Aggressive Angiomyxoma in the Scrotum: A Case Series and Literature Review.

Purpose: Aggressive angiomyxoma (AAM) was identified as a distinct clinicopathological entity in 1983. Since then, a few cases of its occurrence in the scrotum have been reported. This case series was performed to increase clinicians' understanding of the clinical features and treatment of AAM in the scrotum. Methods: We evaluated the clinical presentations, treatments, and follow-up of two patients with AAM in the scrotum in our hospital and 34 cases reported in the literature. Results: Among the 36 patients, the average age was 48.3 ± 20.6 years old (range from 1 to 81); the average maximum diameter of the tumor was 8.36 cm (1.6-25 cm); the site of one (2.78%) patient was located in the epididymis, two (5.56%) in the testes, five (13.89%) in the spermatic cord, and 28 (77.77%) in the scrotum. The clinical symptoms were generally non-specific and 20 patients inadvertently discovered their slow-growing painless masses. The treatments for all these patients were surgical excision once the tumor had been found and one case underwent excision followed by radiotherapy. The median follow-up time for the remaining 32 cases was 24.5 months (1 to 84 months). Recurrence occurred in three cases (9.09%) at the primary sites and no cases of distant metastasis. Conclusion: AAM of the scrotum can occur in middle-aged and elderly men. The clinical manifestation generally involves a long history of asymptomatic masses or swelling in the scrotum. Ultrasound is the most commonly used diagnostic technique but magnetic resonance imaging may be more effective. The mainly treatment is surgical excision and postoperative histopathological examination is still the gold standard for its diagnosis. Although it is locally aggressive, metastasis is extremely rare in males.

Treatment of upper tract urothelial carcinoma with ureteroscopy and thulium laser: a retrospective single center study.

BACKGROUND: Treatment with the combination of ureteroscopy and thulium laser ablation may provide an alternative to radical nephroureterectomy (RNU) for patients with upper tract urothelial carcinoma (UTUC). The purpose of this study was to investigate the efficacy and safety of this technique. METHODS: We performed a retrospective review of the data for patients who were treated surgically for upper tract urothelial carcinoma in a single center. It included 32 patients treated by endoscopic thulium laser resection and 107 patients treated by radical nephroureterectomy (RNU). We compared the data of patient sex, age at diagnosis, location of carcinoma, length of hospitalization, tumor site, size, grade, recurrence, preoperative creatinine and postoperative creatinine in two groups. Patients were examined by ureteroscopy every 3 months during the first year after surgery, then every 6 months each year. RESULTS: All 32 patients were treated successfully, among which 6 were operated by a flexible ureteroscope. The average tumor size was 13 ± 7 mm in diameter. The tumor was rated as low grade in 27 patients and high grade in 5 patients. Ureteral stricture developed in 4 patients 3 months later after surgery, but the stricture was succesfully treated through endoscopic dilation. Seven patients had tumor recurrence, 3 of which underwent nephroureterectomy during the follow-up. Postoperative creatinine levels (umol/L) were respectively 89 ± 7.5 in laser group and 123 ± 15.4 in RNU group (p < 0.01). Length of hospitalization was respectively 3.6 ± 1.9 and 8.6 ± 2.4 days (p < 0.01). Local or bladder recurrence rate of thulium laser group and RNU group was respectively 21.9 and 13.1% (p < 0.01). CONCLUSIONS: Thulium laser group is associated with a less loss of renal function, a shorter length of hospitalization, but a higher rate of tumor recurrence. Thulium laser therapy combined with ureteroscopic treatment can be considered as an acceptable treatment for selected cases of UTUC. Lifetime intensive surveillance is necessary.

Verbal compliance-gaining strategies used by male physicians and patient healthcare experience.

This study explores male physicians' use of verbal compliance gaining strategies to encourage patients to adhere to medication regimens, lifestyle changes, or future appointments, and assesses which strategies are associated with patients' reported healthcare experiences. Five physicians from a family practice clinic in northern British Columbia, Canada, were audio-recorded while interacting with 31 patients during actual consultations. Compliance-gaining utterances were coded into five categories of strategies, while patient experience with care was assessed using a questionnaire. A number of intriguing findings emerged: direct orders were related to a more negative experience with interpersonal aspects of care, but were fairly frequently used, especially with female patients. Persuasion was the only strategy that promoted a positive patient experience, but was rarely used. However, the effect of persuasion on patient experience was no longer significant when adjusting for patients' health status. Physicians relied mostly on motivation strategies to encourage adherence, but these strategies were not related to patients' assessment of their healthcare experiences. These results suggest that the most frequently used verbal compliance gaining strategies by physicians are not always appreciated by patients. To be more effective, it is necessary to inform physicians about which compliance-gaining strategies promote a positive patient healthcare experience.

The dynamics of resident-patient communication: data from Canada.

The objectives of this study were to examine patterns of resident-patient communication and the relationship between resident patterns of speech with patient satisfaction. Forty consultations, ten in each of the four gender combinations (male resident/male patient, male resident/female patient, female resident/female patient, female resident/male patient) were audiotaped and microanalyzed using the Roter Interaction Analysis System. Several findings depart significantly from previous studies with physician-only or physician-resident-mixed samples. First, the average length of the 40 consultations was 19.5 minutes, 11.3 minutes longer than consultations in a physician-only sample drawn in the same clinic previously. Second, male residents engaged in twice as much psychosocial talk as female residents and conducted longer consultations. Third, residents asked 80% of the total questions while patients asked 20% of the questions. Previous studies with physician-only or physician-resident-mixed samples reported that physicians ask 89-99% of the total questions. Finally, patients' overall satisfaction and communication satisfaction were negatively correlated with residents' positive talk, which constitutes 31% of a given resident's total utterances. In the study conducted in the same clinic with a physician-only sample, physician positive talk was 26% and physician positive talk was not correlated with patient satisfaction. Is this a signal that residents should reduce the amount of positive talk? Apparently more studies with resident-only samples are needed to answer this and other unanswered questions in the field to offer directives to resident training.

Rethinking culture and self-construal: China as a middle land.

Amid criticisms of current paper-and-pencil type questionnaires measuring self-construal across cultural groups, the authors used a graphic representation scale to examine whether Anglo Canadians (N = 220) were more independent than Mainland Chinese (N = 196) and Indians (N = 212) in construing their relationships with closest family member, family members, closest friend, friends, (other) relatives, colleagues, and neighbors. Data generated 5 intriguing findings: (a) Chinese were more interdependent than Canadians but less so than Indians, indicating that Chinese culture has become more individualistic. (b) Canadians were more independent than Chinese in 6 relationship dimensions but were as interdependent as Chinese in self-closest-friend connectedness, somewhat contradicting 1 assumption of theories of independent-interdependent self-construal and individualism-collectivism (I-C). (c) Canadians were more independent than Indians in all relationship dimensions, supporting theories of independent-interdependent self-construal and I-C. (d) Chinese were as interdependent as Indians in self-closest-family-member, self-close-family-members, and self-relatives connectedness but more independent than Indians in the other categories of self-other relationships. (e) Participants' age did not have strong correlations with variables measuring self-construal in any sample, indicating that a person's attachment style may not change greatly over a lifespan. The authors discussed theoretical and methodological implications.

Reconceptualizing interruptions in physician-patient interviews: cooperative and intrusive.

Results of past research on physician-patient interruption present an inconclusive picture. This study reconceptualizes interruption into cooperative and intrusive categories. Thirty physician-patient interviews, 13 male/male and 17 male/female, were audiotaped and microanalyzed. It was found that physicians did not interrupt patients more or vice versa. Rather, physicians and patients interrupted differently, the former more intrusively and the latter, more cooperatively. Furthermore, physicians did not dominate speaking turns nor speak more words than patients, as previously believed. We argue that their difference may not be measured by the number of words or speaking turns because it is embedded in their respective communication style. It was also found that female patients exhibited eleven times as much cooperative interruptions as did male patients. When physicians interrupted patients, they were unsuccessful only 6% of the time. When patients interrupted physicians, they were unsuccessful 32% of the time. The results of this study point out the necessity to reconceptualize interruptions in physician-patient interviews.