The prevention of youth violence. The rationale for and characteristics of four evaluation projects.

In response to the magnitude of violence in the United States, a number of violence-prevention programs have been implemented throughout the country. However, relatively few have been rigorously evaluated for effectiveness. To encourage development and evaluation of violence-prevention interventions that focus on young children and their families, the Centers for Disease Control and Prevention (CDC) provided funding to four projects in 1996. This paper briefly describes the rationale for funding these projects, which is based on our understanding of the development of aggressive and violent behavior and on the literature regarding promising approaches to prevent problem behavior in this age group. We provide an overview of the four specific projects funded by the CDC as well as a short discussion of some of the many challenges encountered during their implementation.

[Treatment of stress incontinence by percutaneous bladder neck stabilization (Vesica)].

We experienced 9 cases of percutaneous bladder neck stabilization (Vesica) for patients with urinary incontinence who were diagnosed with stress incontinence from December 1995 to June 1998. None of the patients were able to control continence with any drugs. Chain cystography was performed on all of the patients before and after surgery. The posterior urethro-vesical angle before surgery was over 130 degrees in all of the patients, and it improved after the operation. Moreover, the mean volume of the pad test greatly decreased from 47 g to 1 g. All of the patients were treated with epidural anesthesia. The operation time was less than 60 minutes. The subjective and objective findings were satisfactory. We conclude that percutaneous bladder neck stabilization is a very useful surgical treatment for stress incontinence.

[Prophylaxis of recurrence of superficial bladder tumor by intravesical chemotherapy].

During the past 10 years, we have experienced 110 bladder tumor cases. Among them, 70 patients were diagnosed superficial bladder tumor. Of these 70 cases, 30 were treated with intravesical adriamycin (ADR) and peplomycin (PEP), 13 with ADR only and one case with PEP and remaining 26 with TUR and hydrostatic pressure technique. We studied the efficacy of combination intravesical chemotherapy with ADR and PEP and other treatments in the prevention of recurrence in the superficial bladder tumor cases. The recurrence rate during 3 years of each group, was 25% in the group treated with ADR and PEP, 35% with ADR and 55% in remaining group. 3 years recurrence rate in the group treated with ADR and PEP was significantly low than that in the group tread with TUR and hydrostatic pressure technique alone (Wilcoxon test). Side effects was pollakisuria, pain after micturition and others. Anaphylactic shock appeared in one case. From these results we concluded that intravesical chemotherapy with combined agents is more effective than that with a single one or no treatment after TUR.

[Urological complications after renal transplantation].

Urological complications occurred in 17.5% of the 80 patients who had received renal transplantations in our clinic between March, 1975 and May, 1984. Urinary fistulas occurred in 3 patients, urolithiasis occurred in 6 patients, ureteral stenosis occurred in 1 patient and urinary tract bleeding occurred in 4 patients. Graft loss was observed in 1 patient, but there were no patients whose death was directly attributable to urological complications. Urological complications can be avoided by careful procedures in donor nephrectomy and urinary tract reconstruction.

[Clinical studies on cefoperazone in renal transplantation].

Two grams of Cefoperazone was intravenously administered twice a day for 5 days by drip infusion to 10 donors and 9 recipients after renal transplantation. The concentration of cefoperazone in the blood after administration in both donors and recipients did not show any accumulation tendency. The urinary recovery rate of cefoperazone for 24 hours in donors was 8.8% and that in recipients was 8.1%. There was no change in the renal function in donors after administration of cefoperazone. No change was observed in blood examination, BUN or creatinine, but S-GOT and S-GPT showed a temporary increase in 1 donor and 1 recipient. It is considered that Cefoperazone is a very useful drug for prophylactic chemotherapy after renal transplantation.

[Prophylaxis of recurrence in superficial bladder carcinoma by intravesical chemotherapy--comparative study between instillation of combined double anticancer agents and single anticancer agent].

We performed a study to compare the usefulness of double or single anticancer agents in the prophylactic treatment after the transurethral resection (TUR) of superficial bladder cancer. We experienced 127 superficial bladder cancer cases. Of these cases, 42 were treated with intravesical adriamycin (ADR) and peplomycin (PEP), 56 with ADR, PEP, epirubicin (epi-ADR) or pirarubicin (THP) only, and the remaining 29 with TUR only. Nonrecurrence rates were significantly higher in the intravesical treated cases than in the cases with TUR only, and also significantly higher in the cases treated with ADR and PEP than the other treated cases. We concluded that intravesical chemotherapy with combined agents was more effective than with a single agent.