ABSTRACT
Objective To discuss the clinical diagnosis and treatment of xanthogranulomatous pyelonephritis (XGP).Methods Clinical data of 41 XGP patients admitted from May 1981 to December 2017 were retrospectively analyzed.There were 17 male cases and 24 female cases,aged from 23 to 78 years,with an average age of 57 years.All were unilateral lesions,including 19 cases on the left and 22 cases on the right.Disease duration ranged from 1 week to 12 years,with an average of 3.5 years.The clinical manifestations showed that 7 cases with gross hematuria (17.1％),16 cases with palpable flank or abdominal mass (39.0％),36 cases with flank pain (87.8％),26 cases with acute or intermittent fever (63.4％) and 17 cases with weight loss (41.5％).Laboratory findings showed that 28 cases with leukocytosis (68.3％),24 cases with anemia (58.5％),27 cases with pyuria (65.9％),positive urine culture 19/34 (55.9％),positive urine lipid-laden macrophages 3/14(21.4％),and 20 cases with rapid erythrocyte sedimentation rate (48.8％).Imaging examination:among 35 patients who received CT examination,25 were diagnosed as XGP,mainly presenting diffuse changes in the kidney with enlarged renal shadow,accompanied by diffusive distribution of multiple low-density lesions.There was no obvious enhancement in the low-density lesions on enhanced scan,accompanied by thickening of renal fascia,adhesion to psoas major muscle or involvement of surrounding tissues and organs.According to the imaging results,there were 33 cases of diffuse type and 8 cases of localized type in this group.Renal biopsy was performed 11 cases and 3 cases were diagnosed as XGP.Results All patients were treated with surgical procedure.33 patients with diffuse type were performed nephrectomy.6 of the 8 patients with localized type underwent partial nephrectomy successfully,and the other 2 patients underwent nephrectomy due to severe renal adhesion and unclear lesion boundaries.All postoperative pathologies suggested xanthogranulomatous pyelonephritis.Patients were followed up for 9 months to 10 years postoperatively,with an average of 4.5 years.All patients had no recurrence.Conclusions The clinical manifestations of XGP are lack of specificity.Diagnosis is difficult and depends on pathology.According to imaging examination,lesions can be divided into diffuse type and localized type.Nephrectomy and partial nephrectomy were performed respectively.
ABSTRACT
The development of tissue engineering has provided new methods for organ replacement and disease treatment.The research of seed cells includes cell selection,culture,transplantation,tracing and so on.The tracing technique of seed cells involves molecular biology,molecular immunology,molecular imaging and many other subjects,making it difficult to select a label for seed cells.This review summarizes the recent research progress in the tracing technique of seed cells.
ABSTRACT
Urethral reconstruction is required in congenital abnormalities such as hypospadia and urethral stricture caused by trauma or infection. The development of tissue engineering has brought new hope to the field of urethral reconstruction. Much progress has been made in the experimental and clinical research of using tissue engineering for urethral reconstruction as well as the research of the scaffold materials. This review focuses on the recent progress in this field.
ABSTRACT
Objective To investigate the relationship between bladder outlet obstruction(BOO) and serum prostatic specific antigen(PSA) in patients with benign prostatic hyperplasia(BPH).Methods The study of pressure-flow urodynamic examination,IPSS score and serum PSA were performed in 253 cases with BPH.Results Based on the bladder outlet obstruction index(BOOI),all patients were divided into three groups: Definite BOO group had 156 patients,mild BOO group had 61 patients,no BOO group had 36 patients.The data of tPSA were(4.54?1.71) ?g/L,(2.45?1.74) ?g/L and(1.85?1.71) ?g/L respectively,there were significant differences between definite BOO group and other two groups(P0.05).Conclusion As a easy detection index,serum PSA may partially reflect the severity of BOO,combined with IPSS score,uroflow, type of B supersonic wave,it would give some guide for patients with BPH to select therapies and judge the prognosis.
ABSTRACT
Objective To improve the diagnosis and treatment of primary adrenocortical carcinoma. Methods Retrospective analysis was performed in clinical data of 16 patients with primary adrenocortical carcinoma. The diagnosis was based on clinical presentations,hormonal studies and imaging. Surgical treatment was underwent on 13 cases. All patients were followed up for 3 to 62 months. Results Of 16 cases,functional tumors were in 8,including Cushing′s syndrome in 5,combination of Cushing′s syndrome and virilization in 2,and hyperaldosteronism in 1. Imaging studies revealed the tumors were 4.8 to 19.5 cm in diameter,average in 7.8 cm. Distant metastasis occurred in 3 cases. Radical surgery was done in 13 cases without distant metastasis,including radical adrenalectomy in 8,adrenalectomy plus nephrectomy in 2,adrenalectomy plus surgical extirpation of intracaval tumor thrombus in 2,and partial resection of the wall of inferior vena cava in 1. Pathologic stages were stage Ⅰ in 2 cases,stage Ⅱ in 8,stage Ⅲ in 3,stage Ⅳ in 3. Among the 11 cases who were treated over 2 years after operation,6 cases were still survival,while 1 case had pulmonary and 1 case had bone metastasis. The other 5 cases survive in average of 26 months. Conclusions Prognosis of primary adrenocortical carcinoma is poor. The keys to early diagnosis are clinical manifestations plus imaging. Surgical treatment is the only effective therapy for the disease.
ABSTRACT
Objective To evaluate the clinical value of cystectomy with prostate capsule sparing in orthotopic bladder replacement for bladder cancer. Methods A total of 56 male patients (mean age,62 years) with bladder cancer were included.Of them 40 cases were of primary tumors and 16 were of recurrent ones.Pathology by cystoscopy and biopsy showed transitional cell carcinoma in 53 cases and squamous cell carcinoma in 3.According to the analysis of B ultrasound,CT,MRI and cystoscopy, they were clinically diagnosed as recurrent multiple superficial tumors (n=27) and invasive tumors (n=29).Radical cystectomy with prostate capsule sparing was performed on them.Detubularized ascending colon (20 cases) or ileal segment (36 cases) was used to form a neobladder,which was anastomosed with distal portion of prostate capsule. Results Mean operative time of ascending colonic neobladder and ileal neobladder was 5 h 50 min and 6 h 20 min,with blood loss of 580 ml and 540 ml,respectively.Pathology showed pT 1N 0 in 28 cases,pT 2N 0 in 25 and pT 3N + in 3.During the follow up of 4 to 102 months (mean,42 months) 3 patients of pT 3N + died of bladder cancer and 5 died of other diseases.The cancer specific 5 year survival was 94% in cases of T 1N 0,83% in T 2N 0.At 1 year follow up,17 out of 18 patients (94%) with ascending colonic neobladder and 30 out of 30 patients (100%) with ileal neobladder were fully continent during the day,and 46 (96%) voided 1 to 2 times at night and could stay dry.Of 31 patients with preoperative adequate sexual function, 23 (74%) maintained potency postoperatively. Conclusions Radical cystectomy with distal prostate capsule sparing and reconstruction with an orthotopic neobladder is a relatively safe and reliable surgical procedure.It can improve the continence and potency without compromising the principle of tumor control.