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Objective:To explore the efficacy of pedicled bladder muscle flap in the repair of urinary tract obstruction.Methods:The data of 26 patients with urinary tract obstruction admitted to Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March 2016 to June 2021 were retrospectively reviewed. There were 14 males and 12 females, with the age ranged from 2 to 75 years old. Refractory bladder neck obstruction after prostatic hyperplasia surgery in 12 cases, with the age of (70.0±3.5) years old.They all experienced at least 2 times of transurethral stenosis incisionor resection. Transpubic cystostomy tube was placed in 9 patients. Posttraumatic pelvic fractures lead to bladder neck atresia and urethral injury in 6 girls, with the age of (10.5±2.1) years old. The bladder neck atresia and urethral obliteration length was 1-2 cm determined by urethrography. Eight cases suffered ureteral strictures after gynecological myomectomy or ureteroscopy holmium laser lithotripsy(4 cases of each type), including two males and six females, with the age of (55.0±3.2) years old. The length of ureteral stricture or defect was 5-6 cm determined by intravenous urography(IVU) or CT urography(CTU). The patients with bladder neck obstruction underwent the following surgery: The "Y" incision of the bladder and stenosis of the prostate urethra was performed and the pedicled bladder muscle flap was inserted into the normal urethral mucosa to complete the Y-V plasty. In the 6 girl patients, pedicled bladder muscle flap(2-4 cm) augmented reconstruction were performed. All above 18 patients, whose urethral catheter was indwelled for 3-4 weeks, urinary flow rate and urethroscopy examination were performed to evaluate the effect of surgery 4 weeks and 3 months after the operation. As the 8 cases with ureteral strictures, the pedicled bladder muscle flap (7-8 cm) ureteroplasty was performed and the ureteral stent was retained for 4 weeks. Ultrasonography and IVU/CTU were performed 4 weeks and 3 months postoperatively. The patency of the ureteral lumen and whether it is accompanied by hydronephrosis, lower back pain, and urinary tract infection were assessed.Results:All patients underwent pedicled bladder muscle flap reconstructive surgery successfully and no serious complications occurred postoperatively. The patients were followed up for (8.2± 2.2) months. As urethral catheters were removed, 10 patients with refractory neck obstruction could return to normal urination with the urinary flow Q max (17.2±2.8)ml/s, while 2 patient had dysuria and were treated with regular urethral dilatation. The catheter was removed 4 weeks after the reconstructive surgery in 6 girls with bladder neck atresia and urethral injury after posttraumatic pelvic fracture. Five could successfully urinate with the urinary flow Q max of (16.7±1.1)ml/s, and one girl had urinary incontinence, waiting for further operation.The ureteral stent was removed after ureteroplasty in 8 patients. CTU and IVU examination showed no ureters with obstruction.No one had low back pain, discomfort, or urinary tract infection. Conclusions:The reconstruction using the pedicled bladder muscle flap was a convenient, minimally invasive and effective technique for the management of adjacent lower ureters, bladder neck, and proximal urethra.
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Objective To investigate the expression of CD90,IGF1R in hepatocellular carcinoma.Methods CD90,IGF1R expression were detected by SP immunohistochemical staining in 36 cases of hepatocellular carcinoma,20 cases of normal liver tissue biopsied from patients of chronic cholecystitis undergoing cholecystectomy. Results The positive rate of CD90 (63.89％,23/36),IGF1R (52.78％,19/36) in hepatocellular carcinoma significantly increased (P ＜ 0.05 ); The positive rate of CD90 was higher in UICC Ⅲ - Ⅳ stage group (79.17％ ) than in UICC stage Ⅰ - Ⅱ group (33.33％,P ＜0.05) ;The positive rate of CD90 was higher in low differentiated group (76.92％ ) than in well-differentiated group (56.52％,P ＜0.05).The positive rate of IGF1R was higher in UICC Ⅲ - Ⅳ stage group (70.83％ ) than in UICC stage Ⅰ - Ⅱ group ( 16.67％,P ＜ 0.05 ). The positive rate of IGF1R was higher in low differentiated group (84.62％) than in well-differentiated group (37.38％,P ＜ 0.05 ).The expression of IGF1R was positively correlated with that of CD90 (P ＜ 0.05 ).The median survival of CD90+ patients (85 days) was shorter than CD90- patients ( 505 days ) ( P ＜ 0.05 ).The median survival of IGF1 R + patients (100 days) was shorter than IGF1 R- patients (408 days,P ＜ 0.05). Conclusions CD90 or IGF1R expression correlates positively with the progression of HCC.
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ObjectiveTo study the expressions of CD90 and hTERT in hepatocellular carcinoma (HCC),and their relationships to progression of tumor.MethodsThe expressions of CD90 and hTERT in hepatocellular carcinoma were detected by S-P immunohistochemical staining.Twenty patients with hemangiomas of liver were used as control.ResultsCompared with the control group,the positive rates of CD90 and hTERT in HCC were significantly higher (63.9％ and 47.2％ vs 0％ and 0％).The positive rates of CD90 and hTERT were significantly higher in patients with tumors at UICC Ⅲ-Ⅳ stage than at UICC stage Ⅰ -Ⅱ (79.1％ and 62.5％ vs 33.3％ and 16.6％).The CD90 expression correlated with hTERT positively.There were significant differences in survival between patients with CD90+ and CD90- or hTERT+ and hTERT-.The median postoperative survivals for patients with CD90+ and hTERT+,CD90- and hTERT- were 85 d and 76 d,505 d and 463 d,respectively.ConclusionsCD90 expression correlated positively with progression of HCC.It has the potential to serve as a prognostic marker for HCC.
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Objective To determine the value and reasonable application of slowly coated vicryl plus and albumin gel in primary suture after common BD exploration. Methods The operation was successfully performed in all 45 patients. The incision of common bile duct was directly sewed up by slowly coated vicryl plus and spurted by albumin gel after the exploration. Results There were no complications such as bile leakage and bile duct stricture etc.The mean payment of hospitalization was low 10.5%. Conclusion This method was safe,feasible and effective.
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Objective To explore the effects of second biopsy and resection on tumor recurrence and progression in patients with high risk non-muscle invasive bladder cancer. Methods The second biopsy and resections were performed 4-6 weeks after the first transurethral resection in 52 patients. Routine follow-up was done in another 71 patients. The tumor recurrence and progression rates were compared. Results Residual tumors were found in 54%(28/52) of patients underwent second biop-sy and resection, including muscle-invasive tumors in 5 patients. Two patients underwent radical cys-tectomy due to resection findings. During same period, 71 patients were routinely followed. After a median observation of 27 months, patients underwent second biopsy and resection showed lower recur-rence rate (P<0.05). The progression rate was no difference between the 2 groups(P0.05). Conclusion Second biopsy and resection may reduce recurrence rate in high risk non-muscle invasive bladder cancers, but may not change the tumor progression rate.
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Objective: To screen and identify serum amyloid A (SAA) in patients with prostate cancer with mass spectrum technique. Methods: SELDI technology was used to detect the changes in protein expression. SAA was screened and separated and then identified by peptide mass fingerprint (PMF) based on matrix-as-sisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS) and database searching. Results: The analysis showed that a mass cluster in the ranges of 11.1-11.9KD in M/Z value in the serum of prostate cancer patients was much higher than that in the control group. Meanwhile, this protein peak was closely correlated with clinical stages of prostate cancer. The level of the protein peak was increased as the illness got serious. Through MALDI technology combined with HPLC, the mass cluster in the range of 11.1-11.9KD in M/Z value on the chip was identified as SAA. And it was also verified through ELISA method. Conclusion: Mass spectrum technology is an effective method to detect the biological markers in prostate cancer patients. This method is convenient, highly sensitive and with good reproducibility. The SAA can be used as a marker in the diagnosis of prostate cancer. These indices are also meaningful in screening and identifying signal proteins from the serum of prostate cancer patients.
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Objective To investigate the effects of medicine androgen deprivation therapy(ADT)on quality of life in patients with prostate cancer.Methods A total of 42 consecutive advanced prostate cancer patients without any other anti-androgen medications after ADT[A subcutaneous depot injection of LHRH-agonist(Zoladex) was instituted every 28 days]were enrolled.Levels of serum testosterone and prostatic specific antigen(PSA)were obtained just prior to ADT and after ADT.The general and disease-specific health-related quality of life were assessed.Results The average testosterone level was less than 50 mg/L after medical ADT in 3 weeks.And PSA level declined dramatically in one month.Although there were no significant differences on physical discomfort and limitations to daily activities.Urinary obstruction symptoms after ADT were disappeared and the size of prostate were reduced after one month.The appetite and vigor were worsened.Overall health status and sexual function were significantly reduced.Conclusion The ADT could make serum testosterone and PSA decline dramatically in short time,and worsen some general health-related quality of life.
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Objective To investigate the usefulness of percentage of free prostate specific antigen(FPSA/TPSA)/PSA density[(F/T)/PSAD]in the diagnosis of prostate cancer of PSA level in 4~10ng/ml. Methods 88 patients of PSA level in 4~10ng/ml were carried out transrectal ultrasound guided prostate biopsy. Among them,21 patients were proved to be suffering from prostate cancer,and other 67 patients were identified as benign prostate hypertrophy. The effect of F/T ratio,PSAD and(F/T)/PSAD in the diagnosis of prostate cancer were investigated. Results The mean value of(F/T)/PSAD of prostate cancer were significantly lower than benign prostate hypertrophy for patients with PSA levels in 4.0-10ng/ml, This difference has arrived statistical significance(P
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Objective To study the influence of gene transfer of TNFR on the tumorcidal activity of TNF. Methods By constructing retroviral expressin vector of TNFR and transfecting package cell PA317,the virus that can transfer TNFR was established.Then the virus was used to infect BIU 87 cell line.The TNFR number on tumor cell membrane and the tumorcidal activity of TNF in vitro were detected. Results The number of TNFR on cell membrane of BIU 87 cell was 912/cell and increased to 2 872/cell( P
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Objective To study the diagnosis and trea tm ent of multiple endocrine neoplasia type 2b. Methods On e case of MEN2b was reported.The clinical features,the diagnosis and treatment o f MEN2b were reviewed and presented. Results The diagno sis was established on B-ultrasonography and CT scanning,and the patient was cu red by operation. Conclusions MEN2b has been rare.Endoc rine check up,imaging procedures,family investigation and DNA analysis are very important to early diagnosis.Surgical removal of the tumors is effective.