidol and flunitrazepam, may have been causative factors for the rhabdomyolysis observed in this patient.
Outcome of precise vesicourethral anastomosis following retropubic radical prostatectomy using a Foley catheter
Authors: FUJISAWA MASATO , HIGUCHI AKIHIRO , GOTOH AKINOBU , MATSUI TAKASHI , HARA ISAO , GOHJI KAZUO , OKADA HIROSHI , ARAKAWA SOICHI , KAMIDONO SADAO
Published: March 2003

Purpose: In order to evaluate precise anastomosis using a Foley catheter, complications following radical retropubic prostatectomy were examined.

Methods: Twenty‐one patients underwent radical retropubic prostatectomy. Precise vesicourethral anastomosis was performed, visualizing the urethral stump by raising up the urogenital diaphragm using a Foley catheter. Complications, such as prolonged urinary extravasation and temporary urinary retention, were checked when the catheter was removed. Incontinence was evaluated both within 6 weeks and more than 6 weeks after operation. Anastomotic and urethral strictures were also checked during follow up.

Results: The follow‐up period ranged from 4 to 47 months (mean (Â± SD) 22.0 Â± 12.1 months). Eighteen of 21 patients (85.7%) achieved continence after the operation. However, two patients still had stress incontinence and one patient had mild incontinence. Neither prolonged urinary extravasation nor temporally urinary retention were observed. Anastomotic and urethral stricture were not experienced during follow up.

Conclusions: Precise anastomosis using a Foley catheter is technically easy and useful, even for relatively inexperienced urologists, to perform. Patients can often achieve continence following this procedure.
Analysis of prognostic factors related to primary superficial bladder cancer tumor recurrence in prophylactic intravesical epirubicin therapy
Authors: Kondo Tsunenori , Onitsuka Shiro , Ryoji Osamu , Kihara Takeshi , Goto Yukiko , Satoh Toshihiko , Nakazawa Hayakazu , Toma Hiroshi
Published: March 2003

Purpose: The aims of the present study were to examine the effects of intravesical instillation of epirubicin on tumor recurrence and to identify tumors that are at a high risk of recurrence.

Methods: Forty‐five patients with primary superficial bladder cancer were treated with prophylactic intravesical epirubicin following transurethral resection of the bladder tumor (TUR‐BT). Epirubicin (20 mg) was administered intravesically every second week for 4 months and then once a month or every 2 weeks for next 8 months. Patients were analyzed with respect to prognostic factors related to tumor recurrence.

Results: The overall recurrence‐free rate, calculated using the Kaplan–Meier method, was 76.1 and 52.3% at 2 and 5 years after operation, respectively. These results were better than those reported for patients treated with TUR‐BT alone. A univariate analysis demonstrated that high‐grade, T1, sessile, large (≥ 2 cm) and multiple tumors were a significantly high risk for recurrence. A multivariate analysis performed by using the Cox proportional hazard model with stepwise selection showed that morphologic features (pedunculated or sessile) were the most prognostic factors for recurrence. This was followed by age and tumor size. The remaining four factors were not found to contribute significantly to recurrence.

Conclusions: Epirubicin appears to be effective in preventing the recurrence of superficial bladder cancer. Morphologic features, patient age and size of the tumor were considered independent risk factors. The risk of recurrence for each tumor should be taken into consideration when the intravesical adjuvant therapy protocol is being selected.
Telomerase activity in human renal cell carcinoma
Authors: Fujioka Tomoaki , Hasegawa Michihiko , Suzuki Yasushi , Suzuki Tohru , Sugimura Jun , Tanji Susumu , Koike Hiroyuki
Published: March 2003

Purpose
: Telomerase activity has been detected in a wide variety of human tumors. The present study evaluated telomerase activity in association with the acquisition of renal cell carcinoma (RCC).

Methods
: Telomerase activity was examined in 30 RCC and the adjacent normal kidney tissue, obtained as surgical specimens. The activity was assayed by polymerase chain reaction‐based telomeric repeat amplification protocol assay.

Results
: Among the 30 RCC, 18 (60%) displayed telomerase activity, whereas none of the normal tissue samples exhibited it. Subdivision of the tumors according to telomerase activity did not reveal any obvious difference in distribution with regard to tumor size, stage, histocytological subtype, or DNA‐ploidy. However, a statistically significant relationship was found between the frequency of telomerase‐positive activity and both serum immunosuppressive acidic protein level in the patient and tumor grade (P < 0.05). There was no significant difference in the recurrent‐free survival and the disease‐specific survival between patients with positive telomerase activity and patients with negative activity.

Conclusion
: The present results indicate that telomerase activity might be related to the progression of RCC and thus a marker of malignant potential.
A case of eosinophilic cystitis in a 5‐year‐old boy
Authors: Sano Katsuyuki , Terashima Kazumitsu , Gotoh Kazuko , Ijiri Rieko , Tanaka Yukichi
Published: March 2003

Eosinophilic cystitis (EC) is rather an uncommon disease in childhood. A case of EC in a 5‐year‐old boy, in which open biopsy was needed for final diagnosis, is reported. After diagnosis, he was treated with pemirolast potassium followed‐up with eosinophil cationic protein (ECP) in serum and urine. Eosinophil cationic protein is an appropriate marker of EC.
Acute renal failure occurring from urinary retention due to a müllerian duct cyst
Authors: Abe Takashige , Shinno Yuichiro , Kawakura Koichi , Moriya Kimihiko
Published: March 2003

A patient with a müllerian duct cyst, which caused acute renal failure secondary to urinary retention, is reported. The case was treated successfully by transurethral unroofing of the cyst.
Cystic renal cell carcinoma diagnosed by cystofiberscopy
Authors: Ikegaya H , Kato A , Matsushima H , Takai K , Hosaka Y , Kitamura T
Published: March 2003

A 64‐year‐old man suffered from hypertensive syncope and was admitted to Branch Hospital, Faculty of Medicine, The University of Tokyo. On admission he had no symptoms; however, two renal cysts of about 5 cm in diameter were found in his left kidney. Cystofiberscopy with a thin optical fiberscope was performed in addition to puncture and cystography. Cytology revealed class I, but the wall surface of the lower cyst was uneven, fluid‐filled, colloid‐like and white‐gray compared with that seen in the upper cyst. It was diagnosed as renal cell carcinoma (RCC) and left nephrectomy was performed (5 cm in diameter, RCC, papillary tubular, common, clear cell subtype, G2 > G1, INF beta, pT2, pMx, pV0, ew(–)).
Telomerase activity in urine after transurethral resection of superficial bladder cancer and early recurrence
Authors: Wu Xiu‐Xian , Kakehi Yoshiyuki , Takahashi Takeshi , Habuchi Tomonori , Ogawa Osamu
Published: March 2003

Background
: To explore the relationship between telomerase activity in urine after transurethral resection (TUR) of superficial bladder cancer and early intravesical recurrence.

Methods
: Urine samples were obtained from 42 patients with superficial bladder cancers prior to TUR and on the postoperative day 1 and day 6. These patients were followed‐up prospectively by cystoscopy at 3 and 6 months after TUR in combination with urinary cytology and telomerase activity. Telomerase activity in the urine was assessed by the telomeric repeat amplification protocol assay.

Results
: Urinary telomerase activity prior to TUR was positive in 24 (57%) of the 42 patients. On the postoperative day 1 and day 6, positive urinary telomerase activity was seen in 13 (31%) and nine (21%) patients, respectively. Postoperative urinary telomerase activity on either day 1 or day 6 was significantly associated with pre‐operative urinary telomerase activity status (P = 0.0024). Fifteen patients showed intravesical tumor recurrence at 3 months cystoscopic check‐up and an additional nine had recurred at the 6 months check‐up. Recurrence rate within 6 months in patients with pre‐operative positive urinary telomerase activity was similar to that in those with negative activity (58.3 vs 58.8%). However, recurrence rate at 3 months for patients with positive activity was higher than that of those with negative activity (50 vs 17.7%), in 23 patients treated only by TUR.

Conclusions
: Presence of cells positive for telomerase activity in urine after TUR of superficial bladder cancer indicates persistently existing cancer cells in the urine. It is, however, not a sole predictor of the early intravesical recurrence.
Trends and characteristics in prostate cancer mortality in Japan
Authors: Nakata Seiji , Takahashi Hirotomo , Ohtake Nobuaki , Takei Tomoyuki , Yamanaka Hidetoshi
Published: March 2003

Background
: In North America, the incidence and mortality of prostate cancer has been declining since the early 1990s. We calculated the age‐adjusted death rates, age‐specific death rates and standardized mortality ratio (SMR) for prostate cancer in Japan and analyzed their features.

Methods
: Yearly age‐adjusted death rates for prostate cancer were calculated by dividing the number of events by the population at risk, with direct standardization to the world population. Age‐specific death rates were calculated for the 1970s, 1980s and 1990s and which age group showed the highest rate of increase was examined. The SMR in each prefecture was also calculated for each period.

Results
: The respective number of deaths and the age‐adjusted death rate was 1107 and 2.29 in 1973 and 6251 and 5.15 in 1997. The age‐specific death rates showed an exponential increase with age in all three periods and the rate of increase was higher in older age groups. The distribution of SMR showed the same tendency in all three periods. The prefectures with significantly high or low SMR were distributed in clusters.

Conclusions
: The prostate cancer death rate is increasing rapidly in Japan. However, the age‐adjusted death rate has remained stable from 1996 to 1997. How this figure will change and whether the prostate cancer death rate in Japan will begin to decline, like in North America, is of interest. The prefectures with significantly high or low SMR showed a characteristic clustered distribution pattern.
Prediction of organ‐confined disease by prostate‐specific antigen nadir after neoadjuvant therapy
Authors: Hachiya Takahiko , Minei Sadatsugu , Kobayashi Ken‐Ichirou , Ishida Hajime , Okada Kiyoki
Published: March 2003

Abstract Background It is not clear whether or not serum prostate‐specific antigen (PSA) levels after androgen deprivation prior to radical prostatectomy (neoadjuvant therapy) have any value in the prediction of the final pathologic stage.

Methods We conducted a study on 49 patients who underwent retropubic radical prostatectomy following neoadjuvant therapy for clinical stage T1c, T2, and T3a prostate cancer. We evaluated progression‐free survival based on the PSA failure rate and the predictive value of the PSA nadir after neoadjuvant therapy and other clinical factors to determine the most important predictor of organ confinement.

Results Of the 49 patients, 30 had organ‐confined disease. Of 31 patients without adjuvant therapy after surgery, the PSA failure‐free rates at 2 years were 81.6 and 34.3% in the subset of organ‐confined disease and non‐organ‐confined disease, respectively (P = 0.0031). Of the 18 patients with adjuvant androgen deprivation therapy after surgery, the PSA failure‐free rate at 2 years was 100% and 59.7% in patients with organ‐confined disease and non‐organ‐confined disease, respectively. Baseline PSA (P = 0.037), PSA nadir (P < 0.0001) and PSA density (P = 0.003) significantly correlated with organ confinement. Multivariate logistic regression analysis revealed that the PSA nadir was the only independent predictor of organ confinement (P = 0.044).

Conclusions There was a trend that the patients with non organ‐confined disease had a higher probability of PSA failure than did the patients with organ‐confined disease. The PSA nadir after neoadjuvant therapy was the strongest predictor of organ confinement. The predictive value of the serum PSA nadir should be validated in well‐designed larger population‐based studies.
Prostate cancer with multiple lung metastases in a hemodialysis patient
Authors: Hayakawa Kunihiro , Matsumoto Mayuko , Aoyagi Teiichiro , Miyaji Keisuke , Hata Makoto
Published: March 2003

Abstract In hemodialysis patients, few cases of prostate cancer have been reported until recently. We present a case of prostate cancer with multiple lung metastases in a chronic hemodialysis patient. A 65‐year‐old Japanese man who had maintained hemodialysis for 5 years was referred to our hospital with multiple metastatic lung tumors. Serum prostate tumor markers were highly elevated although his plasma testosterone level was within the normal range. A transrectal needle prostate biopsy confirmed a histologic diagnosis of moderately differentiated adenocarcinoma. Androgen blockade therapy was very effective as evidenced by a quick decrease of serum tumor markers. The follow‐up computed tomography scan of the chest performed 3 months later showed a complete disappearance of the coin lesions. The early detection of prostate cancer in hemodialysis patients is difficult because of a lack of urologic symptoms, which indicate the importance of periodic screening by serum tumor markers. Combined androgen blockade is effective even in hemodialysis patients. However, close follow up is necessary because long‐term results and prognoses are still unknown.
Repair of a fistula between the bladder and the perineal skin by femoral gracilis flap interposition
Authors: Osawa Shuichi , Nishimura Taiji , Akimoto Masataka , Abe Hiroyuki , Hamasaki Tsutomu , Kuroda Shuichi
Published: March 2003

Abstract The successful repair of a fistula between the bladder and the perineal skin using a femoral gracilis flap is reported. A 70‐year‐old woman, who 10 years previously had undergone a total hysterectomy for uterine cancer, developed a fistula between the bladder and the perineal skin after she underwent Mile's operation for rectal cancer. Initially, an attempt was made to repair the fistula by the transabdominal approach. This failed, probably because of the lack of supporting tissue between the bladder and the perineal skin. The second repair was performed with plastic surgeons. A secure three‐layer bladder closure was accomplished. A right femoral gracilis flap was developed and rotated 180° to fill the defect in the skin and subcutaneous tissue. Four weeks after surgery, cystography revealed no fistula or urinary leakage and the drainage catheter was removed. Femoral gracilis flap interposition was successful for repair of a fistula between the bladder and the perineal skin when there was no supporting tissue due to extensive exenteration in the surgical removal of rectal cancer and after other repair procedures had been unsuccessful.
Renal angiomyolipoma associated with micronodular pneumocyte hyperplasia of the lung with tuberous sclerosis
Authors: Matsumoto Seiji , Nishioka Tsukasa , Akiyama Takahiro
Published: March 2003

Abstract Tuberous sclerosis complex is an autosomal‐dominant disorder characterized by the triad of mental retardation, epilepsy and adenoma sebaceum. Micronodular pneumocyte hyperplasia is a rare but distinctive pulmonary epithelial lesion, usually associated with tuberous sclerosis. To the authors' knowledge, the relationship between renal angiomyolipoma and micronodular pneumocyte hyperplasia in cases of tuberous sclerosis has not received attention in the urological literature. The case of a woman with renal angiomyolipomas associated with micronodular pneumocyte hyperplasia of the lung with tuberous sclerosis is reported here.
Secondary amyloidosis of the bladder causing macroscopic hematuria
Authors: Oka Natsuo , Fukumori Tomoharu , Takahashi Masayuki , Kanayama Hiro‐Omi , Kagawa Susumu
Published: March 2003

Bladder involvement in amyloidosis is unusual. The case of an 80‐year‐old man with macroscopic hematuria caused by secondary amyloidosis of the bladder is described. Cystoscopic examination revealed only a diffuse edematous area and bleeding. No tumor‐like lesions were identified. Transurethral biopsy revealed amyloid deposits. Macroscopic hematuria disappeared spontaneously after cystoscopy and bladder biopsy. The patient has been followed up without treatment and is currently free of symptoms.
Adrenal hemangioma removed by a retroperitoneoscopic procedure
Authors: Yagisawa Takashi , Amano Hiroyuki , Ito Fumio , Horita Shigeru , Yamaguchi Yutaka , Toma Hiroshi
Published: March 2003

Abstract Only about 50 surgical cases of adrenal hemangioma have been reported in the literature. Presented here is the first case of a large adrenal hemangioma that was removed by a retroperitoneoscopic procedure.
Primary signet ring cell carcinoma of female urethra
Authors: Suzuki Kazumi , Morita Tatsuo , Tokue Akihiko
Published: March 2003

Abstract A 69‐year‐old woman presented with difficulty in urination and bloody fluid discharge from the urethra. Based upon a diagnosis of primary urethral carcinoma, she underwent total cysto‐urethrectomy and hysterectomy with pelvic lymph node dissection and urinary diversion of ileal conduit. Microscopically, the tumor was composed of mucinous adenocarcinoma and signet ring cell carcinoma. There was no recurrence 17 months after the surgery.
Renal arteriovenous fistula developing after tumor enucleation using a microwave tissue coagulator
Authors: Akiyama Tatsuya , Samma Shoji , Fujimoto Ken , Fukui Yoshihisa , Hirayama Akihide
Published: March 2003

Abstract With the increase in detection of incidental renal cell carcinoma, nephron‐sparing surgery for small renal cell carcinomas is now recognized as one of the surgical options. We report a case of renal arteriovenous fistula developing after non‐ischemic tumor enucleation of a small renal cell carcinoma using a microwave tissue coagulator. A 50‐year‐old Japanese man presented with right flank pain and gross hematuria. The patient had undergone non‐ischemic tumor enucleation for right renal cell carcinoma, 2 cm in diameter, 1 month previously. Doppler ultrasound revealed the formation of an arteriovenous fistula at the enucleated portion. Transcatheter super‐selective occlusion of the feeding artery was successfully performed with two metallic coils. The patient has been followed up with no sign of recanalization of the fistula. In this case, the tumor was located close to the renal hilus with thick arterial branches around the tumor. Additional microwave coagulations against arterial bleeding from the cutting surface might have been the cause of the fistula formation of this case. Non‐ischemic tumor enucleation using a microwave tissue coagulator is a relatively easy and secure nephron‐sparing surgical procedure. Excessive coagulation, however, should be avoided, since it might be the cause of unexpected postoperative vascular complications.
Retroperitoneal cystic metastasis from a small clear cell renal carcinoma
Authors: Ishii Nobuyuki , Yonese Junji , Tsukamoto Tetsurou , Maezawa Takuya , Ishikawa Yuuichi , Fukui Iwao
Published: March 2003

A 39‐year‐old housewife was referred to our hospital for the treatment of a small renal tumor. A 25 × 35 mm cystic mass that had been detected by computerized tomography scan just caudal to the renal hilus proved to be a metastasis from the renal carcinoma of clear cell type. The pathogenesis may have been due to tumor cells obstructing a lymphatic vessel draining the kidney. Cystic metastasis from renal cell carcinoma is very rare and this appears to be the second published case in the world.
Post‐traumatic high flow priapism: Demonstrable findings of penile enhanced computed tomography
Authors: Suzuki Kazumi , Nishizawa Shuji , Muraishi Osamu , Fujita Akifumi , Hyodoh Hideki , Tokue Akihiko
Published: March 2003

Post‐traumatic high flow priapism is a rare disease. A review of English published reports revealed 63 cases. Enhanced computed tomography (CT) of the penis has not previously been used as a diagnostic method for post‐traumatic high flow priapism. We present a case of post‐traumatic high flow priapism diagnosed with enhanced CT of the penis. Additionally, diagnostic modalities for post‐traumatic high flow priapism are discussed with review of published work.
Extracorporeal shock wave lithotripsy produces a lower stone‐free rate in patients with stones and renal cysts
Authors: DELIVELIOTIS CHARALAMBOS , ARGIROPOULOS VASILIOS , VARKARAKIS JOHN , ALBANIS STEFANOS , SKOLARIKOS ANDREAS
Published: March 2003

Abstract Background: Renal cysts have a space‐occupying effect and therefore can distort the pelvicalyceal anatomy. This distortion often produces abnormalities in normal urinary drainage. In the same way, it may effect the ability of the kidneys to become stone free after extracorporeal shock wave lithotripsy (ESWL). The purpose of the current study is to evaluate the effect of renal cysts on the outcome of ESWL.

Methods: We studied 15 patients who had renal stones and coexistent renal cysts. Four patients had polycystic disease, five patients had multiple cysts and six patients has solitary ones. All cysts produced a distortion to the calyceal system of the kidneys, a fact confirmed by intravenous urography (IVU) and computed tomography (CT). All patients underwent ESWL and their stone‐free status was evaluated 1 month later by ultrasound and plain kidney ureter bladder (KUB) X‐ray.

Results: We had a total 60% (9/15) stone‐free patients in our study group and a stone fragmentation rate of 100%. Patients with more cysts had lower stone‐free rates. Patients with polycystic kidneys had a 25% (1/4) stone‐free rate, while patients with multiple cysts and solitary cysts had, 60% (3/5) and 83.3% (5/6), respectively. These results are lower than the rates reported in patients without renal cysts.

Conclusions: We believe that renal cysts may interfere with the passage of stone fragments, due to the impediment of drainage and urinary stasis from the stretching and distortion of the calyceal system by the renal cysts.