Efficacy and complications of intravesical instillation of BCG for prevention of recurrence of moderate and high-risk non muscle invasive bladder cancer / 中华泌尿外科杂志

Objective To assess the efficacy and side effects of intravesical instillation of BCG after transurethral resection of the bladder tumor (TURBT) in non-muscle invasive bladder cancer (NMIBC) patients.Methods The clinical data of patients treated with BCG 120 mg per course induced perfusion or more after TURBT from December 2013 to October 2016 in 18 hospitals of northeast China region,were analyzed retrospectively.The first part,data of 106 patients with moderate,high-risk NMIBC were collected.A total of 83 patients were male,while the other 23 patients were female.The average age was 66.7 years old.The clinical staging were T1 in 86(81.1％) cases,Ta in 20(18.9％) cases and carcinoma in situ in 6 (5.7％) patients.Intravesical instillation of BCG was executed after transurethral resection of the bladder tumor.The incidence rate of recurrence and progression during more than 6 months' follow-up time were observed.Multivariate analyses were done by using logistic analysis and Cox proportional hazards regression model with Kaplan-Meier method.The second part,treatment compliance of 276 patients with bladder cancer,including moderate/high-risk NMIBC in 263 cases,moderate/high-risk NMIBC followed with renal pelvis/ureteral carcinoma in 8 cases were and moderate/high-risk NMIBC with renal pelvis/ureteral carcinoma in 5 cases who treated with BCG after the surgeries,were observed.Patients consisted of 211 males and 65 females with average age of 68.3 years.Results With a median follow-up of 12 months,9 (8.5％) patients experienced tumor recurrence and 2 (1.9％) patients were found progression in the first part.The one-year cancer free recurrence rate of the patients was 91.5％.Statistically significant prognostic factors for recurrence identified by multivariable analyses were prior recurrence of the tumors (OR =3.214,95％CI0.804-12.845,P =0.099).In the second port,an incidence rate of adverse effects was 64.1％ (177/276).The Ⅲ/Ⅳ degree complications were occurred in 11 patients and satisfactory outcomes achieved with active treatment.A total of 36 patients withdrawal with the major causes were recurrence and progression of bladder tumor in 12 cases (4.4 ％),9 cases (3.3 ％) with economic reasons and 11 cases (4.0％) with serious complications.Conclusions NMIBC patients treated with intravesical BCG therapy have approving cancer free recurrence rates and acceptable adverse effects.Prior recurrence may be prognostic factor of recurrence after intravesical BCG therapy.

Percutaneous nephroscopic resection of pyelocaliceal transitional cell carcinoma in solitary kidney

Percutaneous approaches to upper tract urothelial cancers have been performed in patients unsuitable for radical nephroureterectomy. We present two cases of transitional cell carcinoma involving the renal pelvis in either functional or anatomical solitary kidney, which were successfully treated by percutaneous nephroscopic resection using monopolar electrocautery

The clinical investigations of pain on the shoulders and epigastrium after the reprotenal laparoscopic operations / 中国医师进修杂志

Objective To discuss the reason of pain on the shoulders and epigastrium after the reprotenal laparoscopic operations. Methods One hundred and eight patients had undergone the laparoscopic adrenalectomy or laparoscopie renal cyst unroofing. They were divided into two groups at random, group A and group B. In group A, discharged CO2 as soon as finished the operation, but did not in group B. At the same period, there were 49 patients who had received retroperitoneal laparoscopic radical nephrectomy, divided into two groups by the CO2-pheunopertomeum time, group C and group D. In the group D, the CO2-pheunopertomeum time was over 90 minutes, and the time was less than 90 minutes in the group C. Evaluated the pain degree through the vision analogue score (VAS) and recorded the pH,PaO2, PaCO2,BE in the arterial blood in group A and B before and after operation. Results The incidence rate of pain postoperation was significantly higher in group B than A (P < 0.05). In group A and group B, there was no difference in PaCO2, PaO2, pH, BE in the arterial blood(P > 0.05 ). The incidence rate of pain and the grade of VSA both were significantly higher in group D than group C (P < 0.05). Conclusions The stimuli of acid materials such as carbonate that derived from postoperative residual CO2 is probably the main cause of the pain on the shoulders and epigastrium after the laparoscopicsurgery.

Compare the clinical efficacy of retroperitoneal laparoscopic versus open radical nephrectomy / 中国医师进修杂志

Objective To evaluate the clinical efficacy and complication rate by open or retroperitoneal laparoscopic radical nephrectomy for renal tumor with stages T1N0M0 or T2N0M0.Methods Between October 2003 and October 2006,90 patients with renal cell carcinoma,which were clinically localized stages T1N0M0 or T2NOM0 Based on the patients' options to undergo retroperitoneal laparoscopic radical nephrectomy (group A,49 patients)and open radical nephrectomy(group B,41 patients).The clinical efficacy were compared between group A and group B,retrospectively.Results In group A,the operations of 46 patients were successful,4 cases occurred major complications(8.7%)during the follow-up visit which lasted for (21.9±6.1)months.The operations in group B were all successful.9 cases occurred major complications (22.5%)during the follow-up visit which lasted for(24.9±7.8)months.All cases were renal malignant tumors with pathologically confirmed stages T1N0M0 or T2N0M0 and there were no renal pedical lymph node metastasis.The age,weight,body mass index(BMI),tumor size,operating time and the time of follow-up were no statistically significant differences between the two groups(P＞0.05),while the blood loss,amount of postoperative drainage,time to ambulation,recovery of intestinal function after operation,hospital stay,use of analgesic and transfusion blood or plasma in group A were significantly reduced than those in group B(P＜0.01). Conclusions As compared with open radical nephrectomy,retroperitoneal laparoscopic radical nephrectomy afords patients with renal cell carcinoma an impreved postoperative course with minimal invasion,less pain,quicker recovery and less complications,while providing equally effective cancer control for patients with T1N0M0 or T2N0M0 tumor.

Comparison between Ordinary MRCP and Half-Fourier Acquisition Single-shot Turbo Spin-echo(HASTE) MRCP Single-slice Acquisition Technique / 实用放射学杂志

Objective To compare HASTE-MRCP single-slice acquisition technique with ordinary MR cholangiopancreatography (OMRCP) and to assess the clinical application value of HASTE-MRCP single-slice acquisition technique.Methods 48 cases with biliary obstructive diseases and 30 cases without obstructive jaundice were studied with a 3. 0T super conductive unit(Magnetom Trio;Siemens,Germany) that used a body coil. Two acquisition techniques of MRCP were used for all patients . The accuracy of the two kinds of technique were compared. Results OMRCP , single-slice HASTE-MRCP had the same sensitivity and specificity in showing the site and feature of the diseases , the proximal dilated biliarys and distant normal cholangiopancreatic ducts .The diameter of dilated bile ducts at the same level was compared and no significant difference in them. Single-slice HASTE-MRCP had a high spatial resolution ,and shot aquisition time ,but more vessel artifact. OMRCP had high density resoultion ,but more motion artifacts.Conclusion The single-slice acquisition of HASTE-MRCP is an excellent technique in the diagnosis of biliary tract diseases.