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Objective:To evaluate the feasibility and perioperative safety of retroperitoneal laparoscopic nephrectomy for autosomal dominant polycystic kidney disease (ADPKD) before kidney transplantation.Methods:A total of 22 patients with ADPKD who underwent laparoscopic polycystic nephrectomy before kidney transplantation in Beijing Friendship Hospital, Capital Medical University from January 2013 to December 2020 were enrolled in this retrospective study. Preoperative epidemiological data, operation time, intraoperative blood loss, perioperative blood transfusion, conversion rate, postoperative gastrointestinal function recovery time, drainage tube placement time, postoperative hospital stay, incidence and severity of complications were collected.Results:The mean age of all patients in this study was (50.95±9.28) years old, and the mean preoperative polycystic kidney diameter was (18.83±2.38) cm. In all patients, 20 patients were scheduled for polycystic nephrectomy due to transplantation and 2 patients were done for polycystic renal cyst rupture and hemorrhage. The mean operation time of all patients was (191.14±70.46) min, and the median intraoperative blood loss was 100 mL. Among them, 5 patients had large intraoperative blood loss, and were given intraoperative blood transfusion. Two of all patients were converted to open due to severe intraoperative adhesions. In terms of postoperative recovery, the mean recovery time of gastrointestinal function was (2.09±0.61) d, the mean time of abdominal drainage tube placement was (5.32±2.08) d, the mean postoperative hospital stay was (7.55±2.34) d. In terms of postoperative complications, 4 patients developed postoperative incision pain, bleeding or other complications, but all improved after symptomatic treatment.Conclusions:For patients with ADPKD, original polycystic kidney can be effectively resected by retroperitoneoscopy before transplantation. At the same time, the operation time is short, and patients have quick postoperative recovery, even the incidence and severity of postoperative complications are low. Therefore, retroperitoneal laparoscopic nephrectomy can be used as the first choice for the removal of original polycystic kidney before renal transplantation in ADPKD patients.
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Objective:To explore the factors related to the difficulty of adult allogeneic renal transplantation.Methods:Used retrospective study method, a total of 183 patients who were diagnosed with end-stage renal disease and underwent allogeneic kidney transplantation in Beijing Friendship Hospital, Capital Medical University from January 2020 to December 2021 were included in this study. With kidney transplant operation time as the evaluation criteria of operation difficulty, relevant clinical indicators that may affect the difficulty of surgery were collected, including recipient age, body mass index, pretransplant dialysis mode, blood lipid level, subcutaneous fat thickness, vascular anastomosis mode, donor kidney length, donor kidney volume, etc. Pearson, Spearman correlation test were used to analyze the correlation between the above indexes and surgical difficulty.Results:In terms of recipients, higher body mass index ( P=0.006), peritoneal dialysis before transplantation ( P=0.035), higher serum cholesterol ( P=0.016) and triglyceride ( P<0.001), thicker subcutaneous fat ( P=0.032) and calcification of the vessels ( P<0.001) all lead to increase the difficulty of kidney transplantation, and also prolong the operation time; in terms of kidney donors, the longer and larger of transplanted kidney length ( P<0.001) and volume ( P<0.001), the longer operation time will be cost. Meanwhile, the anastomosis of complex multi-vessel between kidney transplantation and recipient was more difficult than single internal iliac artery and single external iliac artery anastomosis ( P=0.005), and the operation time was also longer. Conclusions:The degree of obesity before transplantation, dialysis mode, blood lipid level, donor kidney size and vascular anastomosis mode were all factors affecting the difficulty of kidney transplantation. For patients with those above risk factors, the operation may be difficult and the surgical time can be much longer. Physicians with more experience in kidney transplantation can be selected to shorten the operation time, even reduce complications after operation.
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Objective:To explore whether prophylactic resection of orthotopic polycystic kidney before allogeneic kidney transplantation can reduce the incidence and severity of perioperative complications in patients with end-stage renal disease due to autosomal dominant polycystic kidney disease (ADPKD), and reduce the difficulty of surgery.Methods:A retrospective case-control study method was used to recruit a total of 27 patients who were diagnosed with ADPKD and underwent allogeneic kidney transplantation in Beijing Friendship Hospital, Capital Medical University from January 2013 to January 2021, they were divided into prophylactic resection group ( n=19) and non-prophylactic resection group ( n=8) according to whether orthotopic polycystic kidney disease was prophylactic resection before transplantation. Patients in prophylactic resection group underwent orthotopic polycystic kidney resection before transplantation, while patients in non-prophylactic resection group didn′t. The indexes such as hemoglobin, platelet, albumin, left ventricular wall thickness, left ventricular ejection fraction, difficulty of kidney transplantation, average postoperative hospital stay, pain, and complication rate before kidney transplantation were analyzed and compared between the two groups. Measurement data were expressed as mean ± standard deviation ( ± s), and independent sample t-test was used for comparison between groups; Chi-square test was used for comparison of enumeration data between groups. Results:There was no significant difference in the general status of hemoglobin, platelets, albumin, left ventricular wall thickness, and left ventricular ejection fraction between the two groups before kidney transplantation ( P>0.05). However, the polycystic kidney volume [(2 409.8±1 899.8) cm 3] in the prophylactic resection group was greater than that in the non-prophylactic resection group [(1 340.2±290.6) cm 3], and the difference was statistically significant ( P=0.027). In terms of postoperative complications, 9 patients in the prophylactic resection group and 5 patients in the non-prophylactic resection group developed long-term low back pain or hematuria after transplantation, which were considered to be related to the unresected polycystic kidney disease, but the difference was not statistically significant ( P=0.678). Meanwhile, in both two groups, 3 patients underwent orthotopic polycystic nephrectomy after transplantation due to severe polycystic kidney complications. Although the incidence of complications in the prophylactic resection group (15.8%) was lower than that in the non-prophylactic resection group (37.5%), the difference was not statistically significant ( P=0.319). Conclusion:Prophylactic resection of orthotopic polycystic kidney before kidney transplantation can reduce the incidence and severity of polycystic kidney-related complications after transplantation, but has little effect on the operation time and intraoperative blood loss of kidney transplantation.
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Objective:To investigate the clinical outcomes of neoadjuvant chemotherapy with Gemcitabine and Cisplatin (GC) for muscle-invasive bladder cancer (MIBC).Methods:Retrospective analysis of 67 MIBC patients admitted to Beijing Friendship Hospital, Capital Medical University from December 2010 to June 2020. Fifty-five MIBC patients (cT2-T4aN0M0) underwent GC plus radical cystectomy-pelvic lymph node dissection. Pathological responses, prognosis and chemotherapy toxicities were analyzed. The Chi-square test and Fisher′s exact probability method were used to compare the count data between groups. The overall survival (OS) and disease-free survival (DFS) were based on the Kaplan-Meier survival curve, and the Log-rank test was used to evaluate the difference between groups in the survival curve. Prognostic analysis adopts Cox proportional hazards regression model.Results:Fifty-five MIBC patients received GC plus radical cystectomy-pelvic lymph node dissection. The 81.8% patients ( n=45) received 2 cycles GC and 18.2% patients ( n=10) received 3 cycles. The complete pathological response (pT0N0M0) rate was 30.9% ( n=17) and partial response (pT 1/Tis/T aN 0M 0) rate was 10.9% ( n=6). Overall pathological response rate was 41.8%. The median follow-up was (47.0±37.7) months, 5-year OS were 82.2% and 22.1% (<pT 2 versus ≥pT 2, P<0.001), and DFS were 86.1% and 32.1% (<pT 2 versus ≥pT 2, P<0.001). Pathological response and positive lymph nodes were independent risk factors of overall survival and disease-free survival on multivariable analysis ( P<0.05). The most common chemotherapy toxicities were hematologic toxicities and gastrointestinal reactions, and none delayed surgery due to toxicities. Conclusion:Neoadjuvant GC plus radical cystectomy-pelvic lymph node dissection has a significant clinical benefit in MIBC patents and chemotherapy toxicities are well tolerated.
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Objective@#To understand the current situation of the social development between only children and firstborn of young age, so as to provide a reference for the promotion of the social development of young children.@*Methods@#Stratified cluster sampling method was used to select 734 only children and firstborn children aged 3-9 in two kindergartens and two primary schools from grade 1 to grade 3 for questionnaire survey in Bengbu City. The content included the general information of children and their parents and the social assessment of children.@*Results@#The rate of emotional symptoms in firstborn children(27.8%) was higher than those of only children (17.6%)( χ 2=9.45, P <0.01). The results of univariate analysis showed that the rate of hyperactivity and inattention in social development of both only children and firstborns decreased with the increase of family socioeconomic status ( P < 0.05 ). Multivariate Logistic regression analysis of only children showed that only children with high economic status had a lower risk of hyperactivity and inattention and had a higher risk of peer interaction( P <0.05). The prosocial behavior of girls was better than that of boys in the aspect of social development of only children and firstborn children( OR =1.70, 2.85, P <0.05). For only children, the occurrence risk of being difficult was lower when the primary caregiver was parents than grandparents( OR =1.63, P < 0.05 ). For firstborn children, the risk of being difficult in nuclear families was lower than that in third generation families( OR = 2.14 , P <0.05). Multivariate analysis of the only child showed that boys had higher risk of hyperactive attention and less prosocial behavior than girls ( OR =2.24, 1.70, P <0.05), and a lower risk of developing mood disorders than girls( OR =0.57, P <0.05). The social development of only children varied among different grades, and the risk of abnormal prosocial behavior was lower with the increase of grades ( P <0.05).@*Conclusion@#Higer family social status is positively associated with children s social development level. But parents with high economic status should also avoid too much material and spiritual doting. Parents should strengthen their own learning to enhance the level of socialized education, raising siblings equally, improve the quality of parent child relationship, and promote the all round development of children s socialization level.
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Objective:To evaluate the effect of intraoperative incision combined with local anesthesia in improving postoperative pain after retroperitoneal laparoscopic living donor nephrectomy.Methods:Using retrospective research methods, 28 donors who underwent hand-assisted retroperitoneal laparoscopic living donor nephrectomy at the Beijing Friendship Hospital, Capital Medical University from January 2018 to December 2020 were selected as the research group. Before the wound was sutured during the operation use 0.2% ropivacaine 20 mL+ 5 mg dexamethasone to block the transverse abdominis fascia and subcutaneously for infiltration anesthesia. The other 1∶1 matched 28 donors who had the same operation method but used on-demand systemic opioid analgesia after the operation as the control group. The demographic indicators (age, gender, body mass index, length of donor kidney), intraoperative conditions (intraoperative blood loss, operation time, warm ischemia time), 2, 12, 24, and 48 hours pain visual analogue scales(VAS) after operation were compared between the two groups of patients, postoperative systemic opioid demand rate, postoperative exhaust time, time to return to the ground, complication rate (postoperative bleeding, lung infection, lymphatic fistula, wound infection, intestinal obstruction), postoperative length of hospitalization and other information. Measurement data were expressed as mean±standard deviation ( Mean± SD), and independent sample t-test was used for comparison between groups; Chi-square test or Fisher exact probability method was used for comparison of count data between groups. Results:The pain VAS of the donors in the research group were significantly lower than those in the control group at 2 h, 12 h, 24 h, and 48 h after surgery (2 h: 1.6±1.0 vs 3.9±1.1; 12 h: 1.9±0.7 vs 3.1±1.0; 24 h: 1.6±0.5 vs 2.9±0.8; 48 h: 1.2±0.5 vs 2.3±0.8; P<0.05). The donors in the research group postoperative morphine requirement rate was also significantly lower than that of the control group (0 vs 21.4%), and the postoperative recovery time was significantly earlier than that of the control group [(25.7±4.5) h vs (30.6±6.6) h], the difference was statistically significant ( P<0.05). Lymphatic fistula was the main postoperative complication. There was no statistically significant difference between the research group and the control group (14.3% vs 25.0%) ( P>0.05). Conclusion:Intraoperative incision transversus abdominis fascia and subcutaneous combined local block anesthesia can effectively reduce the pain after laparoscopic donor nephrectomy, reduce the use of opioids, promote early postoperative activities of the donor, and will not increase postoperative complications incidence rate.
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Objective@#To explore the efficacy and safety of converting from traditional calcineurin inhibitor-based immunosuppressive regimen to sirolimus plus low-dose calcineurin inhibitor after kidney transplantation from expanded criteria donors.@*Methods@#For this prospective, open-label, non-randomized controlled clinical trial, 15 recipients of initial transplant from expanded criteria donors received sirolimus plus low-dose calcineurin inhibitor regimen 3 months after transplantation during June 2017 and March 2018. The follow-up period was over 1 year. The allograft survival time, changes in blood creatinine and glomerular filtration rate before and after conversion (0, 1, 3, 6, 12 months), changes in urinary protein before and after conversion, incidence of acute rejection after conversion, BK virus or cytomegalovirus infection and sirolimus-related complications were observed.@*Results@#Renal functions of all 15 patients improved after conversion and 1-year allograft survival rate was 100% (15/15). Serum creatinine decreased markedly and glomerular filtration rate increased significantly at 1 month and 3 months after conversion (P<0.05). BK viruria was detected in 5 patients before conversion. After conversion, BK virus turned into negative in 3 patients within 3 months and viral load also decreased in another 2 patients. After conversion, only 2 patients (13.3%) developed de novo proteinuria. Eight patients (53.3%) developed de novo hypertriglyceridemia responding well to medications. None of them experienced acute rejection during follow-ups.@*Conclusions@#Sirolimus plus low-dose calcineurin inhibitor is a safe and effective maintenance immunosuppressive regimen for recipients of kidneys from expanded criteria donors, especially for those with abnormal renal function during recovery. But it cannot completely replace the traditional immunosuppressive regimen. Individualized treatment should be chosen properly for recipients.
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Objective To explore the efficacy and safety of converting from traditional calcineurin inhibitor-based immunosuppressive regimen to sirolimus plus low-dose calcineurin inhibitor after kidney transplantation from expanded criteria donors .Methods For this prospective ,open-label ,non-randomized controlled clinical trial ,15 recipients of initial transplant from expanded criteria donors received sirolimus plus low-dose calcineurin inhibitor regimen 3 months after transplantation during June 2017 and March 2018 .The follow-up period was over 1 year .The allograft survival time ,changes in blood creatinine and glomerular filtration rate before and after conversion (0 ,1 ,3 ,6 ,12 months) ,changes in urinary protein before and after conversion ,incidence of acute rejection after conversion ,BK virus or cytomegalovirus infection and sirolimus-related complications were observed .Results Renal functions of all 15 patients improved after conversion and 1-year allograft survival rate was 100％ (15/15) .Serum creatinine decreased markedly and glomerular filtration rate increased significantly at 1 month and 3 months after conversion (P<0 .05) .BK viruria was detected in 5 patients before conversion .After conversion ,BK virus turned into negative in 3 patients within 3 months and viral load also decreased in another 2 patients .After conversion ,only 2 patients (13 .3％ ) developed de novo proteinuria .Eight patients (53 .3％ ) developed de novo hypertriglyceridemia responding well to medications .None of them experienced acute rejection during follow-ups .Conclusions Sirolimus plus low-dose calcineurin inhibitor is a safe and effective maintenance immunosuppressive regimen for recipients of kidneys from expanded criteria donors ,especially for those with abnormal renal function during recovery .But it cannot completely replace the traditional immunosuppressive regimen .Individualized treatment should be chosen properly for recipients .
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Wild-type p53-induced phosphatase 1 is a member of the protein phosphatase family and is an established oncogene due to its dephosphorylation of key protein in pathways and negative control of the DNA damage response system.Wild-type p53-induced phosphatase 1 serves a major role in tumorigenesis,progression,invasion,distant metastasis and chemotherapy resistance in various types of human cancer.Therefore,it may be a potential biomarker and therapeutic target in the diagnosis and treatment of cancer.In the paper,the current knowledge on the role of wild-type p53-induced phosphatase 1 in cancer is discussed.
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Objective To evaluate the efficacy and safety of modified technique of ureteral stent placement during transurethral resection of bladder tumor.Methods Seventeen patients with muscle invasive bladder cancer invading the ureteral orifice from March 2014 to June 2016 in Beijing Friendship Hospital were randomly divided into two groups.In the modified technique group (group A,n =10),tumor was resected until the ureteral orifice was exposed.Then,a guide wire was placed through the tunnel of Electrode loop and the ureteral stent was placed along the guide wire.In control group (group B,7 cases),after ureteral orifice exposed,the guide wire and ureteral stent was placed with cystoscopy.The demographic,oncological baseline and operative factors were evaluated between two groups.Results There was no difference in tumor grade and maximum diameter between two groups (P ＞ 0.05).The operation time in group A was significantly shorter than that in group B [(39.5 ± 14.8)min vs (59.3 ± 16.2) min,P =0.020],and the intraoperative vision clarity score was better in group A as well [(7.7 ± 1.3) vs (5.9± 1.2),P =0.010].There was no statistical difference between the two groups in the complication.Conclusions The modified technique can improve the efficiency of ureteral stent placement during transurethral resection of bladder tumor without any risk enhancement.
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Objective To systematically review the effect of ω-polyunsaturated fatty acids-supplemented nutrition support on the immune function and nutritional status of patients with gastrointestinal malignancies.Methods Databases of MEDLINE,EMBASE,Cochrance Central register of controlled trials,China National Knowledge Infrastructure (CNKI),China Biology Medicine disc (CBM) were searched.The search words were omega-3 polyunsaturated fatty acids,fish oil,cancer,turmor,neoplasms in English or Chinese.All the high quality randomized controlled trials were included after assessed with Jadad scale.RevMan 5.2 was used for statistical analysis.Results Altogether 12 studies were included.Meta-analysis results showed that CD4+％ (I2 =0％,95％ CI=3.44～6.93,Z=5.82,P＜0.00001),CD8+％ (I2 =0％,95％ CI=2.44～7.13,Z=4.00,P＜0.000 1),CD4+％/CD8+％ (I2 =74％,95％ CI=0.16～0.83,Z=2.87,P=0.004),IgA (I2=14％,95％ CI=0.21 ～0.43,Z=5.84,P＜0.00001),prealbumin (I2 =0％,95％CI =0.02 ～ 0.05,Z =3.94,P ＜ 0.000 1) in the treatment group were higher than in the control group,C-reactive protein (I2 =76％,95％ CI =-21.33 ～-5.03,Z =3.17,P =0.002) in the treatment group was lower than in the control group,the differences were all statistically significant.But there were no statistically significant differences in CD3 + ％ (I2 =0％,95％ CI =-3.50 ～ 2.56,Z =0.31,P =0.76),IgG (I2 =92％,95％ CI=-0.32 ～5.54,Z=1.74,P=0.08),IgM (I2 =99％,95％ CI=-0.52～1.89,Z=1.11,P=0.27),total protein (I2 =0％,95％CI=-4.08 ～1.77,Z=0.78,P=0.44),albumin (I2 =29％,95％ CI=-0.87 ～1.45,Z=0.49,P=0.63),transferrin (I2 =0％,95％ CI=-0.23～0.19,Z =0.19,P =0.85) between treatment and control groups.Conclusion Omega-3 polyunsaturated fatty acids can improve the perioperative immune function of patients with gastrointestinal malignant tumor,reduce inflammatory and stress reactions,but have no obvious effect on the improvement of the nutritional status.
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Objective To conduct an investigation on diabetes nutrition knowledge, attitude and practice in outpatients with type 2 diabetes, understand the nutritional knowledge and dietary behaviors in patients with type 2 diabetes to guide individualized nutrition education. Methods The diabetes nutrition Knowledge, Attitude and Practice(KAP) questionnairewas designed based onChinese dietary guidelines (2007)andChinese diabetes medical nutrition therapy guidelines (2013). Data of out-patients with type 2 diabetes from January to March 2015 were collected. The method of investigation was face-to-face interview. Results Totally 915 patients were enrolled into this survey(male 495 and female 420). The mean BMI was (27.23 ± 3.18)kg/m2, glycosylated hemoglobin A1c (HBA1c) was (8.03 ± 2.17)%. Among the questions on knowledge, only on 4 questions the rate of awareness was over 80%, and there was a misunderstanding on diet, only 54.10%of diabetes patients believed that diabetes diet should be balanced and reasonable, rather than just limiting staple food and meat. Patients generally could realize the importance of diet for diabetes treatment. For questions on practice, the rate of reaching the standard generally was not over 80%. The rate of correct answers was not significantly different among different age groups, gender, and durations. There was a linear correlation between the rate of correct answers and glycosylated hemoglobin (P=0.043), the correlation coefficient was-0.258. The higher the rate of correct answers, the lower the level of glycosylated hemoglobin. Conclusion Outpatients with type 2 diabetes had good awareness level about diabetic nutritional knowledge and attitude but the awareness level of balanced diet needs to improve, the awareness rate on behavior was relatively low.
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Purpose To investigate the expression and clinical significance of the cell cycle inhibitors p16 protein and specific recogni-tion of viral replication intermediate TLR3 in the cervical intraepithelial neoplasia ( CIN) and cervical invasive carcinoma. Methods Immunohistochemical stain was used to detect the expressions of p16 and TLR3 in 19 cases of normal cervical epithelium ( NCE) , 62 cases of CIN, and 17 cases of cervical squamous cell carcinoma (SCC). Results The positive rates of p16 protein were 0, 72. 5%and 100% in NCE, CIN and SCC respectively in which the difference among those groups were statistically significant ( P<0. 01 ) . Similarly, the positive rates of TLR3 protein were 26. 3%, 87% and 100% in NCE, CIN and SCC respectively and the difference a-mong those groups was significant (P<0. 01). Furthermore, there was a significant and positive correlation between the expression of p16 and TLR3 (rs =0. 538, P<0. 01). Conclusion Increased expression is observed in CIN and SCC compared with NCE and the expression of p16 and TLR3 is associated with level of CIN. Those could provide certain experiment basis for the pathologica diagnosis of early cervical cancer.
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Objective To explore the different operation modes for treating native renal pelvic and ureteral neoplasms occurring at the same side of transplanted kidney.Method A retrospective analysis was performed on 48 cases of native renal pelvic and ureteral neoplasms occurring at the same side of transplanted kidney,including 14 cases receiving open surgery (open surgery),22 cases receiving laparoscopic radical nephroureterectomy with bladder cuff resection through a lower abdomen oblique incision (oblique incision group) and 12 cases receiving modified endoscope assisted Plunk technique (Plunk group).The operating time,amount of bleeding and blood transfusion during operation,recovery of intestinal function,time of indwelling drainage tube and wound suture,the total cost of hospitalization,the hospital stay and the incidence of complications were comparatively analyzed.Result The operating time in open group was shortest.Group of Pluck is better than other groups in the aspects of Time of wound suture and intestinal function time in shorter in Plunk group than the rest two group (P＜0.05),and amount of bleeding and incidence of complication in Plunk group were higher than oblique incision group (P＜0.05).The incidence of complications and amount of bleeding were decreased significantly as compared with the rest groups (P＜0.05).Conclusion The mode of the laparoscopic radical nephroureterectomy with bladder cuff resection through a lower abdomen oblique incision has the advantages of high security,minimal invasion and satisfactory treatment effect.It is especially suitable for treating native renal pelvic and ureteral neoplasms occurring at the same side of transplanted kidney.
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Objective To evaluate whether the unidirectional barbed suture is safety and efficiency enough for laparoscopic partial nephrectomy.Method From March 2013 to March 2014,27 patients with renal mass have been involved into this study and divided into 2 groups wsing a lottery.Group A used Coated Vicryl in renorrhaphy after LPN,and group B used unidirectional barbed suture.All patients underwent LPN preformed by single group of surgeons.Perioperative and postoperative indicators were compared in two groups.Result It is identical in age,BMI,tumor size,R.E.N.A.L nephrometry scoring system between 2 groups.However,using barbed suture has significantly shortened in warm ischemia time (WIT).The postoperative indicators,such as blood loss,hospital stay and surgery complication has no significantly difference in two groups.Conclusion The unidirectional barbed suture is safety and efficiency using in LPN which can shorten WIT significantly.
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Objecitve To conclude the clinical manifestation of Fournier's gangrene (FG) and its emergency treatment.Methods From 2006 to 201 1,12 patient were involved in the study,all had received debridement,wide spectrum antibiotics and support therapy,the clinical manifestation,treatment choice and prognosis were analyzed retrospectively.Results All patients were male with 67.7 year-old mean age.Initial lesions were all in scrotal skin,an average procedures of each patient was 3.5,mean hospitalization days was 29.7 days.Surgical wound was healed by left scrotal skin in all cases,2 cases with huge urethra defect were received perineostomy.Ten cases were survived with 57-months follow-up and mortality was 16.7％.Conclusions Fournier is one of emergency disease of Urology.Its mortality is still high.Intensive care and appropriate anti-biotic therapy combined with surgical treatment is the key of FG's management.
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Objective To explore the efficacy and safety of Gemcitabine and Cisplatin combination chemotherapy in treatment of muscle-invasive urothelial cell carcinoma.Methods Analyse of 72 cases of patients with muscle-invasive urothelial cell carcinoma receiving chemotherapy from September 2010 to September 2012,including 47 male and 25 female,the avarage age was 65 (86-33).All patients were received GC chemotherapy (Gemcitabine 800-1 000 mg/m2,ivgtt,dl,d8,d15; Cisplatin 70 mg/m2,ivgtt,d2).Efficacy was reviewed after 1 cycle of chemotherapy.Results Fifty-one cases in all the patients completed two or more chemotherapy cycles and CR 10 cases,PR 27 cases,total effective rate was 51.39％ (37/72).The main toxic reactions included nausea,vomit,myelosuppression,and then damage of liver and renal function.Cconclusion GC regimen is a good choice for urothelial cell carcinoma.Close follow-up and the usage of adjuvant drugs can contribute to reduce the side effect of chemotherapy.
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Objective To improve the technology of retroperitoneal laparoscopic living donor nephrectomy and observe its clinical effect.Methods Forty-one cases of living donors subject to nephrectomy by the new retroperitoneal laparoscopic technique from July 2009 to June 2012 were retrospectively.The new technique was modified as follows: (1) Alternate use of blunt dissection,sharp dissection and harmonic scalpel; (2) After separation of renal vein,artery and ureter,a 5-6 cm incision parallel to rectus abdominis from Trocar was made in order to put a hand inside retroperitoneum; (3) A biopsy of the kidney was made from Trocar with the help of a hand for holding the kidney; (4) Pulling the kidney with a proper strength and blocking renal artery and renal vein with Hem-o-lock,then cutting off them and taking out the kidney.Results Forty-one cases of live donors subject to nephrectomy were operated on successfully,and were not converted to open operation.The operative time was 65-130 min (mean 85 min).The warm ischemia time was 58-110 s (average 78 s).Living donor kidney artery length was 2.1-3.7 cm (average 2.9 cm).Living donor kidney vein length was 2.5-4.1 cm (average 3.5 cm).Blood loss was 15-80 ml (average 28 ml).Hospital stay after surgery was 4-7 days (average 4.8 days).All biopsy specimens were achieved from 41 cases.None suffered from complications except two cases of perilymphorrhea.Forty-one recipients recovered well after renal transplantation.Conclusion The improved retroperitoneal laparoscopic living donor nephrectomy is considered to be safe,effective and feasible.It is a good way to protect renal function and reduce injury.
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Objective Concluding the clinical feature and prognosis of primary testicular lymphoma to improve the understanding of this disease.Methods During 1995 and 2010,17 cases of primary testicular lymphoma treated in Beijing Friendship Hospital of Capital Medical University were retrospectively analyzed of its clinical features,diagnosis,treatment and prognosis.Results Seventeen patients with a mean age of 68 years complained the testicular sohd mass as their first symptoms.The mean tumor diameter was 4.7 cm,and all patients underwent orchidectomy,and testicular non- Hodgkin's lymphoma was confirmed by pathologic examination.Fourteen cases were diffuse large B cell type and 3 cases were anaplastic large cell type.The clinical stage of all the patients was IE.Fourteen cases were followed up (3 cases were lost)with mean follow-up time of 37.8 months by outpatient interview and telephone,all patients were treated with CHOP chemotherapy,and some of them were combined with rituximab and preventive lowdose pelvic radiotherapy.Five cases died of other chronic medical complications,1 case with contralateral testicular metastasis received surgery again.There were 9 tumor free survival cases in total.Conclusion Primary testicular lymphoma is rare and more common in older men.Postoperative pathologic diagnosis is gold standard.The systemic treatment and individual therapy is the first choice for primary testicular lymphoma.
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Objective To investigate the clinical characteristics and treatmentof ureteral endometriosis.MethodsA retrospective analysis was made on the clinical data of 16 cases of ureteral endometriosis of the Department of Vrology,Beijing Friendship Hapital,Affiliated to Copital Medical Universty from January.1991 to Augest.2011.ResultsSixteen cases were pathologically confirmed endometriosis,including 11 cases of outer lumen type,5 cases of lumen type ; endomctriosis lesions were all located in the lower ureter.Ureteral stricture length was 1.0-4.0 cm.During 12 months to 20 years follow-up,hydronephrosis detected by ultrasonography in 15 patients was released significantly,and no recurrence occurred except one case who was found hydronephrosis 3 years later.Ureter anastomosis was undergone later.ConclusionsUreteral endometriosis onset is undetectable which could impact renal function.Renal ultrasonography can reduce misdiagnosis.The principle of treatment is to remove the obstruction and protect renal function,and well follow-up to prevent recurrence.