Assessment of the Perioperative Risk of Different Operation Times on Renal Angiomyolipoma Patients with Rupture and Hemorrhage / 中山大学学报(医学科学版)

[Objective] To investigate the perioperative risk of different operation times on renal angiomyolipoma (AML) patients with rupture and hemorrhage.[Methods] From January 2006 to December 2016,AML patients with rupture and hemorrhage who receiving surgical treatment were recruited.According to the operation time,patients receiving surgery within 7 days after the hemorrhage were classified as short-term operation group.Patients receiving surgery exceeded 30 days after the hemorrhage were classified as long-term operation group.The general and perioperative data were compared between the two groups.[Results] There were no statistically significant differences in age,tumor size,clinical symptoms and operative methods between the two groups.However,as compared to the long-term operation group,the hemorrhage during surgery [(780±451) vs.(572±913) mL,P=0.029],the volume of transfused blood [(2600 ± 1733) vs.(820±582) mL,P=0.027],the nephrectomy rate (60.0％ vs.22.6％,P=0.027) were significantly increased in the short-term operation group.[Conclusions] A long-term operation group for AML patients with rupture and hemorrhage could have a lower perioperative risk.

Clinical characteristics and surgical treatment for localized Castleman's disease / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics and treatment of localized Castleman's disease (CD), and review the literatures to improve the diagnosis and management of this disease.</p><p><b>METHODS</b>The clinical symptoms, histopathology, CT, MRI findings and results of surgery in 20 patients with localized CD were evaluated retrospectively.</p><p><b>RESULTS</b>The average age of the patients was 37.7 years. The lesions were located in the retroperitoneal space (9 cases), mediastinum (7 cases), pelvic cavity (1 case), neck (1 case), upper arm (1 case), and axillary (1 case). All patients underwent surgical resection, including 9 cases for retroperitoneal resection (6 cases had open operation and 3 cases laparoscopic resection) and 7 cases for mediastinal resection (open operation in 5 cases and thoracoscopic resection in 2 cases). The Castleman's disease was confirmed by histopathology. There were hyaline vascular type of CD in 17 cases, plasma cell type of CD in 1 case, and mixed cellularity type of CD in 2 cases. The duration of follow-up ranged from 12 to 165 months for 16 cases. Among them 15 patients were alive without recurrence, and 1 case had recurrence in the primary site at 47 months after the operation.</p><p><b>CONCLUSIONS</b>Patients with Castleman's disease have no typical clinical symptoms and have normal laboratory results. The majority of patients are of hyaline vascular type of the disease. Imaging examination is helpful to diagnosis, and the final diagnosis depends on pathologic examination. Complete surgical resection of the tumor is the best treatment for localized Castleman's disease.</p>

Shorter recurrence-free survival time, higher risk of multiple recurrences: a retrospective study of non-muscle invasive bladder cancer after transurethral resection / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Multiple recurrences are common in non-muscle invasive bladder cancer, but the risk of multiple recurrences has not been fully described. Identifying patients at high risk of multiple recurrences will help to select an optimal therapeutic strategy and to improve prognosis. This study was conducted to identify the risk factors for multiple recurrences of non-muscle invasive bladder cancer.</p><p><b>METHODS</b>We reviewed the clinical data of all patients with non-muscle invasive bladder cancer in our hospital between January 2003 and February 2010. Patients with at least one recurrence were included. Multivariate analysis was performed for theorized risk factors (age, gender, tumor stage, grade, size, location, number of lesions, adjuvant intra-vesical chemotherapy after transurethral resection, and recurrence-free survival after each resection) to clarify risk factors for multiple recurrences of non-muscle invasive bladder cancer.</p><p><b>RESULTS</b>Of the 278 patients with non-muscle invasive bladder cancer, 84 were with at least one recurrence and a total of 222 recurrences among them were followed up for 6 - 70 months (mean, 36.1 months). Recurrence-free survival after initial resection predicted the overall frequency of bladder cancer recurrence (risk ratio (RR) = 37.83, 95% confidence interval (CI) = 3.45 - 396.13, P = 0.001) and second recurrence (RR = 6.15, 95%CI = 1.28 - 29.57, P = 0.023). Similarly, recurrence-free survival after a second resection was the only significant risk factor for third recurrence (RR = 31.08, 95%CI = 2.53 - 381.47, P = 0.007). Moreover, recurrence-free survival after initial resection was the only significant factor to predict later progression to muscle invasive bladder cancer (RR = 8.62, 95%CI = 1.47 - 58.34, P = 0.001).</p><p><b>CONCLUSIONS</b>Recurrence-free survival after resection is an independent predictor of multiple recurrences of non-muscle invasive bladder cancer. The shorter the period between resection and recurrence is, the higher the risk of multiple recurrences.</p>

The analysis of perioperative complications during radical cystectomy using a standardized reporting system / 中华外科杂志

<p><b>OBJECTIVES</b>To analyze the perioperative complications of radical cystectomy using a standardized reporting methodology.</p><p><b>METHODS</b>The clinical data of 233 cases of radical cystectomy from January 1996 to December 2008 were reviewed. Two hundred male patients and 33 female patients were included. The mean age was 58.9 years old. All complications within 30 days of surgery were recorded and classified using a 5-grade modification of the Clavien system.</p><p><b>RESULTS</b>Overall mean operative time was 339 (170 - 610) minutes, and mean blood loss was 818 (range 100 to 3500) ml. Of the 233 subjects at least 1 postoperative complication developed in 84 (36.1%), including five cases of intraoperative complications. According to the modified Clavien system, 27 patients (11.6%) had grade 1, 38(16.3%) had grade 2, 16(6.9%) had grade 3, and 3(1.7%) had grade 4 complications. The most frequent complication was gastrointestinal complications (15.9%), then the incision-related complications (15.0%) and lung infections (4.7%). An association between hypoproteinemia and any complication was found after adjusting for confounding variables (OR = 2.963, 95%CI: 1.451 - 6.050, P = 0.003), and American society of anesthesia score (ASA score) was significantly associated with any major complication (OR = 2.520, 95%CI: 1.003 - 6.332, P = 0.049).</p><p><b>CONCLUSIONS</b>Radical cystectomy is associated with a high perioperative complications, using the modification of the Clavien system has allowed us to stratify complications during radical cystectomy. Hypoproteinemia is independently associated with any complication in these patients and ASA score was significantly associated with any major complication.</p>

Factors associated with increased blood loss in patients undergoing radical cystectomy in a contemporary series / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate factors predictive of blood loss in radical cystectomy in a contemporary series.</p><p><b>METHODS</b>From December 1996 to December 2008, clinical data of 233 patients who underwent radical cystectomy were reviewed retrospectively. Various preoperative and operative factors were assessed for their association with blood loss using univariate, multivariate regression and correlation analysis.</p><p><b>RESULTS</b>One hundred eighty-one patients underwent open radical cystectomy and 52 cases were treated by laparoscopic radical cystectomy. Overall mean operative time was (339 ± 84) minutes, and mean blood loss was (818 ± 756) ml. On univariate analysis, body mass index (F = 9.039), history of pelvic operation (t = -4.365), anesthetic techniques (t = 3.125), surgical type (t = 6.643), use of Ligasure (t = 6.923), and urethra resection (t = -1.984) correlated with blood loss. However, multiple linear regression showed that body mass index (R(2) = 0.256, P < 0.001), history of pelvic operation (R(2) = 0.222, P < 0.001), use of Ligasure (R(2) = 0.172, P < 0.001), and surgical type (R(2) = 0.271, P = 0.027) were significant predictors of blood loss. The transfusion was required in 176 of 233 patients (75.5%) with a median requirement of (649 ± 569) ml. Likewise logistical regression analysis revealed that older age (OR = 3.2, P = 0.010), female gender (OR = 33.7, P = 0.013), anemia (OR = 6.6, P = 0.039), increased blood loss (OR = 14.3, P < 0.001), open radical cystectomy (OR = 6.4, P = 0.036) and nonuse of Ligasure (OR = 10.1, P < 0.001) were predictors of transfusion need.</p><p><b>CONCLUSIONS</b>Increased body mass index, history of pelvic operation, open radical cystectomy, and non-use of Ligasure were independent predictors of increased blood loss during radical cystectomy. Such a prediction formula has an important role in identifying high risk patient for increased blood loss and transfusion need before radical cystectomy.</p>

Transrectal ultrasonography in the etiological diagnosis of male obstructive azoospermia: analysis of 695 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To assess the role of transrectal ultrasonography (TRUS) in the etiological diagnosis of male obstructive azoospermia.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data and TRUS findings of 695 patients with obstructive azoospermia from January 2007 to May 2009.</p><p><b>RESULTS</b>Concerning the etiology of obstructive azoospermia, the main TRUS findings included ejaculatory duct abnormality (29.2%), seminal vesicle abnormality (25.4%) and prostate midline cyst (18.5%). TRUS revealed 203 cases of ejaculatory duct dilation, 177 cases of seminal vesicle abnormality (including 108 with absence or agenesis and 51 with dilation of the seminal vesicle), and 128 cases of prostate midline cyst (including 75 with ejaculatory duct cyst and 39 with Müllerian cyst). Calcification of the verumontanum or ejaculatory duct was suspected to be the causes of obstructive azoospermia in 34 cases. However, no significant etiological abnormality was found in 153 cases. Obvious etiology was shown by TRUS in 78.0% of the patients.</p><p><b>CONCLUSION</b>TRUS can clearly display the structural abnormality of the ejaculatory duct and seminal vesicle, and provide important information on the etiology of male obstructive azoospermia.</p>

A case-control study of environmental and genetic factors and prostate cancer in Guangdong / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the etiologic relationship of prostate cancer and environmental and genetic polymorphism in southern China</p><p><b>METHODS</b>A hospital-based and 1:1 matched case-control study was conducted. A total of 142 matched pairs of subjects were investigated in this study. The blood samples were collected from 85 cases of prostate cancer and 82 controls of other diseases after informing consent. The CYP1A1, CYP17 and AR genes were analyzed by using the method of PCR, PCR-RFLP. The data were analyzed with conditional logistic regression model.</p><p><b>RESULTS</b>An increased risk of prostate cancer development was observed with the early first spermatorrhea (age < 18) (OR = 2.90, 95% CI: 1.76 - 4.80), early first sexual intercourse (age < or = 24) (OR = 2.38, 95% CI: 1.14 - 4.96), frequent sexual intercourse before 35 year old (OR = 1.80, 95% CI: 1.19 - 2.70), family history of cancer (OR = 2.70, 95% CI: 1.31 - 5.58), more intake of pork (OR =2.27, 95% CI: 1.38 - 3.70). Factors in lowing the risks were the fruit intake and drinking of green tea by OR value at 0.25 (95% CI: 0.08 - 0.75) and 0.52 (95% CI: 0.28 -0.96) respectively. CYP17 A1/A2 and CYP17 A2/A2 genotypes were related with a high risk of prostate cancer and OR values of 1.78 (95% CI: 0.70 - 4.53) and 2.57 (95% CI: 0.91 - 7.25) respectively. Study also showed that there was an interaction between CYP17 polymorphisms and early first spermatorrhea and family cancer history related to the risk of prostate cancer with OR value at 13.35 (95% CI: 1.58 - 113.00) and 4.01 (95% CI: 1.22 - 13.17) respectively.</p><p><b>CONCLUSION</b>Sexual intercourse, dietary intake and family cancer history should be related to prostate cancer occurrence. CYP17 polymorphism might be associated with a high risk of prostate cancer. It suggests that there are multiple environmental and genetic factors to the prostate cancer.</p>

Holmium laser urethrotomy for male urethral stricture / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate transurethral holmium laser incision, its safety and effect in the treatment of male urethral stricture.</p><p><b>METHODS</b>Thirty-eight males with urethral stricture were treated by 1045 W holmium laser urethrotomy, 18 with the stricture length shorter than 1.0 cm, 9 between 1.0 cm and 1.5 cm, 7 longer than 1.5 cm , 4 with occlusive stricture and 6 companies with bladder calculus. The average peak urinary flow rate (Q(max)) was (5.6 +/- 2.3) ml/s.</p><p><b>RESULTS</b>Successful surgery was achieved in 36 of the cases, with no complications and the average Q(max) increased to (17.5 +/- 3.4) ml/s. Two cases were converted to open surgery. Thirty-two cases were followed up for 3-18 months, of whom 4 received urethral dilation and 2 underwent a second holmium laser urethrotomy.</p><p><b>CONCLUSION</b>Holmium laser urethrotomy is a safe, effective and minimally invasive therapeutic modality for male urethral stricture.</p>

Clinical analysis of renal cell carcinoma: report of 271 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To study the diagnosis and treatment of renal cell carcinoma.</p><p><b>METHOD</b>From January 1993 to December 2000 the data of 271 cases of renal cell carcinoma were reviewed.</p><p><b>RESULTS</b>Ultrasonography and CT scanning were still the main diagnostic methods. Surgical operation was performed on 234 patients. Radical nephrectomy was performed on 197 patients (72.6%); Nephron sparing surgery was performed on 19 patients; Metastatic tumor resection was performed on 6 patients and other procedures for 12. The pathological results showed that 137 cases (61.4%) were clear cell carcinoma, 18 cases (8. 1%) of granular cell carcinoma, 32 cases (14. 3%) being combination of the above two varieties, 23 cases (10.3%) of renal papillary adenocarcinoma, 13 cases being renal cell of other types. And 210 cases (77.5%) had been successfully followed up. The 1, 3, 5 and 10 year survival rates were 95.3% (182/191), 88.7% (107/122), 74.7% (56/75) and 32.1% (10/31) respectively.</p><p><b>CONCLUSIONS</b>Ultrasonography is the first select examination method of detecting of renal cell carcinoma, and CT scanning is the most valuable diagnostic mean. Early diagnosis and prompt radical nephrectomy or nephron sparing nephrectomy are the critical points for achieving long-term survivals of patients with renal cell carcinoma.</p>

siRNA knocks down the expression of AR gene in PC3 cell lines / 中华男科学杂志

<p><b>OBJECTIVE</b>To observe the suppression of the expression of androgen receptor (AR) gene in PC3 cells after AR-specific siRNAs transfection, and to search for the siRNA (s) with the greatest suppressing efficiency.</p><p><b>METHODS</b>Five AR-specific siRNAs were selected, RNAi expression vectors were constructed and transfected into PC3 cells, and the AR expression was detected by real time FQ-PCR and Western blot. A nonsense small RNA was set as negative control.</p><p><b>RESULTS</b>Compared with the control group, the AR expression decreased in various degrees in the 5 experimental groups (P < 0.05), and siRNA1, siRNA4 and siRNA5 showed the greatest suppressing efficiency as compared with the other experimental groups, with statistically significant difference (P < 0.05).</p><p><b>CONCLUSION</b>The AR-specific siRNAs could suppress the endogenous expression of target gene. Three siRNAs with great suppressing efficiency were identified and the expression vectors were constructed successfully. It can be applied in the future researches in vivo.</p>