Intraoperative contrast-enhanced ultrasound guided surgery for isoechoic completely endogenous renal tumor: a case report / 中华泌尿外科杂志

Intraoperative ultrasound assisted localization is routinely used in the surgical treatment of completely endogenous renal cell tumor, however the localization and guidance ability of conventional ultrasound will decline to a certain extent for isoechoic renal tumor. A 62 years old female patient with right renal tumor was reported. The tumor diameter was about 2.3 cm× 1.7 cm, equivalent to the isoechoic of kidney. Laparoscopic partial nephrectomy was performed under the real-time guidance of contrast-enhanced ultrasound. The tumor was found to be lack of blood supply during the operation, and the tumor contour was clearly developed by contrast agent.The operation was successfully completed, and the pathological diagnosis was polycystic renal tumor with low malignant potential.The incisional margin was negative.The patient recovered well after operation without complications.No recurrence or metastasis was found after 6 months of follow-up.The renal function was good.

Application of transrectal contrast-enhanced ultrasound in the diagnosis of prostate cancer in different tPSA intervals / 现代泌尿外科杂志

【Objective】 To investigate the clinical value of transrectal contrast-enhanced ultrasound (CEUS) in the diagnosis of prostate cancer in different total prostate specific antigen (tPSA) intervals. 【Methods】 According to serum tPSA levels, 96 patients meeting the inclusion criteria were divided into 3 groups:4-10 ng/mL, >10-20 ng/mL and >20 ng/mL groups. All patients underwent transrectal CEUS. With pathological results as reference, the diagnostic value of transrectal CEUS in different tPSA intervals was evaluated. 【Results】 Of the 96 cases, 62 were confirmed by pathology as prostate cancer and 34 as benign prostatic hyperplasia (BPH). The main perfusion characteristics of prostate cancer under CEUS were rapid enhancement (64.52%), rapid clearance (70.97%), uneven enhancement (83.87%) and high enhancement (61.29%);the main characteristics of BPH were non-rapid enhancement (70.59%), non-rapid clearance (73.53%), uniform enhancement (76.47%) and non-high enhancement (52.94%). There were significant differences in terms of enhancement speed, clearance speed and enhancement uniformity between prostate cancer and BPH (P<0.05), but no significant difference in the enhancement intensity. The sensitivity of transrectal CEUS in the diagnosis of prostate cancer in low, medium and high tPSA groups were 58.33%, 70.37% and 95.65%, the specificity were 83.33%, 76.92% and 66.67%, and the accuracy were 73.33%, 72.50% and 92.31%, respectively. Transrectal CEUS showed consistency at different serum tPSA levels for the diagnosis of prostate cancer, with statistical significance. Moreover, in the 4.0 ng/mL ≤tPSA<10.0 ng/mL group, the diagnostic specificity was the highest. 【Conclusion】 Transrectal CEUS is helpful in the differential diagnosis of benign and malignant prostatic lesions, especially for patients with different serum tPSA levels.

IgG4 related disease involving the adrenal glands: a case report / 中华泌尿外科杂志

IgG4-related diseases have a low incidence and are easily misdiagnosed as tumors in clinical treatments. A 26-year-old male patient was admitted to the hospital because of a left adrenal tumor found in health examination for more than 5 months. The tumor in the left adrenal region could be seen from abdominal CT, and the retroperitoneal laparoscopic resection of the left adrenal tumor was performed. Postoperative pathology was consistent with IgG4-related diseases, and serum IgG4 was abnormally high. After 2 months’ follow-up, serum IgG4 returned to normal, and no special discomfort.

Chinese expert consensus on diagnosis, treatment and prevention of venous thrombus embolism associated with chest trauma (2022 version) / 中华创伤杂志

Chest trauma is one of the most common injuries. Venous thromboembolism (VTE) as a common complication of chest trauma seriously affects the quality of patients′ life and even leads to death. Although there are some consensus and guidelines on the prevention and treatment of VTE at home and abroad, the current literatures lack specificity considering the diagnosis, treatment and prevention of VTE in patients with chest trauma have their own characteristics, especially for those with blunt trauma. Accordingly, China Chest Injury Research Society and editorial board of Chinese Journal of Traumatology organized relevant domestic experts to jointly formulate the Chinese expert consensus on the diagnosis, treatment and prevention of chest trauma venous thromboembolism associated with chest trauma (2022 version). This consensus provides expert recommendations of different levels as academic guidance in terms of the characteristics, clinical manifestations, risk assessment, diagnosis, treatment, and prevention of chest trauma-related VTE, so as to offer a reference for clinical application.

Solitary fibrous tumor of the seminal vesicle: a case report / 中华泌尿外科杂志

The incidence of solitary fibroma of seminal vesicle is low, and the source of seminal vesicle is rare. A 38-year-old patient was admitted to hospital because of intermittent gross hematuria for more than one month. Seminal vesicle space occupying lesions can be seen in pelvic MRI. Laparoscopic resection of right seminal vesicle tumor was performed, and the pathological diagnosis tended to solitary fibroma. During the 5-month follow-up, the symptoms of hematuria disappeared and no recurrence.

Clinical study of radical cystectomy under totally laparoscopy and ρ shape orthotopic ileal neobladder / 中华泌尿外科杂志

Objective@#To explore the feasibility and advantages of totally laparoscopic radical cystectomy plus ρshape orthotopic ileal neobladder, and to summarize the experiences.@*Methods@#The clinical data of 11 patients with bladder cancer admitted to the second hospital of Hebei medical university from October 2018 to May 2019 were retrospectively analyzed. All patients were male, aged 33 to 77 years, with an average of 64.4 years. Body mass index ranged from 18.0 to 31.8 kg/m2, with an average of 23.2 kg/m2. One case underwent partial cystectomy and 10 cases underwent transurethral resection of bladder tumor, with 10 cases of invasive urothelial carcinoma and 1 case of adenocarcinoma. No case underwent neoadjuvant therapy, and all cases were clinically staged as cT2a-3bN0-2M0. Totally laparoscopic radical cystectomy and ρ shape orthotopic ileal neobladder intraperitonealy were performed. The specific procedures were described as follows. After bladder resection, the ileal segment of 55 cm in length was intercepted at 25 cm from ileocecal valve, with the proximal part retaining 15 cm lumen as the input loop, and the distal part of 40 cm ileum being folded in 1∶1 ratio. The folded intestinal segment was made into a allantoic sac by using a linear incision closure device, forming a "ρ" shape with the input loop, bilateral ureters and the input loop. Anastomosis of wall, distal end of allantoic and urethra was performed.Record the perioperative data such as operation time, estimated bleeding, postoperative recovery, complications, and follow-up results.@*Result@#All of the 11 cases underwent successfully operation, and no cases were transferred to open surgery. The operation time ranged from 320 to 440 minutes, with an average of 357.1 minutes. The estimated amount of bleeding ranged from 100 to 300 ml, with an average of 207.1 ml. The total time of intestinal tract procedure was 80-100 minutes, with an average of 89.3 minutes, and the time of allantoic preparation was 14-19 minutes, with an average of 16.1 minutes. The pain score was 2-5 points at 4 hours after operation, with an average of 3.8 points, and 1-4 points at 24 hours after operation, with an average of 2.3 points. Postoperative exhaust time ranged from 2.5 to 3.5 days, with an average of 3.0 days.Catheter removed 21 days after operation, with 9 cases of urinary incontinence, including mild in 6 cases, moderate in 2 cases and severe in 1 case, with daytime pad of 0-3 and nighttime pad of 1-3.which improved gradually following pelvic exercise for 4-18 weeks. Postoperative hospital stay ranged from 7 to 13 days, with an average of 10.4 days. The drainage removal time was 4-11 days, with an average of 6.7 days. Postoperative pathology revealed 7 cases of high-grade invasive urothelial carcinoma, 3 case of low-grade invasive urothelial carcinoma and 1 case of adenocarcinoma. The tumors invade the prostate in adenocarcinoma patient, with left (3/13) and right (1/9) positive lymph nodes. One case of high-grade invasive urothelial carcinoma had both left (2/11) and right (1/9) positive lymph nodes, and the other cases were negative. The margin were negative in all patients. Pathological staging was pT2a-4aN0-2M0. Postoperative adjuvant chemotherapy with gemcitabine+ cisplatin regimen were performed in 9 patients.The follow-up period ranged from 3 to 29 weeks, with an average of 17.4 weeks, the patients with adenocarcinoma died of multiple organ failure at the 13th week after operation, and the other cases have no recurrence or metastasis. Dual J-tube was removed in 9 cases in the last follow-up, and the new bladder volume was estimated 300-350 ml, with residual urine of 0-43 ml and 19 ml of average. There is no stone formation in the new bladder.No hydronephrosis or ureteral dilatation aggravated.@*Conclusions@#Totally laparoscopic radical cystectomy plus ρ shape orthotopic ileal neobladder simplify the procedure of making allantoic storage and shorten the procedure time. The patients suffered less pain and recovered quickly after operation.It is a safe and feasible surgical procedure based on this study.

Clinical study of radical cystectomy under totally laparoscopy and p shape orthotopic ileal neobladder / 中华泌尿外科杂志

Objective To explore the feasibility and advantages of totally laparoscopic radical cystectomy plus ρshape orthotopic ileal neobladder,and to summarize the experiences.Methods The clinical data of 11 patients with bladder cancer admitted to the second hospital of Hebei medical university from October 2018 to May 2019 were retrospectively analyzed.All patients were male,aged 33 to 77 years,with an average of 64.4 years.Body mass index ranged from 18.0 to 31.8 kg/m2,with an average of 23.2 kg/m2.One case underwent partial cystectomy and 10 cases underwent transurethral resection of bladder tumor,with 10 cases of invasive urothelial carcinoma and 1 case of adenocarcinoma.No case underwent neoadjuvant therapy,and all cases were clinically staged as cT2a-3b N0-2 M0.Totally laparoscopic radical cystectomy and ρ shape orthotopic ileal neobladder intraperitonealy were performed.The specific procedures were described as follows.After bladder resection,the ileal segment of 55 cm in length was intercepted at 25 cm from ileocecal valve,with the proximal part retaining 15 cm lumen as the input loop,and the distal part of 40 cm ileum being folded in 1∶1 ratio.The folded intestinal segment was made into a allantoic sac by using a linear incision closure device,forming a “ρ” shape with the input loop,bilateral ureters and the input loop.Anastomosis of wall,distal end of allantoic and urethra was performed.Record the perioperative data such as operation time,estimated bleeding,postoperative recovery,complications,and follow-up results.Result All of the 11 cases underwent successfully operation,and no cases were transferred to open surgery.The operation time ranged from 320 to 440 minutes,with an average of 357.1 minutes.The estimated amount of bleeding ranged from 100 to 300 ml,with an average of 207.1 ml.The total time of intestinal tract procedure was 80-100 minutes,with an average of 89.3 minutes,and the time of allantoic preparation was 14-19 minutes,with an average of 16.1 minutes.The pain score was 2-5 points at 4 hours after operation,with an average of 3.8 points,and 1-4 points at 24 hours after operation,with an average of 2.3 points.Postoperative exhaust time ranged from 2.5 to 3.5 days,with an average of 3.0 days.Catheter removed 21 days after operation,with 9 cases of urinary incontinence,including mild in 6 cases,moderate in 2 cases and severe in 1 case,with daytime pad of 0-3 and nighttime pad of 1-3.which improved gradually following pelvic exercise for 4-18 weeks.Postoperative hospital stay ranged from 7 to 13 days,with an average of 10.4 days.The drainage removal time was 4-11 days,with an average of 6.7 days.Postoperative pathology revealed 7 cases of high-grade invasive urothelial carcinoma,3 case of low-grade invasive urothelial carcinoma and 1 case of adenocarcinoma.The tumors invade the prostate in adenocarcinoma patient,with left (3/13) and right (1/9) positive lymph nodes.One case of high-grade invasive urothelial carcinoma had both left (2/11) and right (1/9) positive lymph nodes,and the other cases were negative.The margin were negative in all patients.Pathological staging was pT2a-4a N0-2 M0.Postoperative adjuvant chemotherapy with gemcitabine + cisplatin regimen were performed in 9 patients.The follow-up period ranged from 3 to 29 weeks,with an average of 17.4 weeks,the patients with adenocarcinoma died of multiple organ failure at the 13th week after operation,and the other cases have no recurrence or metastasis.Dual J-tube was removed in 9 cases in the last follow-up,and the new bladder volume was estimated 300-350 ml,with residual urine of 0-43 ml and 19 ml of average.There is no stone formation in the new bladder.No hydronephrosis or ureteral dilatation aggravated.Conclusions Totally laparoscopic radical cystectomy plus ρ shape orthotopic ileal neobladder simplify the procedure of making allantoic storage and shorten the procedure time.The patients suffered less pain and recovered quickly after operation.It is a safe and feasible surgical procedure based on this study.

Preliminary application experience of resectoscope combined with laparoscopy in the treatment of paraganglioma of urinary bladder / 中华泌尿外科杂志

Objective To analyze the feasibility and safety in application of resectoscope combined with laparoscopy in the operation treatment of paraganglioma of urinary bladder.Methods 7 cases patients with paraganglioma of urinary bladder treated in our hospital from November 2014 to August 2018 were analyzed retrospectively.There were 5 males and 2 females,average age of 31.1 years (22-37 years),average body mass index was 22.3 kg/m2 (18.3-22.5 kg/m2).All the 7 cases patients complained of dizziness and palpitation after urination,average basal systolic blood pressure was 111.8 mmHg (97-124 mmHg),the average fluctuation of systolic blood pressure before and after urination was 64.9 mmHg(28-91 mmHg),the CT and cystoscopy prompt bladder tumor,the average diameter was 2.7 cm(2.1-3.5 cm).The average of plasma norepinephrine was 706.3 pg/ml(330-997 pg/ml);the average of plasma dopamine was 101.1 pg/ml(44-145 pg/ml);the average of 24h urinary vanilmandelic acid was 13.4 mg/24h (10.3-16.1 mg/24h).All the patients has controlled the blood pressure and dilate the blood vessels with phenoxybenzamine hydrochloride,accepted the operation of resectoscope combined with laparoscopy partial cystectomy and bladder sutura per abdomen after ample dilatancy.The patients had lithotomy position with trendelenburg,preparation of gas peritoneal cavity by transabdominal,inside the resectoscope by transurethral at the same time,mutilated bladder mucosa beside 1cm at the edge of the tumor,and cut full thickness bladder wall,take the extraperitional fat as the standard procedure;we could see the cutting edge clear at this time by laparoscopy,cut off the pelvic peritoneum,extraperitional fat and the tumor.The sample placed in bladder,close the bladder with absorbable or barbed wires,take out the sample by resectoscope.Results All the 7 cases patients operation was successfully completed,no cases has been transfered to open.The average time of operation is 85.3 min(65-100 min),the average amount of bleeding is 27.9 ml(10-50 ml).The average fluctuation of systolic blood pressure is 8.7 mmHg(6-15 mmHg).Bladder washout was stopped 24h after operation,catheter was removed 1 weeks after operation.There is no obvious complications occurred.The average hospital stay is 3.7 days (3-5 days).The average pain score of 4 cases 4h after operation is 3.8 (2-5),reevaluation 24h after operation is 2.3 (1-4).The average follow-up time is 7.9 months(2-15 months).All the 7 cases patients clinical symptoms disappeared,there is no fluctuation of systolic blood pressure before and after urination,there is no recurrence of the tumor.Conclusions To the paraganglioma of urinary bladder in fundus of bladder or anterior wall of bladder,we can accurate resection tumor by resectoscope combined with laparoscopy,reduce blood pressure fluctuations,reduce the surgical trauma and the distress of patients.It is a safety and effective minimally invasive surgery.

The development and features of multi-acupoints moxibustion instrument / 中国针灸

A new type of multi-acupoints moxibustion instrument was developed to effectively solve the issue of simultaneously performing moxibustion at multiple acupoints. The moxibustion instrument consisted of a bracket and a moxibustion cartridge mounted on the bracket. The upper end of the bracket was equipped with gooseneck tubes. The free end of the gooseneck tubes was equipped with moxibustion cartridge used for moxibustion. The moxibustion cartridge consisted of the cartridge body, the moxa needle and the ash net. This current instrument with novel and unique structure was simple and reasonable, safe and reliable, and had the advantages of convenient operation, time and labor saving, and high moxibustion efficiency, and was an innovation of moxibustion instrument.

Discussion on standardized training of resident physicians of acupuncture and tuina graduate students / 国际中医中药杂志

The standardized training of resident physicians of Chinese medicine specialized graduate students (standardized training) is a great reform of clinical postgraduate education and a major initiative to improve professional degree graduates education. It contributes to higher professional qualities of clinicians in China. At this stage, the standardized training in our school just started and some problems existed such as department arrangement, training and checking system, curriculum and tutors instruction. Here, taking the standardized training in our school as an example, this paper discussed some issues on the training and put forward suggestion. This will help standardize our training, improve the training quality of our graduate students and develope medical professional talents.

Brief discussion on technique and application experience of penetrating moxibustion / 中国针灸

The penetrating moxibustion technique is proposed based on experience of the ancients and clinical practice for many years. From the aspects of definition, action characteristics and technique at different parts, the advantage and application experience of penetrating moxibustion have been discussed. The adequate dose of moxibustion is necessary in penetrating moxibustion; in addition, moxibustion sensation should be penetrating; therefore, with a temperature of 43℃ for more than 20 min, sweating, flushing, speckle appearing after penetrating moxibustion. Due to individual differences of age, gender and constitution factors, the effects of penetrating moxibustion are different, in clinical practice the body reaction and patient's feelings should be deliberately focused on other than does or sore and blister of moxibustion. The technique is common used in the abdomen, waist and knee joint, etc.

Penetration moxibustion with different dosage for insomnia of insufficiency of heart and spleen type / 中国针灸

<p><b>OBJECTIVE</b>To observe the clinical efficacy differences between acupuncture combined with 40-min penetration moxibustion and 60-min penetration moxibustion at back-points for insomnia of insufficiency of heart and spleen type.</p><p><b>METHODS</b>Sixty patients of insomnia with insufficiency of heart and spleen type were randomly assigned into a 40-min group and a 60-min group. The two groups were treated with acupuncture at Jueyinshu (BL 14), Xinshu (BL 15), Geshu (BL 17), Pishu (BL 20), Shendao (GV 11) and Zhiyang (GV 9). With moxibustion box, the penetration moxibustion was applied at the back until sweating and redness on the back. The moxibustion was given for 40 min in the 40-min group and 60 min in the 60-min group. The treatment was given once a day, five days per week. Each session was consisted of 5 treatments, with an interval of 2 days between session and totally 4 consecutive weeks were provided. The Pittsburgh sleep quality index (PSQI), TCM symptom scale were observed and recorded before and after treatment in the two groups. The even temperature at raising period, effective period, reducing period, as well as minimum high temperature, comfortable temperature, minimum cold temperature and medication status were compared; also the effect was compared between the two groups.</p><p><b>RESULTS</b>The total effective rate was 96.6% (28/29) in the 60-min group, which was higher than 89.3% (25/28) in the 40-min group (<0.05). Compared before treatment, the total score of PSQI and sleep quality, sleep time, sleep efficiency, sleep disorder, daytime dysfunction as well as the total TCM symptom score and its drowsiress in the morning, palpitation, amnesia, appetite were reduced after treatment in the 40-min group (all<0.05). After treatment, the total score and each score of PSQI as well as total score and each score of TCM symptom scale were reduced after treatment in the 60-min group (all<0.05). After treatment, the total score and each score of PSQI as well as total score and each score of TCM symptom scale were significantly different between the two groups (all<0.05).</p><p><b>CONCLUSIONS</b>Acupuncture combined with penetration moxibustion can improve the symptomsof insomnia with insufficiency of heart and spleen type, which is more significant in the 60-min group, indicating prolonged time of penetration moxibustion can improve sleep latency.</p>

The association between drainage volume and removal of chest tube after video-assisted thoracoscopic lobectomy / 天津医药

Objective To investigate the association between drainage volume and removal of chest tube after video-as?sisted thoracoscopic surgery(VATS) lobectomy. Methods Patients with VATS were randomly divided into three groups:the drainage volume was less than 100 mL/24 h (group A), the drainage volume was more than 100 mL/24 h but less than 200 mL/24 h(group B) and the drainage volume was more than 200 mL/24 h but less than 300 mL/24 h (group C). According to in?clusion criteria and exclusion criteria, finally there were 90 patients in group A, 87 patients in group B and 83 patients in group C. The duration of chest-tube drainage, the occurrence of pulmonary infection, pulmonary atelectasis, pneumothorax, hydrothorax, seepage or delayed union after removal of chest tube, the dosage of analgesic and the length of hospital stay af?ter surgery were recorded. Data were analyzed statistically. Results The average durations of chest-tube drainage were (91.76±15.59)h, (84.17±18.33)h and (56.14±12.25)h, the average morphine consumptions were (236.82±67.20)mg, (187.36± 76.64)mg and (139.29±52.74)mg, and the average lengths of hospital stay after surgery were (11.47±1.90)d, (10.68±2.50)d and (10.23 ± 2.14)d for three groups of patients, respectively. And the indexes in group C were distinctly lower than those in group A and group B (P 0.05). Conclusion It is safe and acceptable that the removal of chest tube after VATS when the drainage volume reaches 300 mL within 24 h.