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Objective To investigate the diagnosis and therapy by improving the further understanding of adrenal hemorrhage.Methods The clinical data of 12 cases of adrenal hemorrhage confirmed by pathology admitted to the First Hospital of China Medical University from October 2006 to October 2017 were retrospectively analyzed.Observe the patient's clinical manifestations,imaging features,treatment methods and prognosis.Results All 12 cases were unilateral adrenal hemorrhage,8 cases manifested lumbago in troubled side,2 cases manifested abdominal pain,and 2 cases were found during physical examination incidentally with no obvious symptoms.Ultrasound-B was performed in 10 cases,revealed low echo of masses in 5 cases,mixed echo of masses in 2 cases,cystic echo of masses in 2 cases,and no abnormality in 1 case.All 12 cases were scanned by CT,9 cases showed cystic masses with mixed density,and 3 cases showed solid masses.The value of plain CT ranged from 31 HU to 77 HU,no obvious enhancement was found in enhanced scan.One case was scanned by MRI,showed round mass in left adrenal gland,with uneven signal.The main signal was iso-signal in T1-weighted and T2-weighted.Six cases underwent adrenal and mass resection through the 11th rib,3 cases underwent retroperitoneoscopic adrenalectomy,2 cases underwent abdominal exploration and accepted adrenalectomy and hematoma removal,and 1 case was discharged after conservative treatment because of surgery contraindication.11 cases of the pathology of postoperation were adrenal hemorrhage.Conclusions Preoperative diagnosis of adrenal hemorrhage is relatively difficult,ultrasound-B,CT,and MRI examination can help diagnose.Surgical treatment should be performed for patients who can tolerate surgery and with larger hematoma (＞5 cm).
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Objective To investigate the role of NF-kB in radiation-induced apoptosis ot human non-Hodgkin lymphoma (NHL) cells and the mechanism involved.Methods Three human non-Hodgkin lymphoma cell lines,Namalwa,Ramos,and Raji cells were divided into control,IR and IR + QNZ ( 10nmol/L) groups,respectively.Annexin-V kit was used to determine cell apoptosis. Protein expression levels of Survivin,Bax,Bcl-2 and cleaved Caspase-3 were evaluated by Western blot.Survivin mRNA was quantified by real-time PCR.Results Inhibition of NF-kB by QNZ pretreatment significantly enhanced X-ray induced apoptosis in human NHL cells in a dose-dependent manner (t =2.93 - 12.52,P ＜ 0.05).At the same time,QNZ significantly reversed the expression levels of Survivin protein and mRNA that were upregulated by radiation(t =3.29 - 16.72,P ＜ 0.05).QNZ also increased the levels of Caspase-3 and proapoptotic protein Bax,but reduced anti-apoptotic protein Bcl-2 expression level and hence the ratio of Bcl-2/Bax.Conclusions Inhibition of NF-kB could enhance radiation-induced cell apoptosis in human NHL cells through down-regulating Survivin expression and decreasing Bcl-2/Bax ratio.
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Objective To study the value of renal CT scan in evaluating split renal function.Methods 147 patients undergone CT scan from June 2009 to June 2011 were involved in this study.There were 73 cases of obstructive hydronephrosis and 74 cases of renal tumors.66 patients were males and 81 were females with a mean age of 53 years ( range 17 - 87 years).GFR detected by single-photon emission computed tomography (SPECT) was used as the reference of split renal function.The kidneys were divided into 3 groups according to the GFR:normal renal function (113 cases,GFR ≥ 34 ml/min),mildly impaired renal function (66 cases,GFR:20 -34 ml/min) and severely impaired renal function (41 cases,GFR ＜20 ml/min).One-way ANOVA and linear regression analysis were used to analyze the relationship between the results of CT scan and split renal functions. Results There were significant differences in the cortical thickness among the normal renal function,mildly impaired renal function and severely impaired renal function groups.The cortical thicknesses were (0.62 ±0.11) cm,(0.45 ±0.10) cm and (0.26 ±0.07) cm,respectively (P ＜ 0.01 ).The renal cortical thickness was strongly correlated with GFR (r =0.806,P ＜0.01 ).There were significant differences in the enhancement during the cortical phase among the 3 groups,which were (162.1 ±25.3) HU,(121.6 ±21.0) HU and (63.5 ±20.0) HU,respectively (P＜0.01).The enhancement during the cortical phase was strongly correlated with the GFR (r =0.851,P ＜ 0.01 ).The enhancement during the parenchymal phase and excretory phase was moderately correlated with the GFR ( r =0.467 and r =0.451,P ＜ 0.01 ). Conclusions The renal cortical tbickness and the enhancement during the cortical phase detected by CT scan might be useful for the clinical evaluation of split renal function.
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Objective To analyze the clinical features and summarize diagnosis and therapeutic efficacy for ureteropelvic junction obstruction(UPJO). Methods Two hundred and twenty-two patients with UPJO were treated from 2000 to 2008,including 155 males and 67 females:the age rangeed from 13 to 75 and mean age was 29 years.One hundred and seventy-three cases presented with back pain;19 cases with urine infection;12 cases with abdomen bump;7 cases with macroscopic hematuria;11 cases found by B-ultrasound examine.Etiological factors included 185 patients of ureteropelvic junction stenosis;18 cases of high location of the junction;19 cases which were diagnosed UPJO due to benign oppression,including fiber cords and peculiar vessels.A total of 222 cases of surgical procedures were conducted,of them Anderson-Hynes dismembered pyeloplasty was conducted for 191 cases,fiber cords and peculiar vessels were relieved for 19,nephrectomy for 12 cases because of nonfunction. Results One hundred and ninety-one cases who underwent Anderson-Hynes dismembered pyeloplasty were all succeeded with operation.They were followed up for 6 months to 8years with a mean of 38 months.B-ultrasound and IVU showed that hydronephrosis was obviously relieved.The clinical symptoms disappeared in all cases.The levels of serum creatinine of 7 cases who had higher ereatinine recovered. Conclusion Anderson-Hynes dismembered pyeloplasty could be a good choice and effective method for the treatment of UPJO.
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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.
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Objective To evaluate the risk factors of urethral recurrences following radical cystectomy for transitional cell carcinoma of the bladder and to discuss the treatment options. Methods Clinical data of 278 patients who underwent radical cystectomy for bladder cancer were analyzed retrospectively. Urethral recurrences were observed in 24 patients. Risk factors of recurrence were evaluated by Cox's multifactor regression model. Results None of the 6 patients undergoing selective prophylactic urethrectomy died;10 of the 24 patients with urethral recurrence died of tumor metastasis.Multiple factor analysis suggested that prostate involvement,bladder neck involvement,trigone tumor,multiple tumor and carcinoma in situ were the high risk factors,and their relative risk coefficients were 1.573,1.532,1.360, 1.337 and 1.213,respectively. Conclusions Simultaneous urethrectomy following radical cystectomy should be performed for patients with high risk factors (prostate involvement, bladder neck involvement, trigone tumor,multiple tumor and carcinoma in situ) of urethral recurrence,while patients without risk factors are eligible candidates for reconstruction of the urinary tract after cystectomy by an orthotopic neobladder.