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Objective To evaluate transurethral fulguration with intravesical instillation of heparin and alkalinized lidocaine for the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS).Methods Data from the chnical records of 31 patients (30 female and 1 male) with IC/BPS were analyzed retrospectively.Transurethral fulguration and biopsy were performed.Intravesical instillation of heparin and alkalinized lidocaine (25 000 units of hepmin,10 mL of 2％ lidocaine,and 5 mL of 5％ sodium bicarbonate) was administered weekly for 8 weeks.Thereafter,intmvesical instillation treatment was administered twice a month.The interstitial cystitis symptom index and problem index (O'Leary-Sant index),visual analog scale score for pain,quality-of-life index,voiding frequency,bladder capacity,and side effects of intravesical instillation were recorded preoperatively and at the first and sixth month follow-ups postoperatively.Results The follow-up period was 6 to 24 months.The interstitial cystitis symptom index and problem index,visual analog scale score for pain,quality-of-life index,daily voiding time,and maximal bladder volume improved significantly in 28 cases (90.32％;P ＜ 0.01),and no significant adverse effects were observed.Two patients underwent cystectomy,and the symptoms disappeared after the operation.Carcinoma in situ was detected on histopathological examination in one patient.Conclusion Transurethral fulguration with intravesical instillation of heparin and alkalinized lidocaine is a safe and effective therapy for IC/BPS.
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Objective To study the diagnosis and surgical outcomes of renal cell carcinoma with inferior vena cava tumor thrombus.Methods The clinical data from 31 cases of renal cell carcinoma with inferior vena cava tumor thrombus were retrospectively reviewed from January 2000 to December 2014.Among them,21 cases were male and 10 cases were female.The mean age ranged from 38 to 79 years,mean 57 years.The location of tumor included right renal in 29 cases and left renal in 2 cases.The distribution of the tumor thrombus was recorded as follow:level Ⅰ in 20 cases,level Ⅱ in 8 cases and level Ⅲ in 3 cases.All patients received radical nephrectomy and tumor thrombectomy.Ipsilateral subcostal oblique incision was chosen in 20 cases.Transrectus incision was chosen in 10 cases.And abdominal transperitoneal L shaped incision was chosen in 1 case.Three patients were given neoadjuvant molecular targeted therapies before operation.Results All patients accepted the operation successfully.There was no death during perioperative period.The pathological diagnosis showed clear cell carcinoma in 30 cases and chromophobe cell tumor in 1 case.The Fuhrman grading showed that 17 cases were grade Ⅱ,8 cases were grade Ⅲ and 5 cases were grade Ⅳ.Among them,the lymphatic metastasis in the renal hilum was found in 5 cases.After operation,16 patients received molecular targeted therapies,including sorafenib in 10 cases and sunitinib in 6 cases.Six patients were given autologous tumor lysate-pulsed dendritic cells co-cultured with cytokine induced killer cells treatment.The median overall survival was 44 months (range 4-60 months).The 1-,3-,and 5-year overall survival rates for all patients were 100％,52％,and 39％,respectively.There were significant differences of the overall survival rates between level Ⅰ / Ⅱ and level Ⅲ tumor thrombi(81.5％ vs 0) (P =0.012).Similar difference was noticed between Fuhrman grade Ⅱ and grade Ⅲ/Ⅳ (94.1％ vs 46.2％)(P =0.003).There was also significant difference between those with or without lymph node metastases (40.0％ vs 80.8 ％) (P =0.0 1 6).Conclusions Radical nephrectomy and tumor thrombectomy could improve the survival of patients of renal cell carcinoma with inferior vena cava tumor thrombus.The overall survival rate might be related to the tumor thrombus level,tumor grade,and local lymph node metastasis.
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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 examine the galectin-3 expression in bladder cancer and explore the relationship between the galectin-3 expres-sion and the clinicalpathological characteristics of bladder cancer.Methods Immunohistochemical streptavidin-peroxidase（S-P）method was employed to examine the expression of galectin-3 in 45 bladder cancer tissues and 6 normal bladder tissues.The relationship between galectin-3 expression and the clinicopathological parameters was analyzed in bladder cancers.Results The positive rate of galectin-3 ex-pression in bladder cancer was 62.2%,significantly higher than that in 6 normal bladder tissues（P 〈 0.05）.The positive rates of galectin-3 expression in primary cases and recurrent cases were 60% and 70% respectively without significant difference（P 〉 0.05）.The up-regulated expression of galectin-3 was positively correlated with the pathological degree and clinical stage of bladder cancer（P 〈 0.05）.Conclusion Galectin-3 expression is up-regulated in bladder cancer and its increased expression is useful for diagnosis of bladder cancer.Additionally,it could be used as an important index to evaluate the pathological degree and clinical stage of bladder cancer.
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Objective To investigate the methods of steroid supplement following adrenalectomy in the patients with Cushing syndrome.Methods The methods and outcome of steroid supplement following adrenalectomy in 75 cases of Cushing syndrome were retrospectively reviewed.Results Supraphysiological doses of glucocorticoid was given during the perioperative period,and the dosage was reduced gradually.Prednisone with a dosage of 5 to 7.5 mg was given once a day on discharge.In the patients with adrenocortical adenoma,4 to 15 month of steroid supplement was required.The patients undergoing bilateral adrenalectomy required lifelong steroid supplementation.Steroid withdrawal syndrome occurred during steroid tapering in 8 patients with adrenocortical adenoma,2 of them had normal plasma cortisol level.Conclusion In the patients with Cushing syndrome,even those with normal plasma cortisol level might have steroid withdrawal syndrome episodes during steroid tapering.