Neonatal circumcision. Benefits, risks, and Family teaching.

Neonatal circumcision is a frequently performed elective surgical procedure, and is one of the oldest known surgical procedures. Neonatal circumcision may be performed for medical, cultural, or religious reasons. This article provides current information from the literature regarding the risks, benefits, and concerns about neonatal circumcision.

Interobserver variability in prostate cancer specific survival.

We evaluated the reliability of disease-specific survival (DSS) as an outcome measure in patients with carcinoma of the prostate (CaP). The records of 50 patients had a diagnosis of CaP and had expired were selected from the hospital tumor registry. Records were reviewed by six individuals and each individual was asked to specify cause of death as due to CaP or some other cause. DSS curves were generated based on the determinations of each reviewer. Although the DSS curves were generally parallel, a high degree of variability was seen at various intervals, leading us to conclude that DSS is dependent upon the individual reviewer. Published by Elsevier Science Inc.

Development of a decision-making tool to predict risk of prostate cancer: the Cancer of the Prostate Risk Index (CAPRI) test.

OBJECTIVES: To provide a simple and reliable clinical prediction for an individual patient's overall risk of cancer at biopsy by deriving an easily implemented test based on a generalizable model. Four variables are analyzed for inclusion in the model: prostate-specific antigen (PSA) level, digital rectal examination (DRE) results, race, and age. METHODS: Two populations were used to develop and validate the test: a model (n = 633) and an independent, geographically separate, external population (n = 766). Pathology records for patients who underwent prostate biopsy between 1991 and 1995 were reviewed and screened for the presence of PSA and DRE results. Records where age and race could be determined were extracted. Multiple logistic regression was used with an iterative approach to optimize each test factor. The Wald chi-square test, receiver operating characteristic (ROC) curve, and Hosmer-Lemingshaw test were used to evaluate the model's predictive capability in the two populations. RESULTS: The model and external populations were significantly different for racial mix, PSA level, age, and biopsy detection rate, providing diverse populations to validate the test. Within a combined model, PSA, DRE, race, and age all demonstrated independent capability to predict cancer at biopsy. Predictive power of the overall test was high within the model population (ROC 80.8%), with minimal loss of power in the external population. The test demonstrated no significant lack of fit in either population. CONCLUSIONS: Within a combined test, PSA, DRE, race, and age all contribute significantly to prediction of prostate cancer at biopsy in an individual patient. The test depicts individual risk in an easily understood, visually provocative manner and should assist the clinician and patient in reaching a decision as to whether biopsy is appropriate.

Caring for the patient with interstitial cystitis.

Interstitial cystitis (IC) is a chronic, painful, debilitating bladder disorder which predominantly affects women. The etiology of IC is unknown, the diagnosis is difficult to make, and treatments are aimed at minimizing symptoms. IC affects every aspect of an individual's life. Both generalist and advanced practice nurses play a vital role in enhancing the IC patient's quality of life through emotional support and education.

Extracorporeal shockwave lithotripsy for kidney stone on surgical clip.

We report the successful use of extracorporeal shockwave lithotripsy for the destruction of a renal stone that had formed around a surgical clip. The SWL led to passage of both the stone and the clip.

Economic impact of urolithiasis in the United States.

PURPOSE: We determined the economic costs to individuals in 1993 for the evaluation and treatment of upper urinary tract calculi. MATERIALS AND METHODS: Hospital discharge statistics, prevalence data for urolithiasis and the relative frequency of surgical treatments from Civilian Health and Medical Program of the Uniformed Services claims data were assessed. RESULTS: The total charges for evaluation, hospitalization and treatment were estimated to be $1.23 billion per year. Professional charges for those who were hospitalized were estimated to be $183 million. Outpatient evaluation of urolithiasis was expected to cost $278 million. Indirect costs for lost wages were estimated to be $139 million. CONCLUSIONS: The total annual cost for urolithiasis in the United States is estimated to be $1.83 billion.

Military rank as a measure of socioeconomic status and survival from prostate cancer.

Previous studies have shown an association between cancer survival and socioeconomic status. In the United States Armed Forces, military rank is a measure of socioeconomic status. To determine whether an association exists between socioeconomic status (as measured by military rank) and prostate cancer, we carried out a retrospective review of the clinical data from 237 patients entered into the Tumor Registry. There was no statistically significant association between rank and the stage of disease at diagnosis or actual 5-year survival. In the military, health care is provided free of charge, independent of rank, and this study showed that when there is equal access to health care, socieconomic status does not correlate with prostate cancer outcome. Future studies comparing outcomes of prostate cancer should control for accessibility to health care.

Renal calculi in army aviators.

A study of U.S. Army active duty aviators was done using the Aeromedical Epidemiology Data Repository (AEDR) for the period of January 1984 through December 1987 to determine the incidence of renal calculi in this population. Age-specific rates were found to be highest in the 30-54 year age group. The overall annual incidence was determined to be 4.7/1000 population of white male aviators. After standardization to the 1960 U.S. white population, the incidence in aviators was found to be 2.2/1000, almost double that of a Rochester, MN male population (1.2/1000). The aviation environment may predispose Army aviators to dehydration and play an etiologic role in the genesis of renal calculi. Medical evaluation, treatment, and administrative disposition of Army aviators with renal calculi are also briefly discussed.