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Gaschromatography-tandemmassspectrometrywasadoptedtoidentifythehydroxylatedmetabolites of polychlorinated biphenyls and analyze the target compounds in fishery products. After the silylation derivatizaiton at 60 ℃ for 40 min, the MS spectrum of derivatives was obtained by GC/MS/MS under fullscan mode, and the fragment ions with the highest relative abundance were identified as m/z 399, 399, 399, 399, 399, 448 and 469, respectively which were defined as the precursor ion for product ion scan. The MS/MS spectrum was obtained under multiple reaction mode ( MRM ) by GC/MS/MS. And the product ions corresponded with the precursor ions were m/z 364, 364, 364, 364, 364, 433 and 434, respectively. The target compounds can be identified accurately by GC/MS/MS. In the present study, we took seven hydroxylated polychlorinated biphenyls as target compounds including 3-OH-PCB101 , 4-OH-PCB106 , 4-OH-PCB112 , 4'-OH-PCB101 , 3-OH-PCB118 , 3-OH-PCB138 and 3-OH-PCB180 . According to the identification method stated as above, the MS and MS/MS spectra of seven compounds were obtained. The compounds can be qualified and quantified by the identification method. The limits of detection ranged from 0. 02 to 0. 14 μg/L, and the limits of quantification ranged from 0. 09 to 0. 48 μg/L. The method has been applied to identify the hydroxylated polychlorinated biphenyls in fishery products.
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Objective To discuss the long term clinical effect of ileal orthotropic neobladder.Methods From 1991 to 1998,79 patients,mean age 55(41～75)years,male 74,female 6,were followed up.The serum creatinine and urea,electrolytes,blood routine,B ultrasonic scan of the neobladder residual urine and IVU or MRU of the patients were followed up.The max transverse diameter of renal pelvis and the max verticaI/level diameter of neobladder were measured in 5,10 to 14,15 years of postoperative when IVU or MRU.All results of different time were compared by the multiple comparisons.The local or distant cancer recurrence and the complications of the operation Were evaluated. Results Sixty-four cases,58 male,6 famle,were long term followed up:mean time was 167 (range,121～216)months.Seven cases died of other diseases.Seven cases had pelvic recarrence.Two cases had urethral recurrence.Three cases died of tumor metastasis.One case had ureter recurrence.Forty-eight patients were alive more than 10 years.The value of the serum creatinine,urea,electrolytes and bloods routine of the patients were normal after 5,10 to 14 and 15 vears postoperative (P＞0.05).The max transverse diameter of the renal pelvis in 5,10 to 14 and 15 years Dostoperative were 14.0 mm,14.1 mm and 13.7 mm,respectively,P＞0.05.The max vertical/level diameter of the neobladder in 5,10 to 14,15 years of postoperative were 110.4 mm/90.4 mm,111.5 mm/95.3mm and 127.0 mm/97.0 mm,respectively,P＞0.05.The residual urine of 5 cases was more than 50 ml and had not increased during follow up.Eight cases with neobladder stone were cured by the intracavitary lithothrypsis.Two cases with uretheral stricture were cured by the intracavitary therapy.Twelve cases of 14 cases with inguinal hernia were cured by reoperation,2 cases accepted conservative treatment.Only 17 cases had no complication involve of the cancer and the operation. Conclusion The upper urinary tract and neobladder of the ileal orthotopic neobladder could be stable for long time,the cure rate of tumor is satisfactory and the lifetime follow up is necessary.
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BACKGROUND: A long-term follow-up indicates that orthotopic ileal neobladder can cause acid-base balance and nutritional metabolic disorder. Otherwise, a long mesenterium is necessary to balance the tension of bladder at pelvic cavity and urinary inosculation due to a high position of ileum. On the contrary, sigmoid neobladder is near by urinary canal, and orthotopic sigmoid neobladder as a bladder substitute after radical cystectomy has few effects on acid-base balance of electrolytes, nutritional metabolism and secretion of mucus.OBJECTIVE: To compare the clinical results of these two operations basis on long-term follow-up. DESIGN: Retrospective analysis.SETTING: Department of Urinary Surgery, the Second Affiliated Hospital of Kunming Medical College.PARTICIPANTS: 164 patients with carcinoma of bladder were selected from Department of Urinary Surgery, the Second Affiliated Hospital of Kunming Medical College form January 1995 to March 2005. Ninety-six of them, including 74 males and 22 females, with age of 43-74 years and the average age of 65 years, accepted the operation of orthotopic ileal neobladder were regarded as the ileal neobladder group, and the other 68, including 64 males and 4 females, with age of 51-72 years and the average age of 62 years, accepted the operation of orthotopic sigmoid neobladder were regarded as the sigmoid neobladder group. All patients were finally diagnosed as pathological examination, and informed consent was provided by all patients. Treatment plan was approved by the local ethical committee.METHODS: ① Orthotopic ileal neobladder: Once the bladder was removed, a segment of ileum about 40-60 cm in length was isolated. In the operative procedure, the distal part of ileum which connected to the caecum often kept, the length of which was 15-20 cm. Both distal ends of the ureters were anastomosed to the homolateral not been split end of the isolated bowel. A perforation was constructed at the bottom of the pouch which served as the outlet, this outlet was then anastomosed to the proximal portion of the remaining urethra. ② Orthotopic sigmoid neobladder: After surgically removing the bladder, a part of the sigmoid colon, the length of which was 30-40 cm was isolated. Other operations were as the same as those mentioned above. MAIN OUTCOME MEASURES: Time of operation, blood loss during the procedure, length of time confined to bed, time of indwelling catheter, the ability to maintain continence and urinate, the results of urodynamic studies, and pouch related complications after operation.RESULTS: In 164 patients, 12 (7.3%) were lost to follow-up. The mean follow-up times were 46 months in the group of orthotopic ileal neobladder and 42 months in the group of orthotopic sigmoid neobladder, respectively. Blood loss during the procedure and the ability to maintain continence and urinate were similar in the two groups (P > 0.05). Compared with sigmoid neobladder group, the ileal neobladder group spent more time on operation, keeping the bed and indwelling catheter. The max volume of ileal pouch was higher than that of sigmoid pouch, and the difference was significant in statistic analysis (t=2.56-3.08, P < 0.05-0.01). Incidence of complication of ileal pouch (16.7%, 29.2%) was higher than that of sigmoid pouch (9%, 16%). The incidence in the early phase was not significantly different, but that in the late phase was significantly different (x2=5.426, P < 0.05).CONCLUSION: Compared with orthotopic ileal neobladder, sigmoid neobladder is worthy of being preferred for its shorter operative time, faster recovery and lower rate of pouch related complications.
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Objective To evaluate the effect of technical improvement of radical retropubic prostatectomy(RRP) for patients and reduction of complications.Methods 22 patients with clinically prostate cancer(mean age 67 years,stage B 19 cases,stage C 3 cases) underwent radical retropubic prostatectomy.During operation the dorsal vein complex,puboprostatic ligament,puborectalis sling,the neurovascular bundle,external urethral sphincter,reconstruction of the bladder neck were carefully managed.Results All the patients recovered uneventful except 2 deaths,and they survived and were followed up for a mean time of 16 months(range 1～4 years).The mean operative time was 140 minutes(range 90～220minutes) and the mean blood loss was 600mL(range 250～1500mL).16 cases received blood transfusion for 300～1200mL and no ureteral or rectal injury occurred.The urinary catheters were removed 2～3 weeks after operation.2 cases had stress incontinence 3 months later,1 case encountered urethral stricture and became well after urethral dilation,15 cases had satisfactory erectile function after operation and 3 patients had biochemical failure and endured continually chemotherapy during follow-up.Conclusions Accurate maneuver is handled according to correct anatomy can protect the apex of prostate and its surrounding tissue and reconstructing the bladder neck is helpful to reduce complications and achieve better outcome.
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Objective To elucidate the diagnosis and treatment of the bladder mixed tumor.Methods 16 cases treated from Jun 1990 to Aug 2004 were reviewed.The clinical manifestations,diagnosis,treatment and prognosis were discussed.Correlative literature was reviewed at the same time.Results 16 cases of the bladder mixed tumor accounted for 6.9% of 223 bladder tumor patients in the same period,of which 7 of 16 were transitional squamous cell carcinoma,4 transitional adenocarcinoma,3 transitional squamous adenocarcinoma and 2 squamous adenocarcinoma mixed tumor.Most of the patients had irritable bladder symptoms and hematurine.Partial cystectomy was undergone for 3 of 16 cases,total cystectomy for 10 and radical total cystectomy for 3.The main treatment was partial or total cystectomy.The overall survival rates at 1,3 and 5 years post operation were 81.3%,56.3% and 12.5% respectively.Conclusion There were higher malignancy and worse prognosis in bladder mixed tumor.Early diagnosis and therapy might prolong survival.Radical total cystectomy seems to be the best method of treatment.