Ethnic differences in prediction of violence risk with the HCR-20 among psychiatric inpatients.

OBJECTIVE: This study examined ethnic differences in assessment of violence risk among psychiatric inpatients by using the Historical Clinical Risk Management-20 (HCR-20). METHODS: The HCR-20 was administered to 169 consecutive psychiatric inpatients. Individual items and total scores on the HCR-20 were compared between patients of Asian-American (N=51), Euro-American (N=46), and Native-Hawaiian (N=38) heritage. Receiver operating characteristic (ROC) and stepwise regressions were calculated for each ethnic group with HCR-20 scores as predictor variables and violent event reports of significant threats and assaults as the outcome measure. RESULTS: Similar rates of overall violence were found between ethnic groups, and the HCR-20 was found to have predictive validity as measured by ROC analysis. Differences in scores on individual HCR-20 items were found, including young age at first incident of violence, psychopathy, early maladjustment, personality disorder, and past supervision failure, as well as total HCR-20 score, with Asian Americans scoring lower (less risk) than Euro-Americans and Native Hawaiians. Stepwise multiple regressions indicated a different pattern of predictor variables for each ethnic group, with impulsivity salient for the Asian-American group, young age at first incident of violence salient for the Euro-American group, and young age at first incident of violence, relationship instability, and risk-management plans' lacking feasibility as salient predictors for the Native-Hawaiian group. CONCLUSIONS: The findings provide preliminary support for the cross-cultural validity of the HCR-20 while at the same time identifying unique ethnic differences in prediction of violence risk among psychiatric inpatients.

Inflammatory pseudotumor of the urinary bladder and sigmoid colon.

We report an unusual case of an inflammatory pseudotumor of the bladder. A biopsy specimen prior to surgical treatment suggested leiomyosarcoma, and computerized tomography and magnetic resonance imaging strongly suggested bladder tumor with sigmoid colon invasion. Accordingly, radical surgical treatment consisting of total cystectomy, anterior resection of the sigmoid colon, and ileal conduit was performed. After operation, however, histological examination revealed an inflammatory pseudotumor of bladder and sigmoid colon. These findings were confirmed by immunohistochemical staining for smooth muscle specific actin, desmin, S-100, and vimentin. Histological examination revealed a diverticulum of the sigmoid colon in the middle of the pseudotumor, and this diverticulum may have ruptured to cause the inflammatory pseudotumor of bladder and sigmoid colon.

Micturitional disturbances due to labial adhesion.

We report 2 cases of micturitional disturbances due to labial adhesion. Two women, aged 78 and 77 years old, visited our hospital with chief complaints of difficult voiding and urinary retention. On examination, their labias were found to be extensively fused. In both cases, the labial adhesions were separated by surgical repair under spinal anesthesia. Gentamicin and steroid ointments were used to prevent readhesion of the labia postoperatively.

Phase II study of intravesical chemoprophylaxis of epirubicin after transurethral resection of bladder tumors. Tottori University Oncology Group.

We performed intravesical instillation of epirubicin in 53 patients with the aim of preventing recurrence of bladder tumors. The patients had undergone transurethral resection of superficial bladder tumors (only transitional-cell carcinoma) within the preceding week, between January of 1990 and July of 1991. Recurrence was found in 11.3% (6/53) of cases during follow-up periods lasting from 1 to 20 months. Side effects occurred in 5.7% (3/53) of the patients. The cumulative nonrecurrence rate was 96.0% for a follow-up period of 6 months and 78.4% for 12 months. The results of this study suggest that intravesical instillation of epirubicin is very useful as adjuvant therapy after transurethral resection of superficial bladder tumors.