[A Case of Polyarteritis Nodosa Diagnosed from Pathological Findings of Refractory Epididymitis].

A 54-year-old man was admitted to internal medicine due to unidentified fever persisting for 3 months, and was examined. Then, he was referred to our department for suspected pyelonephritis. Although he was initially being treated for pyelonephritis, right epididymitis occurred during the course of treatment. Antibiotics were ineffective, and symptoms such as weakness and subctaneous nodules also appeared. We performed epididymectomy to differentiate this intractable epididymitis from other systemic diseases. Pathological findings were fibrinoid necrotic vasculitis of middle and small arteries. Of the diagnostic criteria for polyarteritis nodosa, 4 major symptoms and histological findings were satisfied. After we started oral administration of predonin, the fever went down and the creative protein level decreased immediatately.

[Solitary Fibrous Tumor in the Retroperitoneum : A Case Report].

A 55-year-old man was diagnosed with an abdominal tumor and referred to our department. Abdominal contrast-enhanced computed tomography revealed a 15-cm tumor in the retroperitoneum. The inferior vena cava was compressed ventrally, the right ureter laterally, and the right kidney toward the head. Part of the tumor was situated on the dorsal side of the abdominal aorta. A preoperative diagnosis of neurogenic tumor or a type of sarcoma was made. We performed en bloc resection of the tumor. The right kidney was also resected. We exfoliated between the tumor and inferior vena cava without temporary interruption. The final diagnosis was a solitary fibrous tumor. The patient received no adjuvant therapy. Neither recurrence nor metastasis has been detected for 8 months postoperatively.

[Case of Behcet's disease diagnosed by bilateral epididymitis].

A 24-year-old man visited our emergency room with testicular pain and left shoulder pain, and was admitted to our hospital for diagnosis of bilateral epididymitis. Antibiotics and anti-inflammatory medication were started, but the symptoms did not improve. During hospitalization, ulcerous lesions, erythema nodosum, folliculitis-like exanthema and multiple oral aphtha appeared. Then, we consulted the department of dermatology. As he had a combination of arthritis and epididymitis, he was diagnosed with the abortive form of Behcet's disease. After diagnosis, we began administering colchicine. Then, all symptoms improved in a few days, and he has remained free of the disease after the discontinuation of colchicine.

The outcomes of adrenalectomy for solitary adrenal metastasis: A 17-year single-center experience.

AIM: We aimed to analyze surgical outcomes of open or laparoscopic adrenalectomy for solitary adrenal metastasis and assess the factors influencing survival. METHODS: We retrospectively reviewed our institutional clinicopathological database for cases of adrenalectomy for solitary adrenal metastasis from solid tumors between 2000 and 2017. RESULTS: Twenty-five patients underwent open adrenalectomy (n = 11) or laparoscopic adrenalectomy (n = 14). The most common primary site was the lung (n = 7), followed by the kidney (n = 5), liver (n = 3), ovary (n = 2), soft tissue (n = 2), and six other sites. The majority of the patients (n = 19) had metachronous metastasis. The median tumor size was 3.1 cm (1-9 cm). With the median follow-up of 32 months (2-144 months), the median progression-free and overall survivals were 14 and 63 months, respectively. Multivariate analysis revealed that synchronous metastasis (hazard ratio [HR] = 7.5) and tumor size ≥ 4 cm (HR = 17.7) were significant prognostic factors for shorter overall survival. There was no significant difference for survival between the laparoscopic and open groups. CONCLUSIONS: Adrenalectomy for solitary adrenal metastasis can be applied for selected patients with various types of malignancy. However, synchronous metastasis and tumor size ≥ 4 cm were prognostic factors for shorter overall survival.

Factors affecting rapid turnover of novice nurses in university hospitals.

Rapid turnover of novice nurses eventually results in a shortage of veteran nurses. This study aimed to clarify the factors affecting rapid turnover of novice nurses in a prospective manner. We carried out an investigation in 20 university hospitals whose directors of nursing service departments accepted our request to cooperate with our research program. These hospitals were selected from all of the 102 university hospitals listed in The Hospital Catalog of Japan. The subjects were 1,203 novice hospital nurses who gave their informed consent for participation in our study. The questionnaires, which dealt with burnout, assertiveness, stressful life events, reality shock, ward assignment preference, transfer preference, job satisfaction (workplace, salary, workload, and overtime), social support and coping mechanisms were completed by 923 novice nurses in June 2003. Then, their turnover was investigated in December 2003. Thirty-seven novice nurses (4.0%) quit during this period. Multiple logistic regression analysis showed that the factors affecting rapid turnover were 1) graduation from vocational nursing schools, 2) dissatisfaction with assignment to a ward contrary to their desire, and 3) no peers for support. Assignment of novice nurses to wards they choose as far as possible, avoidance of assigning novice nurses to wards alone, and establishment of a support system for nurses who graduate from vocational nursing schools seem to be important for preventing rapid turnover of novice nurses.