ABSTRACT
Objective:To simulate the urinary tract environment in vitro and observe the local thermal effects generated by the holmium laser when it is continuously emitting under different mode settings, working medium and perfusion speed.Methods:This study was conducted from March to December 2019. Static medium model: Under normal pressure, 25℃ constant temperature and 50% humidity, a glass test tube with an inner diameter of 1cm and working medium of 1ml was placed into a beaker containing 300ml of 37℃ constant temperature water, and a 550 μm laser fiber was placed in the working medium in the test tube. The laser was continuously emitting for 60.0 seconds, and the temperature of the water in the test tube was continuously recorded using a temperature measuring instrument. The laser working mode was set as dusting, fragmenting, and "popcorn" mode, the energy was set at 10-20 W, and the working medium was normal saline, distilled water, and 5% mannitol solution. Flow medium model: In the same environment, the same optical fiber and temperature probe were placed in a 6mm flush tube, and the laser was continuously fired and continuously perfused with saline. The flushing speed was controlled between 100 ml/h and 1 200 ml/h, and the water temperature change during laser emission was recorded. The real-time temperature changes around the fiber tip with different modes, different media, and different perfusion rates were analyzed.Results:Static medium model: After the holmium laser was continuously fired for about 6.0±1.2 seconds, it exceeded the safe temperature of 43℃ , reached the plateau temperature in about 27.6±2.1 seconds and drop to the safe temperature after stopping excitation for 38.2±2.4 seconds. The plateau temperature dusting group > "popcorn" group > fragmenting group ( P<0.01), of which the dusting group(78.67±0.45)℃ (20 W) was the highest and the fragmenting group (55.67±0.22)℃ (10 W) was the lowest. The temperature of 5% mannitol solution (73.92 ± 0.44) ℃ was the lowest among the three experimental working media, which was (75.57±0.14)℃ of distilled water group and (78.67±0.45)℃ of normal saline group (0.4 J×50 Hz, 20 W). Flow medium model: The perfusion rate of 800ml/h can ensure that the continuous emitting of the holmium laser remains at a safe temperature (40.96±0.36)℃. It only took 7.0±1.0 seconds to decrease to the initial temperature after stopping emittion. Conclusions:Under the same total power, the high-energy-low-frequency fragmenting lithotripsy mode has a relatively lower thermal effect. Under the same total power, the thermal effect of holmium laser emittion is relatively lower in the environment of 5% mannitol solution. Perfusion of ≥800ml/h can effectively reduce the local high temperature caused by the thermal effect of holmium laser.
ABSTRACT
Objective To investigate the clinical manifestations,imaging and pathological features and treatment prognosis of primary renal sarcoma in adults.Methods A retrospective analysis was performed on the clinical data of 48 patients with primary renal sarcoma from January 2009 to December 2018 in the first affiliated hospital and cancer center of Sun Yat-Sen university.There were 30 males and 18 females.Their aged ranged from 27 to 76 yrs with an average age of 50 yrs.A total of 24 patients presented with lumbar and abdominal pain.Abdominal mass was found in 2 cases.Gross hematuria was noticed in 4 cases.Febrile was recorded in 2 cases and 21 cases were diagnosed by physical examination.31 tumors located in the left kidney and 17 tumors located in the right kidney.The tumor diameter ranged from 3 to 16 cm with an average diameter of 8 cm.All patients underwent ultrasound or CT/MRI examination of the urinary system before surgery.The ultrasound showed the undistributed echo inside the tumor with the undistinguished border.The image of necrosis and liquefaction could be seen in some cases.The CT/MRI examination showed the lesion site with the necrosis,liquefaction or cystic changing.The mass exhibited the unregular enhancement with undistinguished border line.The mean diameter of liposcarcoma was 10.2 cm.CT scan demonstrated the relative low density of tumor,which was hard to be identified with AML.The average diameter of leiomyosarcoma was 6.5 cm.The enhanced CT scan showed the low density of tumor,compared with renal parenchyma.46 patients underwent radical nephrectomy,2 patients underwent renal tumor biopsy.And postoperative follow-up was performed.Results Pathological diagnosis revealed that 19 cases with liposarcoma,9 cases with leiomyosarcoma and 4 cases with synovial sarcoma,especially 4 cases with Ewing' s sarcoma and 12 cases with other sarcoma.36 cases were followed up and survived for 4 to 64 months.The average survival time was 28 months.The longest mean survival time was seen in patients with liposarcoma,which was 32 months (ranging 11 to 64 months).The mean survival time of synovial sarcoma group was 25 months (ranging 5-58 months).The mean survival time of Ewing's sarcoma group was 22 months(ranging 12-46 months).and the survival time of leiomyosarcoma group was the shortest 20 months (ranging 4-36 months).Conclusion Renal sarcoma is rare and highly malignant.It needs to be diagnosed with clinical manifestations,imaging and pathological data together.