ABSTRACT
Objective To discuss the lymph node metastasis of chromophobe renal cell carcinoma (chRCC) in children.Methods One case of chRCC was reported.A eleven-year-old boy was admitted to our hospital on November 2,2017 and presented gross hematuria 4 weeks.No mass was palpable in the abdomen and he felt tenderness in the left back.The ultrasound showed a solid mass in the lower pole of the left kidney.There were a lot of tortuous blood vessels in the tumor.Contrast enhanced CT suggested a mass of 4.5 cm × 6.3 cm × 4.9 cm.The left renal artery and vein were thickened.There was no enlarged lymph nodes were seen in both examinassions.During the operation,the tumor was located in the lower pole of the kidney.The frozen section diagnosis was benign renal tumor.Nephron-sparing surgery was performed.Results The pathology showed that the tumor cells had well-defined cell borders and characteristic perinuclear halos surrounded by eosinophilic cytoplasm that was positive for Hale's colloidal iron stain.Immunohistochemical studies were positive for EMA (+),Ki-67 (5％ +),CK19 (+),CK (+),CD10 (+),CD117(+),CD56(+).Fluorescence in situ hybridization showed absence of TFE3 protein,a strong immune marker of Xp11.2/TFE renal cell carcinoma.1 year after the operation,contrastenhancement magnetic resonance showed long T1 signal near the left renal hilum and the mass showed slight enhancement.ChRCC with regional lymph node metastasis hereby was considered.Intraoperatively,an approximately 2.5 cm × 2.0 cm × 2.0 cm mass was seen near the the left renal hilum.The tumor did not involve left kidney,abdominal aorta and inferior vena cava.The mass was completely removed and introoperative fast-frozen pathology revealed chRCC.Nephron-sparing surgery was performed.Postoperative pathology report chRCC local lymph node metastasis.Follow-up at six months after resection,there was no recurrence or metastatic disease identified.Conclusions chRCC is rare in children and clinical stage is low with a good prognosis.Local recurrence and distant metastasis is rare.
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Objective To summarize the diagnosis and treatment of epispadias with complete prepuce.Methods Between January 2007 and April 2017,clinical records were reviewed for 5 patients diagnosed as epispadias with complete prepuce.The patients were 34 to 66 months old (mean age 44.3 months),who presented with short beaked penis and nonretractile prepuce.A dorsal midline gap between corpora cavernosa could be felt on palpation.There was dorsal chordee with broad spade like glans.The preputial opening was stenosed and dorsally placed urethral opening after retraction of the prepuce.Two patients were incontinent before surgery.Epispadias were coronal type in 2 cases and penile type in 3 cases.All 5 cases were repaired by Thiersch-Duplay procedure.Results The mean follow-up time was 44.5 months (ranged 3 to 98 months).The stricture occurred in 1 patient 1 month after operation,and after dilation and indwelling catheter for a month,the problem resolved.One needed a secondary preputial plasty due to redundant ventral foreskin 8 years after operation.In 3 of 5 cases,parental satisfaction was not achieved mainly due to short length.Only 1 case was incontinent after surgery and the other four achieved urinary continence.Voiding cystourethrogram (VCUG) and ultrasonography (USG) were done in 2 patients who were incontinent before surgery.One case presented right vesicoureteral reflux of Grade Ⅱ and the other was normal.The urodynamic results of 2 patients were normal.Conclusions Epispadias with complete prepuce is extremely rare and its preoperative diagnosis remains difficult.A definitive diagnosis is based upon history,physical examination and imaging tests.Fewer complications and better continence rates were achieved in the boys with epispadias and intact prepuce.Penile length is an important factor affecting surgical outcome.
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The neurogenic urinary bladder in children is defined as a dysfunctional bladder associated with a known neurological injury which can cause voiding dysfunction and serious damage to the upper urinary tract. There are many principles of treatment available for patients with a neurogenic bladder,and drug therapy is one of the major treat-ments. The main goals for drug therapy are lowering storage pressures,preventing detrusor overactivity and lowering the residual volume and treating or preventing urinary tract infections. As more and more new drugs are put into clinical trials,the quality of life of patients with neurogenic bladder is improved and complications are reduced. However,due to the special nature of groups of children,the clinical application of drugs is relatively cautious,the effectiveness of treat-ment is not clear. This article reviews the data on pharmaceutical agents used in the treatment of neurogenic bladder in children in order to improve the medical quality and prognosis.
ABSTRACT
Posterior urethral valves(PUV) is the most common cause of lower tract obstruction in boys.With the understanding of the prognostic factors of PUV in depth,PUVs can have a profound effect on the function of bladder and upper urinary tract though valves are completely resected.The treatments of PUV include prenatal intervention,the antenatal vesicoamniotic shunt and fetal cystoscopy can be considered in selected patients with oligohydramnios.But the role of antenatal intervention is unclear.The gold standard for postnatal treatment of PUV is valve ablation.Vesicostomy is reserved primarily for the children with PUV whose urethra cannot accommodate an endoscope, as well as have severe urinary tract infections.Circumcision should be encouraged as a prophylactic measure for children with PUV who should have high rate of urinary tract infection.Vesicoureteral reflux is very common in PUV patients, and life-long monitoring of these patients is mandatory, as bladder dysfunction and valve bladder may be found during follow-up.These factors contribute toward the devolution of a bladder into dysfunction status are high voiding pressures and increased residual urine.Medication and clean intermittent catheterization are two main interventions, for the children who difficult to treat, an appendicovesicostomy utilizing the Mitrofanoff principle presents an useful option.Renal transplantation is an alternative for patients with PUV who progress to end-stage renal disease.Bladder dysfunction plays an important role in the development of PUV and urodynamic examination can be used to assess the function of the bladder to achieve timely and effective intervention.
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The absorptioa of zinc in the fermented soybean weaning food was studied using methed of neutron activation analysis of a stable isotope 70Zn. The results indicated that the rate of zinc absorption (38.7%), activity of alkaline phosphatase in serum (102.3V/L) and the increment of weight (0.5kg) of the infants (7-18m) eating the soybean fermented weaning food were higher than those eating the nonfermented soybean weaning food (30.9%, 71.0V/L, 0.4kg) and the traditional grain weaning food (rice gruel and noodle) (27.5%, 61.5V/L, 0.4kg)