Properties of non-coding mutation hotspots as urinary biomarkers for bladder cancer detection.

Mutations at specific hotspots in non-coding regions of ADGRG6, PLEKHS1, WDR74, TBC1D12 and LEPROTL1 frequently occur in bladder cancer (BC). These mutations could function as biomarkers for the non-invasive detection of BC but this remains largely unexplored. Massively-parallel sequencing of non-coding hotspots was applied to 884 urine cell pellet DNAs: 591 from haematuria clinic patients (165 BCs, 426 non-BCs) and 293 from non-muscle invasive BC surveillance patients (29 with recurrence). Urine samples from 142 non-BC haematuria clinic patients were used to optimise variant calling. Non-coding mutations are readily detectable in the urine of BC patients and undetectable, or present at much lower frequencies, in the absence of BC. The mutations can be used to detect incident BC with 66% sensitivity (95% CI 58-75) at 92% specificity (95% CI 88-95) and recurrent disease with 55% sensitivity (95% CI 36-74) at 85% specificity (95% CI 80-89%) using a 2% variant allele frequency threshold. In the NMIBC surveillance setting, the detection of non-coding mutations in urine in the absence of clinically detectable disease was associated with an increased relative risk of future recurrence (RR = 4.62 (95% CI 3.75-5.48)). As urinary biomarkers, non-coding hotspot mutations behave similarly to driver mutations in BC-associated genes and could be included in biomarker panels for BC detection.

Some excitatory and inhibitory factors involved in the epileptic state.

Many factors are involved in the determination of the epileptic threshold and the precipitation of epileptic seizures. The balance between the underlying excitatory and inhibitory mechanisms are often imperfectly understood. However, some of these factors must be fully considered if the management of those with epilepsy is to be effective. This applies especially to children. Certain types of epilepsy are genetically determined, and others are age-related. Development of the brain plays a crucial role in the changing liability to epilepsy. If these processes are disturbed by various lesions and diseases, such as metabolic and toxic disorders, protective mechanisms may suffer. Kindling and mirror foci, the role of the cerebellum, and reflex epilepsy will be discussed. There are some seizure-inducing factors which are susceptible to change, and can be as important as anti-epileptic drugs in controlling seizures. The use and limitations of these measures, and of drugs, will be considered.

Influencing mental health nursing practice through the teaching of research and theory: a personal critical review.

This paper will critically review the factors that influence the teaching of theory and research to mental health nurses. Following a brief historical review it is asserted that current educational approaches fail to address the complexity and context-dependent nature of mental health nursing practice. The author then argues for a radical approach to education which will enable students and practitioners to engage critically in deconstructing and developing theories that illuminate and help us understand the multiple realities of our post-modern professional world. In conclusion, the author provides an example of a casework-based curriculum that emphasizes the ways in which clinical experience with clients in a range of contexts should be the main focus of knowledge and skill development for the emerging profession of mental health nursing.

Focal dystonia, with special reference to writer's cramp.

If focal dystonia affects the hand muscles writer's cramp will result, but also other types of activity when the task involves repetitive movements such as typing and playing the piano. Writer's cramp is described, both simple and dystonic, and also the possibility of genetic causes, especially in the latter group. The characteristics of the electromyogram in this condition are discussed. The possible causes of focal dystonia and writer's cramp are reviewed: both the role of excitatory and inhibitory mechanisms and how these may influence treatment. Various treatments have been tried, and the most effective seems to be the use of botulinum toxin. However, if this does not relieve the symptoms, operations such as stereotactic lesions of the basal ganglia may be justified.

The tide is stemmed. A method of catheter traction for the control of venous haemorrhage following transurethral resection of prostate.

Local pressure for the control of venous haemorrhage during the performance of surgery is the primary method of control of bleeding when ligation is technically impossible. A method of catheter traction for the control of profuse bladder neck venous haemorrhage is described.

Costing transurethral resection of the prostate and diagnosis related group in Australia compared with United States costs.

The cost of a transurethral resection of the prostate is of considerable concern to the community. More of these procedures are being performed as the number of patients in the aged population increases. The costs of wages and salaries, purchase of equipment and depreciation, stationery, linen, investigations (pathology) and pharmaceuticals are compared with the bed charges (as charged to a private patient), the cost per inpatient day and the cost per inpatient treated, which is calculated from the operating fund budget expenditure of The Bendigo Hospital. The cost per diagnosis related group (DRG) 336 (defined as: transurethral prostatectomy, age greater than 69 and/or complication/co-morbidity; mean length of stay 7.0; relative weight = 0.9869) and DRG 337 (defined as: transurethral prostatectomy, age less than 70 without complication/co-morbidity; mean length of stay 5.8; relative weight = 0.7788) are compared with the figures for a similar procedure in 1987 in a United States hospital and extrapolated, by the use of the Consumer Price Index, to 1992 levels. The findings demonstrate that transurethral resection of the prostate as costed in this hospital compares very favourably with that in a US hospital, and favourably from the point of view of health care costs.

Catheter-free same day surgery transurethral resection of the prostate.

PURPOSE: Transurethral resection of the prostate using electrocautery has long been the standard method of management of lower urinary tract obstructive symptoms. While there has been a trend towards reduced catheterization time following transurethral prostatic resection, this study outlines the methods and results of transurethral prostatic resection performed in the day surgery setting. MATERIALS AND METHODS: The study was performed at a free-standing licensed day surgical hospital serving a patient population of more than 150,000. A total of 58 patients of a mean age of 68.77 years (range 49 to 87) underwent same day conventional transurethral prostatic resection. Of the procedures 39 (67%) were performed with spinal and the remainder with general anesthesia. RESULTS: Mean overall duration of catheterization was 6.54 hours. Of the 48 patients (82.76%) undergoing single catheterization mean duration was 5.59 hours. Mean total duration of catheterization for 10 patients (17.24%) who required reinsertion of a catheter was 11.09 hours. Duration of catheterization was 7.69 hours for patients treated with spinal and 3.86 for those treated with general anesthesia. Repeat catheterization was required in 10 patients and was due to urethral discomfort in initiating micturition in 8. Postoperative urinary tract infections occurred in 2 patients. No patient was readmitted to the hospital for retention of urine but 1 was admitted to a private hospital for management of postoperative fever and 1 for monitoring of tachycardia. CONCLUSIONS: Conventional transurethral resection of the prostate can be effectively managed in the day surgery setting with minimal morbidity. There are significant advantages in reduction of catheterization time and duration of hospital stay, and the procedure compares favorably with new modalities.

A critical reflection on the personal impact of managerial hegemony within nurse education.

This paper, written by two male nurse teachers, describes and analyses their experience of working in a nurse education culture permeated by the philosophy of business management. The introduction of business management practices to nurse education is discussed as a reflection of the current political hegemony of market forces and individualism. The authors discuss the implications for nurse teachers of being continually exposed to these politically motivated forces which increasingly provide the paradigm for service developments within the United Kingdom health services. In discussing the impact of this exposure it is argued that at the personal level individual teachers are experiencing a degree of apathy and personal dissonance which undermines their professional value system, resulting in emotional distress and a crisis of identity. It provides a critical reflection on the way organizational dynamics and power relations influence the subjective sense-making of individuals. The authors use a multiplicity of perspectives, including those provided by individual psychology, power relations, feminism and personhood, to argue for the need to develop an alternative paradigm which is characterized by the valuing of individual persons, empathic sensitivity and the fostering of creativity.

Transurethral resection of the prostate: still the gold standard.

BACKGROUND: In recent times there has been a number of newer methods advocated as treatment for bladder outlet obstruction. Prior to embracing these newer technologies, the authors' experiences with conventional transurethral resection of the prostate should be evaluated and compared with those experienced in the newer modalities. The objective was to determine whether a standard transurethral resection of the prostate (TURP) still compared favourably with the newer modalities in terms of duration of stay, duration of catheterization, re-admission rate, re-catheterization rate, cost and long-term results. The results are compared with those of workers whose level of expertise was the best that could be achieved with transurethral needle ablation (TUNA) and laser prostatectomy. METHODS: During the 3-year period from September 1992 to September 1995, 575 TURP were carried out in a regional hospital. The total duration of stay, the postoperative duration of stay, the re-catheterization and re-admission rates were assessed and the costs estimated. RESULTS: Transurethral resection of the prostate was shown to compare favourably in terms of the duration of hospital admission and the duration of catheterization, and to have a significantly lower re-catheterization rate and a significantly lower re-admission rate than the newer modalities. CONCLUSION: Transurethral resection of the prostate is still the method of choice for surgical management of bladder outlet obstruction, and it remains as the gold standard. Having reviewed the results of the newer modalities as carried out by the experts in those fields, it was found that TURP compares favourably with those procedures. From the point of view of duration of stay, duration of catheterization, re-admission rate and re-catheterization rate, as well as cost and long-term results, TURP remains as the gold standard and the newer modalities are not believed to be advantageous at this stage.

Pelvic lipomatosis with cystitis cystica, cystitis glandularis and adenocarcinoma of the bladder: first reported case.

Pelvic lipomatosis is a rare disease which may cause obstructive uropathy. It has been reported with cystitis cystica and cystitis glandularis. Cystitis cystica and cystitis glandularis have been reported previously as progressing to adenocarcinoma of the bladder. The first reported case of pelvic lipomatosis, cystitis cystica, cystitis glandularis and adenocarcinoma of the bladder is presented and the literature reviewed.

Use of a new device for endoscopic suturing in the laparoscopic Burch procedure.

An innovation in surgical instrumentation for performing endoscopic suturing was applied in 15 patients who underwent a laparoscopic approach to the traditional retropubic modified Burch procedure.

Closure of fascial incisions made at the time of laparoscopy: development of a device.

Incisional hernias follow approximately 3% of major laparoscopic procedures when the fascia is not adequately closed. Fascial closure, however, is difficult when skin incisions are small and subcutaneous tissue is thick. We report the development of a self-contained device that sutures the anterior abdominal wall peritoneum and fascia at the completion of laparoscopic surgery without extending the cutaneous incision.

Controlled trial of plasma exchange in acute inflammatory polyradiculoneuropathy.

A randomised controlled trial of exchange versus no exchange was conducted to find out whether plasma exchange would be useful in acute inflammatory polyradiculoneuropathy. It was calculated that 15 patients would be required in each group to demonstrate a worthwhile improvement in functional ability 1 month after completion of treatment. Treatment comprised five exchanges in 10 days (55 ml plasma/kg body weight/exchange). Both groups received normal supportive care and were followed up periodically for a year. Overall the treated group showed a slight but not significant benefit (p greater than 0.05); at two weeks' follow-up of patients admitted to the trial within 14 days of onset of neuropathic symptoms, p = 0.07. These results do not provide grounds for recommending plasma exchange for the treatment of severe AIP.