ABSTRACT
Objective Investigating the CT features and related prognostic factors of high-grade renal clear cell carcinoma.Methods The data of 141 patients with renal clear cell carcinoma treated by radical nephrectomy in our hospital from November 2012 to April 2017 were analyzed retrospectively.There were 102 males and 39 females.Age from 30 to 86 years old.The tumors were located in the left side in 73 cases and 68 in the right.The tumor size ranged from 1.6 cm to 12.7 cm.50 cases of clinical stage T1a,stage T1b 67 cases,24 cases above T2.All patients had CT examination before operation.According to the postoperative pathological nuclear grade,patients were divided into high grade group (Ⅲ-Ⅳ) and low grade group (grade Ⅰ-Ⅱ),clinical data and CT findings were compared between the two groups (tumor size,capsule,CT,with or without leafs,with or without hemorrhagic necrosis),survival situation after the operation.Result The results of CT examination of 141 cases of this study indicated there were 109 cases of complete capsule,85 cases of tumor showed lobulation,102 cases of tumor showed hemorrhagic necrosis,the average CT value is 10-72 HU,35.4 HU in average;enhanced CT value is 32-308 HU,102.1 HU in average.After pathological examination,the nuclear classification was 66 cases in high grade group and 75 cases in low grade group.The CT examination in thc high grade group and the low grade group showed the number of cases with complete capsule [44 cases (33.3％) vs.65 cases (13.3％)] and plain CT scan value [(38.9 ± 1.1) HU) vs.(32.3 ± 1.1) HU],the difference was statistically of significance (P ＜0.01).The high level of patients in group T1 and group above T2 stage were 46 cases and 20 cases.And the cases of low grade group were 71 cases and 4 cases,there was significant difference between two groups (P ＜ 0.01).The 141 cases were followed up for 2-58 months,with an average of 26.4 months.There was statistical significance difference between the two groups of T1 patients and patients above T2 (P ＜ 0.01).The results of CT examination were compared.There were significant differences in the case of intact capsule and the value of CT scan (P ＜ 0.01).The overall survival rate between the two groups was statistically significant (P ＜ 0.05).Conclusions The CT examination of high-grade renal cell carcinoma shows that most of the capsule is not complete and the CT value of the scan is much higher.The pathological grading of renal cell careinoma indicates the malignancy of tumor cells,which is closely related to prognosis.
ABSTRACT
Objective To discuss the diagnosis and treatment of normotensive pheochromocyto-ma. Methods The clinical data of 22 patients with normotensive pheochromocytoma were reviewed. Inclusion criteria for normotensive pheochromocytoma were no previous history of hypertension and episode of symptoms suggesting high blood pressure. The blood pressure on admission was 90-130/ 60-90 mm Hg with an average of 113/72 mm Hg. Seven patients were found adrenal mass by routine ultrasonic examination. Twelve patients presented with superior abdominal or flank pain. Four pa-tients were present with fatigue, and 2 patients had fever. Headache and palpitation were found in 1 patient. Most of patients were present with large and round mass with low density area in the center of the tumor by uhrosonography and CT. Four patients had elevated level of plasma epinephrine and nor-epinephrine. 24 hours urine CA and VMA were elevated in 5 and 4 patients respectively. Seven pa-tients were prepared with infusion preoperatively to expand intravascular volume, and 2 patients were given prazosin 1.5 mg/d for 5 to 7 days. Results During the operation, seventeen patients had ele-vated blood pressure and 5 patients had no changed. One of seven patients with preoperative prepara-tion had obvious hypertension during operation, and 11 of 15 patients without preoperative preparation had obvious hypertension. The tumors were removed successfully in 21 patients. All the patients were diagnosed pheochromocytoma pathologically. Twenty-one patients had normal blood pressure with no recurrence during the follow-up from 1 month to 7 years. Conclusions The patients with normotensive pheochromocytomas may have lower catecholamine in their plasma and urine. The application of α-blockers and the expanding intravascular volume before operation could be important for the patients safe.
ABSTRACT
Objective To study the diagnostic and therapeutic means of kidney cortex suppurative infection. Methods 27 cases of kidney cortical suppurative infection were studied retrospectively. Results 14 cases of acute bacterial nephritis and 7 cases of renal cortical abscess were cured on antibiotics therapy.Nephrectomy was performed for 2 patients with acute bacterial nephritis and 4 cases of renal cortical abscess greater than 5 cm in diameter were cured by surgical intervention. Conclusions These two diseases can be diagnosed by comprehensive evaluation of clinical manifestation,auxialliary examination and treatment trials.CT and B ultrasonography both play an important role.Renal cell carcinoma should be excluded in diagnosis because these two likewise show a mass on imaging.Antibiotics can be used in acute bacterial nephritis and in renal cortical abscess less than 5 cm in diameter whereas in abscess larger than 5 cm, surgical intervention is needed.