Clinical efficacy of percutaneous nephrolithotomy with holmium laser and no help of irrigating pump in the treatment of renal calculi:report of 127 cases / 中国基层医药

Objective To observe the clinical efficacy of percutaneous nephrolithotomy ( PCNL ) with Holmium laser and no help of irrigating pump in the treatment of renal calculi in 127 cases.Methods From January 2012 to November 2017 ,a total of 127 patients with renal calculi have suffered mini -PCNL with Holmium laser and no help of irrigating pump by using 16F or 18F Urovision percutaneous nephrostomy kit in Peking University Shougang Hospital ,the Hospital of Mentougou District and the Traditional Chinese Medicine Hospital of Mentougou District were collected.The operation time, intraoperative blood loss, hospitalization stay, lithotripsy rate, stone clearance and principal complications of operation were analyzed statistically .Results The first phase success rate of percutaneous nephrostomy was 100％, lithotripsy rate was 24.4％, stone clearance rate was 24.4％.The operation time was (36.1 ±15.6)min.The intraoperative blood loss was (45.4 ±31.7)mL.But postoperative abdominal X-ray showed that 96 patients with residual calculi ≥ 4mm needed to receive the second look PCNL .These 96 patients reached 100.0％ of lithotripsy rate and 100.0％ of stone clearance postoperatively .The operation time was ( 64.5 ± 31.1)min.The intraoperative blood loss was (23.1 ±21.9)mL.No severe complications such as massive hemorrhage occurred.The hospitalization stay was (12 ±5 ) d.Conclusion Larger renal calculus except complete staghorn calculus,and upper ureteral calculus are the indications for PCNL with Holmium laser and no help of irrigating pump . It is safe and feasible to perform PCNL with Holmium laser and no help of irrigating pump .

Correlation between molecular biomarkers and risk factors for the clinical progression of benign prostatic hyperplasia using tissue microarray immunostaining / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The pathogenesis of benign prostatic hyperplasia (BPH) has been widely studied, and several biomarkers are known to play roles in its development. This study aimed to investigate the possible role of cysteine-rich protein 61 (CYR61), vascular endothelial growth factor (VEGF), androgen receptor (AR), interleukin-6 (IL-6), cytochrome c, caspase-3, and proliferating cell nuclear antigen (PCNA) in the clinical progression of BPH.</p><p><b>METHODS</b>Tissue specimens from 96 BPH cases who underwent transurethral resection of the prostate were processed and transferred to tissue microarrays. Patient age, prostate volume, serum prostate-specific antigen (PSA) level, and International Prostate Symptom Score (IPSS) of all BPH cases were collected before surgery. The expression of CYR61, VEGF, AR, IL-6, cytochrome c, caspase-3, and PCNA was examined by immunostaining in the BPH specimens, and any possible correlation between the different biomarkers and risk factors for BPH clinical progression was analyzed.</p><p><b>RESULTS</b>The expression of CYR61, VEGF, AR, IL-6, cytochrome c, caspase-3, and PCNA in the BPH cases was 68.8% (66/96), 77.1% (74/96), 43.8% (42/96), 31.3% (30/96), 35.4% (34/96), 56.3% (54/96), and 29.2% (28/96), respectively. The expression of both CYR61 and VEGF was positively correlated with patient age, prostate volume, and serum PSA level (P < 0.05). Furthermore, cytochrome c and caspase-3 expression were inversely related to prostate volume (P < 0.05), and AR expression was positively related to serum PSA level (P < 0.05).</p><p><b>CONCLUSION</b>CYR61 and VEGF expression might serve as biomarkers for predicting the clinical progression of BPH due to effects on stromal cell proliferation and angiogenesis.</p>

Re-discussion of warm ischemia time during retroperitoneal laparoscopic partial nephrectomy for renal carcinoma / 中国癌症杂志

Background and purpose:Laparoscopic partial nephrectomy has been one of the surgery options for patients with single renal carcinoma of T1 stage. Under the effect of some factors, intraoperative renal blood lfow clamping somtimes exceeds the safe limit of 30 minutes of warm ischemia time (WIT) for renal tissues, that might results in warm ischemia-reperfusion injury to severe extent. However, there still remains controversy about the depth of this warm ischemia-reperfusion injury. So this study aimed to evaluate the effects of longer WIT on ipsilateral residual renal tissues. Methods:Forty-four patients underwent retroperitoneal laparoscopic partial nephrectomy from Jan. 2012 to Jan. 2014. All of them were divided into observe group (WIT>30 min) and control group (WIT≤30 min). The differences of glomerular filtration rate (GFR) of operative kidney Pre- and post-operatively between two groups were analyzed. Results: The pre- and post-operative GFRs of operative kidney in observe group were 29.3-53.0 mL/min[(33.1±5.2) mL/min], 23.1-40.5 mL/min[(27.3±5.9) mL/min] respectively (P=0.054). The pre-and post-operative GFRs of operative kidney in control group were 27.4-49.6 mL/min[(32.3±4.1) mL/min], 23.8-44.4 mL/min[(29.1±5.0) mL/min], respectively (P=0.07). There was no statistically differences of the depth of the decrease of GFRs after surgery between the two groups (P=0.051). Conclusion: WIT of 30-60 min does not result in statistically signiifcant injury for ipsilateral residual renal function. However, it is still necessary to reserve more ipsilateral residual renal function through minimizing WIT under the premise of ensuring the safety of surgery.

Clinical analysis of forty-nine patients with renal cell carcinoma of stage T_(1-3a)N_0M_0 combined with inflammatory enlargement of hilar lymph nodes / 中国癌症杂志

Background and purpose: Systemic reports about the prognosis of patients with renal cell carcinoma (RCC) of stage T_(1-3a)N_0M_0 combined with inflammatory enlargement of hilar lymph nodes have not been observed in the literature. This study was to investigate the prognostic role of inflammatory enlargement of hilar lymph nodes in the patients with RCC of stage T_(1-3a)N_0M_0 and its association with clinical features. Methods; Forty-nine patients with RCC of stage T_(1-3a)N_0M_0 combined with inflammatory enlargement of hilar lymph nodes were reviewed and all these patients underwent radical nephrectomy from January 1995 to January 2000. Results: The duration of follow-up was 8-14 years with the average of 7.5 years. Seven patients were lost to follow-up. Seventeen patients without RCC and four with RCC metastases are alive at present. Eighteen patients died of RCC relatad complications and three died of cerebro-cardiovascular disease. Metastases occurred in twenty-two patients one year after surgery. The 5- and 10- year survival rates were 53.1% and 42.9%, respectively. Conclusion: Most of the enlarged hilar lymph nodes in RCC were diagnosed as lymphadenitis. The rate of inflammatory enlargement of hilar lymph nodes in the long-term survival patients with RCC of stage T_(1-3a)N_0M_0 were comparatively low. Regional lymphadenectomy or resection of enlarged inflammatory lymph nodes could not protect the patients from metastasis completely. It is advised that limited lymphadenectomy with resection of enlarged inflammatory lymph nodes should be performed for the patients in RCC combined only with inflammatory enlargement of hilar lymph nodes.

Expression of KAI-1,Ki-67 and HER-2/neu on T_(1-3)N_0M_0 stage renal carcinoma(RC) and its significance to predict postoperative metastasis of RC / 中国癌症杂志

Background and purpose:Regular physical exam became the main means to discover the population with early stage RCC. So far, there have been no reports with large sample that have been published about the biomarkers as predictor for the metastasis of the postoperative patients with stage T_(1-3)N_0M_0 (RCC) in China. Furthermore, the underlying mechanism of metastasis of RCC is not clear. This research was carried out in order to study the correlation between delayed metastasis of early stage renal cell carcinoma after surgical operation and expressions of KAI-1、Ki-67 and HER-2/neu on RCC. Methods:Two hundred and forty-one patients with RCC underwent surgical operations and were pathologically diagnosed as T_(1-3)N_0M_0 stage. Twenty-four patients were found to have metastases after long-term follow-up and their clinical data were reviewed (metastasis group). One hundred and ninety-four patients without postoperative metastases were taken as control group. Twenty three patients were excluded from this study because they were lost to follow-up. The expressions of KAI1、 Ki-67 and HER-2/neu in the samples of the two groups were tested with immunohistochemical staining by PowerVision or EnVision two-step procedure. Significant difference was calculated with Chi square test.Results:The positive expression rates of KAI1、HER-2/neu and Ki-67 in 218 RCC were 82.6%、27.5% and 83.5%, respectively. Both mild (20.8%) and strong positive rates (4.2%) of KAI1 in metastasis group were dramatically less than that in control group (90.2%, 73.7%, P

The clinical characteristics of different pathological subtypes of cyst-associated renal cell carcinoma / 中国癌症杂志

Purpose:To study the pathological and clinical characteristics of different subtypes of cyst-associated renal cell carcinoma and summarize the experience in diagnosis and therapy. Methods:39 cases with cyst-associated renal cell carcinoma underwent urological operations in our hospital from 1991 to 2000. Their medical data were analyzed and then divided into different subtype according to pathological characteristics. Results:The data included 2 patients with renal cell carcinoma on the background of polycystic kidney, 20 cases with renal cell carcinoma originating in a cyst and 17 cases with cystic renal cell carcinoma.3 patients underwent partial nephrectomy and 36 cases unilateral radical nephrectomy.16 patients were Robson stage Ⅰ and 23 were RobsonⅡstage.The pathological diagnosis was 38 cases of clear cell carcinoma and one of chromophobe cell carcinoma. The survival rates at 1,3,5 years are 100%、100%、94.8%(37/39) respectively after follow-up. Conclusions:The cases with renal cyst need periodical health check-up.Most of cyst-associated renal cell carcinomas belong to low stages. Contrast-enhanced computed tomography and selective digital subtraction angiography of renal artery are the main methods for preoperative clinical diagnosis. The long-term effect of operations of cyst-associated renal cell carcinoma is better.

Diagnosis and treatment of pheochromocytoma:a fifty-year clinical experience / 中华泌尿外科杂志

Objective To review and discuss the changes of diagnostic techniques and therapeutic modalities of pheochromocytoma during the past fifty years. Methods The clinical data of 362 patients (196 men and 166 women; age range,7-75 years;mean age,38 years) with pheochromocytoma from January 1955 to July 2004 were retrospectively analyzed.The disease course ranged from 20 d to 20 years with a mean of 3.9 years.According to the premedication,the past 50-year period was divided into 3 stages;and the diagnostic techniques,premedication, anesthetic skills,surgical procedures and perioperative death rate were compared among the 3 stages. Results There were 60 patients in the first stage (1955-1975) and their diagnoses were made on urine VMA and retroperitoneal air-contrast imaging.They had no premedication except for tranquilizers.The therapeutic modality was open surgery of resecting tumors under peridural anesthesia.The perioperative mortality was 8.3% (5/60).The second stage (1976-1994) included 105 patients and they were diagnosed mainly by 24-h urine catecholamine, ultrasonography and CT.Phenoxybenzamine was taken as the regular premedication and open surgery general anesthesia was used; the mortality decreased significantly to 1.0% (1/105).The third stage (1995-2004) consisted of 197 cases.In addition to 24-h urine catecholamine,ultrasonography and CT, 131I-MIBG scan was used as the specific diagnostic technique for pheochromocytoma widely.The premedication was phenoxybenzamine and urapidil.The microcirculation imaging analysis was used to judge the volume expansion preparation. Laparoscopic resection of the tumor under general anesthesia was adopted as the regular means.The perioperative mortality was 0.5% (1/197). Conclusions The diagnostic techniques for pheochromocytoma have become enriched and mature.The premedication has been standardized and included more medicines.The microinvasive surgery has become the current method for resecting tumors,and the perioperative mortality has become significantly decreased.