Tacit Knowledge in Low-Status Eldercare Work.

Cultural failure to recognize tacit knowledge that informs eldercare is key to understanding how and why the labor of workers in this area of professional caregiving, especially those earning low wages, is dramatically undervalued in the US health sector. This essay first explains key differences in credential-based knowledge and tacit forms of health knowledge and then considers how status differentiation privileges credential-based knowledge of clinicians of higher status, such as physicians and nurses, who do not perform the hour-to-hour care for most of our country's elders. Finally, this article suggests the ethical and clinical importance of health care organizations' sources of knowledge and roles in equitably valuing labor to promote quality service delivery, better working conditions, and better pay for workers earning low wages.

Functional Outcome and Complications following Ileal Neobladder Reconstruction in Male Patients without Tumor Recurrence. More than 35 Years of Experience from a Single Center.

Purpose: There is a lack of data on true long-term functional outcome of orthotopic bladder substitution. The primary study objective was to report our 35-year clinical experience.

Materials And Methods: Since October 1985, 259 male patients from a large single center radical cystectomy series with complete followup of more than 60 months (median 121, range 60-267) without recurrence, irradiation or undiversion that might have affected the functional outcome, were included.

Aggression by male bonobos against immature individuals does not fit with predictions of infanticide.

The selective advantage of male infanticide is enhancement of reproductive success of the aggressor. This implies that aggression is directed at individuals sired by others, infant loss shortens the mother's inter-birth interval, and the aggressor has a greater likelihood of siring the next offspring of the victims' mother. As these conditions are not always met, the occurrence of male infanticide is expected to vary, and hominoid primates offer an interesting example of variation in male infanticide.

[Prostate biopsy: Procedure in the clinical routine].

Over the last decade there has been a 25% decrease in the mortality rates for prostate cancer. The reasons for this significant decrease are most likely associated with the application of urological screening tests. The main tools for early detection are currently increased public awareness of the disease, prostate-specific antigen (PSA) tests and transrectal ultrasound (TRUS) guided topographically assignable biopsy sampling.

Intensifying the saturation biopsy technique for detecting prostate cancer after previous negative biopsies: a step in the wrong direction.

Objective: To report the results using an extensive saturation biopsy in men with negative prostate biopsies but in whom there is still a clinical suspicion for carcinoma.

Patients And Methods: Between February 1999 and October 2004 we offered 40 patients (median age 63 years) an extensive saturation biopsy if there was clinical suspicion of prostate cancer after previous negative prostate biopsies. The median (range) number of cores taken was 64 (39-139) and was adjusted to the size of the prostate.

Clinical value of transrectal ultrasound in the diagnosis of suspected neoplasia in the small pelvis.

Purpose: In daily clinical practice, it is challenging to accurately diagnose suspected neoplasias in the small pelvis by minimal invasive means, and CT-guided biopsy is often limited in its feasibility. The aim of our study was to evaluate whether transrectal ultrasound (TRUS)-guided biopsy can verify suspected neoplasias in the small pelvis histologically.

Material And Methods: The study population consisted of 12 patients who underwent biopsy of suspected malignancy in the pelvis by TRUS.

Use of transrectal ultrasound-guided biopsy in the diagnosis of pelvic malignancies.

Purpose: To describe our experience with transrectal ultrasound (TRUS)-guided needle biopsy of pelvic malignancies.

Methods: Eleven patients with clinical suspecion of advanced malignant pelvic tumor were referred to our institution with a history of unsuccessful CT-guided biopsy, although a target lesion was demonstrated on pelvic CT or MRI. Cholin-PET and FDG-18-PET were also obtained individually in each patient.

Imaging prostate cancer with 11C-choline PET/CT.

Unlabelled: The ability of 11C-choline and multimodality fusion imaging with integrated PET and contrast-enhanced CT (PET/CT) was investigated to delineate prostate carcinoma (PCa) within the prostate and to differentiate cancer tissue from normal prostate, benign prostate hyperplasia, and focal chronic prostatitis.

Methods: All patients with PCa gave written informed consent. Twenty-six patients with clinical stage T1, T2, or T3 and biopsy-proven PCa underwent 11C-choline PET/CT after intravenous injection of 1,112 +/- 131 MBq 11C-choline, radical retropubic prostatovesiculectomy, and standardized prostate tissue sampling.

[Rational diagnostic and therapy of renal colic in the year 2005--what's new?].

The acute flank pain is the most frequent urological emergency. Patients with renal colic are usually treated in emergency care units or by their family doctors and require immediate diagnosis and treatment. Up to 10 % of the population is estimated to suffer from kidney colic at least once in their lifetime.

[Innovative concepts in early cancer detection and staging of localized prostate cancer].

Prostate cancer is the most common malignancy in males. Men aged 50 years and older are recommended to undergo an annual digital rectal examination (DRE) and determination of prostate-specific antigen (PSA) in serum for early detection. Fortunately, disease-specific mortality continues to decline as a result of advances in screening, staging, and patient awareness.

Staging bladder carcinoma by three-dimensional ultrasound rendering.

Organ-confined staging for bladder cancer has major impact on further treatment. Most imaging techniques for this purpose are insufficient. We, therefore, assessed the value and the limitations of a new diagnostic tool, the 3-D ultrasound (US) rendering, to distinguish invasive from noninvasive bladder cancers.

Classification of incidental carcinoma of the prostate using learning vector quantization and support vector machines.

The subclassification of incidental prostatic carcinoma into the categories T1a and T1b is of major prognostic and therapeutic relevance. In this paper an attempt was made to find out which properties mainly predispose to these two tumor categories, and whether it is possible to predict the category from a battery of clinical and histopathological variables using newer methods of multivariate data analysis. The incidental prostatic carcinomas of the decade 1990-99 diagnosed at our department were reexamined.

Classification of prostatic carcinoma with artificial neural networks using comparative genomic hybridization and quantitative stereological data.

Staging of prostate cancer is a mainstay of treatment decisions and prognostication. In the present study, 50 pT2N0 and 28 pT3N0 prostatic adenocarcinomas were characterized by Gleason grading, comparative genomic hybridization (CGH), and histological texture analysis based on principles of stereology and stochastic geometry. The cases were classified by learning vector quantization and support vector machines.

[Complications of transrectal prostate biopsy. Determination of current status].

The procedure for prostate biopsy has undergone a dramatic change in the last 2 decades. The introduction of PSA into diagnostics for prostate carcinoma and simultaneous development of modern biopsy techniques have led to a marked increase in transrectal prostate biopsies. At the same time, serious complications have become less frequent.

[Remarks on the introduction of the German Diagnosis-Related Groups (DRGs) for the specialty of urology].

In January 2003 a new system to charge inpatient treatment was established in Germany: the G-DRGs. This system is based on the thought that equal medical service causes equal costs all over Germany. Hospitals offering a broad spectrum of diagnostics and therapies and being unable to select their patients according to economical aspects are put at disadvantage: Despite a perfect documentation the G-DRGs reflect their medical service only in an insufficient way.

Chromosomal regions in prostatic carcinomas studied by comparative genomic hybridization, hierarchical cluster analysis and self-organizing feature maps.

Comparative genomic hybridization (CGH) is an established genetic method which enables a genome-wide survey of chromosomal imbalances. For each chromosome region, one obtains the information whether there is a loss or gain of genetic material, or whether there is no change at that place. Therefore, large amounts of data quickly accumulate which must be put into a logical order.

Transvaginal bone anchors in female stress urinary incontinence: poor results.

Objective: This study evaluates the results of a minimally invasive technique for correcting female stress urinary incontinence by transvaginal implantation of pubic bone anchors.

Patients And Methods: Female stress urinary incontinence was treated by fixing a gelatin-coated Dacron sling between two miniature titanium anchors with Prolene sutures.

Results: A total of 26 patients (median age 57.

Surgical intervention for complications of tension-free vaginal tape procedure.

Purpose: The tension-free vaginal tape procedure has become a state of the art operation for female stress urinary incontinence. Cases of complications requiring surgical revision are reported to be rare. We report on 6 patients with complications necessitating surgery.

Interventional treatment of traumatic priapism.

Purpose: To describe the effectiveness of transarterial embolization of traumatic priapism.

Methods: Six patients ranging in age from 6 to 37 years with traumatic high-flow priapism underwent superselective embolization with gelatin sponges (n=3) or minicoils (n=3). Embolization was repeated up to 3 times.

Chromosomal changes in incidental prostatic carcinomas detected by comparative genomic hybridization.

Objectives: The genetic changes underlying the development and progression of prostate cancer are poorly understood. To identify chromosomal regions in incidental prostatic carcinoma (T1a and T1b) was the primary aim of this study.

Materials And Methods: We used comparative genomic hybridization (CGH) to search for DNA sequence copy number changes on a series of 48 T1 prostate cancer diagnosed by transurethral resection (TURP) and by adenomectomy.

Evaluation of disintegration in prevesical ureteral calculi by 3-dimensional endo-ultrasound with surface rendering.

Purpose: Lower ureteral calculi are accessible by transrectal endo-ultrasound, including 3-dimensional image processing with surface rendering. We analyzed the efficiency of this innovative technology compared with that of standard radiographic examinations with respect to the outcome of extracorporeal shock wave lithotripsy (ESWL) (Dornier Medical Systems, Marietta, Georgia).

Materials And Methods: In patients with prevesical or intramural calculi we performed excretory urography and transrectal endo-ultrasound using a Combison 530 device (Kretz Technik, Zipf, Austria) with integrated optional 3-dimensional image processing and surface rendering.

High-flow priapism: a combined interventional approach with angiography and colour Doppler.

Traumatic high-flow priapism caused by a pathologic influx from lacerated arteries to the cavernous bodies is usually treated by transcatheter arterial embolisation. The purpose of this study was to evaluate a combined interventional approach with intraoperative perineal colour Doppler ultrasound (US) while performing the embolisation procedure. Our aim was to reduce radiation exposure and application of iodinised contrast media.

Visualization of urinary stones by 3-D ultrasound with surface rendering.

The purpose of this study was to evaluate the diagnostic value of 3-D ultrasound with surface rendering in stones located in different parts of the urinary tract. A total of 55 patients with urinary stones were examined by transabdominal 3-D ultrasound (US) with surface rendering of the stone. In calculi of the prevesical ureter, bladder and prostatic urethra, transrectal 3-D endosonography was performed as well.