Developmental role of adenosine kinase for the expression of sex-dependent neuropsychiatric behavior.

Deficits in social memory, cognition, and aberrant responses to stimulants are common among persons affected by schizophrenia and other conditions with a presumed developmental etiology. We previously found that expression changes in the adenosine metabolizing enzyme adenosine kinase (ADK) in the adult brain are associated with deficits in various cognitive domains. To distinguish between developmental and adult functions of ADK, we used two transgenic mouse lines with widespread disruption of ADK expression in the adult brain, but differences in the onset of ADK deletion. Specifically, we compared Nestin-Cre+/-:ADK-floxfl/fl (ADKΔBrain) mice with global loss of ADK in the whole brain, beginning in mid-gestation and persisting for life, with Gfa2-Cre+/-:ADK-floxfl/fl (ADKΔAstro) mice that have normal ADK expression throughout development, but lose astrocyte-specific ADK-expression in young adulthood. Because ADK-expression in adulthood is generally confined to astrocytes, adult ADKΔAstro mice show a similar expression profile of ADK in key areas of the brain related to neuropsychiatric behavior, compared to adult ADKΔBrain mice. We sought to determine a neurodevelopmental role of ADK on the expression of psychiatric behaviors in adult male and female mice. Adult ADKΔBrain mice showed significant deficits in social memory in males, significant contextual learning impairments in both sexes, and a hyper-responsiveness to amphetamine in males. In contrast, ADKΔAstro mice showed normal social memory and contextual learning but hypo-responsiveness to amphetamine in males. Our results demonstrate a key developmental role of ADK in mediating behaviors in adulthood related to neuropsychiatric disease and support the greater prevalence of these disorders among males.

Managing patients with a distended bladder.

A distended bladder is a serious medical situation that requires prompt intervention to drain urine and promote patient comfort. The presence of suprapubic pain distinguishes acute urinary retention from chronic retention. After decompression of the bladder, patients must be monitored closely for post-decompression complications. Additional nursing management may include preparing patients for surgery or additional diagnostic tests.

Cancer of the prostate: treatment and nursing implications.

PURPOSE/OBJECTIVES: To review the clinical manifestations, current treatment, and nursing management of prostate cancer. DATA SOURCES: Published articles, book chapters, American Cancer Society booklets. DATA SYNTHESIS: Prostate cancer is a slow-growing malignancy and usually is asymptomatic in its early stages. It causes acute urinary obstruction at more advanced stages, and patients may present with metastatic disease. Diagnosis is made by biopsy, and treatment options include periodic observation, surgery, radiotherapy hormonal manipulation, and chemotherapy with standard or investigational drugs or combination therapy. The major complications associated with surgery and radiation therapy are transient or permanent incontinence and impotence. CONCLUSIONS: Because no definitive method for identifying clinically important lesions exists, much controversy surrounds prostate cancer treatment. Issues significant to the diagnosis and treatment of all stages of prostate cancer are identified, and nursing care concerns focusing on treatment and disease-related problems are presented. IMPLICATIONS FOR NURSING PRACTICE: Nursing care focuses on providing patients with accurate information to make informed decisions regarding treatment for early stage disease, on promoting comfort, and on preventing and managing treatment and disease-related complications. Nursing diagnoses include knowledge deficit; altered sexual patterns, body image disturbance, altered urinary elimination, diarrhea, impaired skin integrity, and pain, fatigue, bleeding, and infection, all of which are related to surgery, pathologic fractures, spinal cord compression, and edema of the scrotum/lower extremities.

Screening for prostate cancer.

PURPOSE/OBJECTIVES: To describe current prostate cancer screening methods and to address the controversies surrounding their use. DATA SOURCES: Published articles, abstracts, books, and press releases; personal communication. DATA SYNTHESIS: Controversy exists about whether efforts to conduct mass screenings for prostate cancer are of value given the related costs and the inability of such screenings to distinguish between indolent and aggressive tumors. The American Cancer Society (ACS) has added prostate cancer to its "Guidelines for the Cancer-Related Checkup" but does not recommend these guidelines for mass screenings. Preliminary findings of the ACS National Prostate Cancer Detection Study have shown that digital rectal examination (DRE) and transrectal ultrasonography (TRUS) have the best positive predictive value when the prostate-specific antigen (PSA) level is greater than 4 ng/ml. CONCLUSIONS: Despite concern over the rising incidence of prostate cancer, the effectiveness of DRE, PSA, and TRUS in screening for early detection of prostate cancer remains controversial. IMPLICATIONS FOR NURSING PRACTICE: As the public becomes more aware of the controversies surrounding prostate cancer screening, nurses are finding that they play a vital role in the educational process. By understanding the abilities and deficiencies of the current screening methods, nurses can offer men concrete information about DRE, PSA, and TRUS. They can reinforce the importance of early detection for high-risk populations, as well as suggest strategies for encouraging compliance.

Evaluation and treatment of the female urethral syndrome.

We reviewed 160 patients who were evaluated for the urethral syndrome. Evaluation included urinalysis, urine culture, cystoscopy and excretory urography in all cases. Minnesota Multiphasic Personality Inventory evaluation was done in 56 patients. Of these methods only the Minnesota Multiphasic Personality Inventory had significant positive findings revealing evidence for a conversion or psychophysiological etiology. Conservation treatment was equally effective as instrumentation.