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Objective:To investigate the effect of pelvic floor muscle exercise (PFMT) combined with transcutaneous electrical nerve stimulation (TENS) on urinary incontinence after radical prostatectomy.Methods:A total of 120 patients with urinary incontinence after radical prostatectomy in Shuguang Hospital, Shanghai University of Traditional Chinese Medicine from July 2020 to June 2021 were retrospective selected and divided into control group and observation groupthe according to different treatment method, 60 cases in each group. The control group was treated with PFMT, and the observation group was treated with PFMT combined with TENS. Urodynamic indexes of 72 h urine pad usage, maximum urine flow rate, maximum cystometric capacity, maximum urethral closure pressure, abdominal leakage point pressure, ICI-Q-SF score and the clinical efficacy were compared between the two groups. Measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used for comparison between groups; Chi-square test was used for comparison of enumeration data between groups. Results:After treatment, the 72 h urine urine pad usage in the observation group [(1.95±1.13) pieces] was lower than that in the control group [(6.28±2.47) pieces], and the difference was statistically significant ( P<0.05). After treatment, the maximum flow rate [(13.92±2.53) mL/s], maximum cystometric capacity [(338.72±19.22) mL], maximum urethral closure pressure [(69.75±5.04) cmH 2O], abdominal leakage point pressure [(90.56±5.26) cmH 2O] in observation group after treatment were better than those in control group [(11.48±2.18) mL/s, (325.81±18.63) mL, (65.29±4.78) cmH 2O, (83.58±5.29) cmH 2O], the difference were statistically significant ( P<0.05). After treatment, the ICI-Q-SF score of the observation group [(5.97±1.82) points] was lower than that of the control group [(10.95±2.64) points], and the difference was statistically significant ( P<0.05); the clinical effective rate of observation group (93.33%) was higher than that of control group (78.33%), and the difference was statistically significant ( P<0.05). Conclusion:PFMT combined with TENS is better than PFMT alone in the treatment of postoperative urinary incontinence after radical prostatectomy.
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Objective To explore the reasons of biliary restenosis after interventional treatment for malignant obstructive jaundice caused by hepatic hilar cholangiocarcinoma and to discuss its management. Methods During the period from June 2010 to Sep. 2013 at authors’ hospital, a total of 36 patients with high biliary obstruction caused by Bismuth Ⅱ - Ⅳ type of hepatic hilar cholangiocarcinoma received percutaneous transhepatic cholangial stenting (PTCS), and as the patients developed biliary restenosis after PTCS percutaneous transhepatic cholangial drainage (PTCD) had to be carried out. All the patients had complete data. Serum total bilirubin, direct bilirubin, glutamyltranspetidase and alkaline phosphatase levels were determined on the operation day and at five days after PTCS and PTCD. The short - term remission of malignant obstructive jaundice produced by PTCS and PTCD were assessed. The causes of biliary restenosis were analyzed by comparing the CT and/or MRI images as well as the cholangiography and drainage test results which were performed at the first and second admission to hospital. Results The interval time from operation to restenosis was 31 - 468 days, with an average of 132.8 days. The effective rates of PTCS and PTCD for relieving jaundice were 77.8% and 75.0% respectively. The main causes of restenosis included the formation of biliary sludge, acute cholangitis and tumor growth. Conclusion PTCS is an effective means to relieve the malignant obstructive jaundice caused by hepatic hilar cholangiocarcinoma, however, the incidence of biliary restenosis after PTCS is higher, which may be mainly due to the tumor growth. Nevertheless, subsequent PTCD can effectively improve the liver function, control biliary infection, remit biliary obstruction and relieve the clinical symptoms.
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Objective To evaluate the therapeutic effect of percutaneous transhepatic biliary drainage (PTBD) with different approaches in patients with hilar cholangiocarcinoma type Ⅱ-Ⅳ.Methods The short-term clinical effect and longterm survival rate were analyzed retrospectively for a group of 97 patients with hilar cholangiocarcinoma type Ⅱ-Ⅳ receiving PTBD with different approaches,i.e.unilateral and bilateral biliary drainage,each including stent placement and drainage tube implantation.Results No significant difference was found in the decreasing of TBIL and DBIL,the survival rate and survival Curve between unilateral and bilateral biliary drainage.The median survival time was 7.5 months in unilateral and 6.7 months in bilateral biliary drainage,6.0 months in single stent and 6.5 months in single drainage tube,and 4.3 months in bilateral stents,respectively.The post operation complications mainly occurred in single drainage tube.Conclusion Single biliary drainage is able to decrease bilirubin for hilar cholangiocarcinoma type Ⅱ-Ⅳ,while stent implantation should be taken as the first choice.
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Objective To investigate the morphological change of intratumoral microvessels after administration of thalidomide in the murine hepatic metastases. Methods Among 20 mice with hepatic metastases created by injection of colon-26 tumor cells into the spleen, 10 were treated with thalidomide (200 mg/kg) by intraperitoneal injection daily, the other 10 were treated with saline only by intraperitoneal injection daily. Fifteen days after inoculation of tumor cell, the intratumoral mierovessel of hepatic metastases with similar size in both groups were studied with in vivo microscopy (26 and 27 neoplasms in experimental group and control group respectively ) and immunohistochemistry for CD34 (52 and 55 neoplasms in experimental group and control group respectively). Two-tailed student t test was used to determine differences in intratumoral microvessel density (MVD), intratumoral branch density (BD) and CD34 positive intratumoral microvessel density (MVD-CD34) between the small ( < 400 μm in diameter) and large metastases in both groups, and that between thalidomide treated group and control group. Results For the control group, although the MVD and MVD-CD34 of larger metastases was more than that of small metastases respectively [(18.1±3.5)% vs (13.0±3.2) %, t =2.840,P<0.01;(22.9±2.8)vs ( 12. 8±2. 5) vessels per field, t = 9. 860, P < 0. 01 ], the BD was similar to that of small metastases [(110.0±20.5)vs(99.7±17.3) branches/rnm2, t = 1.040,P >0.05]. For the thalidomide treated group, despite the MVD-CD34 of larger metastases was more than that of small metastases [ ( 17.4±2. 3)vs (11.5±2. 5 ) vessels per field, t = 8. 770, P < 0. 01], the MVD and BD was similar to that of small metastases respectively [(14.7±3.5)% vs(13.2±3.3) %, t =0.826,P >0.05; (95.3±18.3)vs (97. 1±21. 0)branches/mm2,t=0. 347,P>0. 05]. The MVD, BD and MVD-CD34 of small metastases were similar to each other between two groups ( t = 0. 098, 0. 392,1. 190; P > 0. 05 ), however, that of large metastases were significantly lower in thalidomide treated group than in control group ( t = 3. 140,2. 870, 9. 850;P < 0. 01 ). Conclusions Thalidomide exerts antiangiogenic effect on the hepatic metastases with angiogenesis only, and the different vascular components in the tumor vasculature demonstrate variousresponses to antiangiogenic therapy.
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Objective To establish rabbit model of remnant carcinoma after RFA therapy, and to observe pathomorphological changes of remnant carcinoma in different time. Methods Forty-eight New Zealand white rabbits underwent ultrasound-guided percutaneous inoculation with VX2 carcinoma, then RFA therapy was performed to made models of remnant carcinoma. These models were averagely divided into 6 groups randomly (each n=8). Rabbits in each group was killed and pathologically observed before RFA and 1 d, 3 d, 1 week, 2 and 3 weeks after operation, respectively. Results The expression of MVD,VEGF and PCNA in remnant VX2 carcinomas tissues decreased significantly, but increased 2-3 weeks after RFA. The remnant VX2 carcinomas tissues were in inhibitory state 2 weeks after RFA. Conclusion The growth of remnant carcinoma could be inhibited in short term after RFA. Further therapy is necessary.
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Objective To evaluate the embolization efficiency,short term clinical effect and adverse reactions of trisacryl gelatin microspheres in interventional treatment of hepatic carcinoma. Methods Twenty three cases of hepatic carcinoma (34 foci)were given 0.5-6 ml of microspheres mixed with some contrast medium via catheter after injection of chemodrugs and lipiodol 3-5 ml; and simultaneously observing the appearance of slow down of blood flow and vascular cast formation to stop the procedure. Enhanced CT or MR and AFP were performed every 1 month after the first procedure. Treatment needed to be repeated whenever the foci or new ones were enhanced in CT scans or increase of AFP value. The clinical effect and adverse reactions were also observed. Results The positive response rate was 39.1% (CR+PR). There were 9 cases of PR,13 cases of NC and 1 of PD; but no case of CR. Residual enhancement was observed in 17 foci after first procedure,10 of which received repeated therapy and 3 were embolized completely. The other 11 foci were completely embolized,among them 4 had new residual enhancement during 4-9 mo follow up and 2 were re-embolized completely. Eighteen cases with positive AFP showed obvious decrease in 11,no change in 6 and increase in one. Eighteen cases of pyrexia,11 cases of pain in hepatic region and 6 cases of nausea occurred 5-14 d after the procedure together with vomiting. We also found increase of ALT in 2 cases,BIL of 1 case,and no change of WBC in all cases. Conclusion Trisacryl gelatin microspheres is an excellent embolization agent with better clinical effect and less adverse reaction in the treatment of hepatic carcinoma.