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Objective:To evaluate the modified efficacy of thoracic paravertebral block (TPVB) combined with general anesthesia in the patients undergoing laparoscopic radical nephrectomy.Methods:Eighty patients, aged 38-64 yr, with body mass index of 18-24 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective laparoscopic radical nephrectomy, were selected and randomly divided into 2 groups ( n=40 each) using a random number table method: general anesthesia group (group GA) and TPVB combined with general anesthesia group (group TPVB+ GA). A paravertebral catheter was placed at T 8 and T 10 under ultrasound guidance before induction of anesthesia, and 0.5% ropivacaine 10 ml was administered via the catheter in group TPVB+ GA.Anesthesia was induced with propofol, sufentanil, etomidate and rocuronium and maintained by intravenous infusion of propofol and remifentanil.Patient-controlled intravenous analgesia was performed with sufentanil, ketorolac tromethamine and tropisetron at the end of surgery.When postoperative visual analog scale score≥4, tramadol 50 mg was intravenously injected as rescue analgesic.Immediately before anesthesia induction (T 0), at 5 min after establishing pneumoperitoneum (T 1), at 2 h of pneumoperitoneum (T 2), and immediately after the end of pneumoperitoneum (T 3), and at 24 h after operation (T 4), venous blood samples were collected for determination of plasma norepinephrine concentrations (by enzyme-linked immunosorbent assay), plasma cortisol level (using radioimmunoassay), and blood glucose concentrations were measured.The intraoperative consumption of sufentanil and remifentanil was recorded.The intraoperative hypertension, hypotension, and bradycardia were recorded, and the nausea and vomiting, pruritus, and requirement for rescue analgesia occurred within 24 h after surgery were recorded. Results:Compared with group GA, the plasma concentrations of norepinephrine, cortisol and blood glucose were significantly decreased at T 1-4, the intraoperative consumption of sufentanil and remifentanil was reduced, and the postoperative requirement for rescue analgesia was decreased in group TPVB+ GA ( P<0.05). There was no significant difference in the incidence of intraoperative and postoperative adverse reactions between the two groups ( P>0.05). Conclusion:TPVB combined with general anesthesia is helpful in carrying out the anesthetic model of low-consumption opioids and is more helpful in inhibiting intraoperative and postoperative stress responses and postoperative pain responses than general anesthesia alone when used for laparoscopic radical nephrectomy.
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Objective To review the experience of the clinical diagnosis and treatment of primary testicular diffuse large B-cell lymphoma.Methods A review was made who were treated in the Tumor Hospital of Zhengzhou University from January 2011 to November 2018.The average age of the patients was 58 years old,with 4 cases in left side and 8 cases in right side.All patients were admitted to hospital with painless testicle mass.Solid mass of testis were detected by ultrasound with no abnormality in tumor markers.All patients underwent orchiectomy and followed by chemotherapy.Results Twelve primary testicular lymphoma (PTL) were identified by pathology,with 8 cases in phase Ⅰ,2 cases in phase Ⅱ,1 case in phase Ⅲ,and 1 case in phase Ⅳ.The mean follow-up was 31 months.Inguinal orchiectomy was recommended as a diagnositc and initial therapy.All patients underwent R-CHOP/CHOP chemotherapy consisting of cyclophosphamide,doxorubicin,vincristine and prednisone with or without rituximab,including 6 cases with R-CHOP and 6 cases with CHOP.Nine of 12 patients underwent intrathecal prophylatic chemotherapy and 6 of 12 patients underwent contralateral testicle radiotherapy.Relapse occured in 2 patient with CHOP in central nervous system and died of the disease.One case with CHOP relapsed in abdominal cavity.No contralateral testicle relapse was observed.Conclusions PTL is a rare extranodal lymphoma.Painless testicle tumor in men over 50 years old should suspect of this disease.Inguinal orchiectomy is an important part of the treatment,which combines systemic chemotherapy and prophylactic modalities such as radiotherapy of contralateral testis and/or central nervous system (CNS) prophylaxis.
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Objective To explore the MR findings of extra?abdominal desmoid?type fibromatosis and the related features of recurrence. Methods MRI and clinical data of 36 cases of extra?abdominal desmoid?type fibromatosis proved by surgical pathology were retrospectively reviewed between March 2010 and October 2016.The ages of the cases ranged from 10 years to 68 years. 14 males and 22 females were included with sex ratio 1∶1.57.the courses of the disease were varied from 1 day to 8 years. The stage was based on Church′s method. 3 cases were only with plain scan and other 33 cases with contrast enhancement. Sagittal or coronal T1WI, STIR?T2WI, PdWI and contrast enhanced T1WI in horizontal, sagittal and coronal view were examined on MR siganl 1.5T or 3.0T of GE Company. Two groups were divided based on the recurrence or not after surgery. The clinical and MR features were analyzed between the two groups with χ2 test, t test or Spearman rank correlation analysis according to the data characteristics. Results Compared with signal intensity of muscle, 34 cases were isointense and 2 cases isointense with hypointense area on T1WI; 34 cases were hyperintense and 2 cases hyperintense with hypointense area on T2WI. On contrast enhanced imaging, 22 cases were markedly enhanced, 7 cases moderately enhanced and 4 cases mildly enhanced.15 cases was with recurrence and 21 cases without recurrence. Infiltration of surrounding tissue was shown in 14 cases(38.9%), 13 cases with recurrence and 1 cases without recurrence. Band sign was shown in all cases. Tentacle sign was shown in 18 cases (50.0%), 15 cases with recurrence and 3 cases without recurrence. Split fat sign was shown in 12 cases (33.3%) and all without recurrence. Fascial tail sign was shown in 15 cases (41.7%), 13 cases with recurrence and 2 cases without recurrence. Hypointense ring around the tumor was shown in 21 cases (58.3%), 2 cases with recurrence and 19 cases without recurrence. The P value of tentacle sign, split fat sign, hypointense ring around the tumor, fascial tail sign and infiltration of surrounding tissue was less than 0.05. Gender, location and the degree of contrast enhancement was without difference of statistical significance between the two groups. There was significant correlation of the recurrence rate with the courses and the stage of the disease(χ2=7.264 , r=0.994 , P<0.05). Conclusions Tentacle sign, fascial tail sign and infiltration of surrounding tissue were attributed to the estimate of recurrence of extra?abdominal desmoid?type fibromatosis, and Be features contributes to the diagnosis and therapy of extra?abdominal desmoid?type fibromatosis.
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Objective@#To summarize the clinical experience of primary bladder lymphoma.@*Methods@#From September 2012 to May 2019, 8 cases of primary bladder lymphoma treated in our institute were analyzed retrospectively, including 4 males and 4 females. The mean age was 50.5 years old, ranged from 15 to 85. There were 3 cases of localized bladder lymphoma and 5 cases of metastatic bladder lymphoma. Three cases presented with painless gross hematuria primarily and 5 cases suffered from abdominal pain and bloating. Imaging examination showed the bladder tumor or pelvic mass with maximum diameter ranged from 3 to 22 cm, with 11.3 cm on average. Preoperative diagnosis of bladder tumor in 3 cases, and pelvic malignant tumor in 5 cases. Two patients underwent TURBT and 6 cases underwent pelvic mass resection and partial cystectomy.@*Results@#Postoperative pathological diagnosis showed 6 cases of diffuse large B-cell lymphoma, 1 case of mucosa-associated lymphoid tissue lymphoma, 1 case of anaplastic large cell lymphoma. Follow-up after surgery ranged 3 to 60 months, with 28.1 months on average. Two patients can not tolerate radiotherapy or chemotherapy for postoperative complications of vesico-vaginal fistula and intestinal fistula, and both were alive at the last follow-up. Six patients underwent CHOP regimen (cyclophosphamide, doxorubicin, vincristine, prednisone), 3 cases were addd with rituximab. Three patients died during the follow-up. One 85-year-old patient died 10 months after surgery. Two cases of metastatic bladder lymphoma died 3 or 6 months after surgery respectively. Three cases were alive after chemotherapy, including 2 young patients undergoing chemotherapy with DICE regime and one patient undergoing pelvic radiotherapy.@*Conclusion@#The primary bladder lymphoma has no special clinical symptoms, and TURBT and needle biopsy are critical for the diagnosis, based on the pathological and immunohistochemical examination. The most common pathological type is diffuse large B-cell lymphoma. R-CHOP chemotherapy is recommended, which can be followed by DICE regime for young patients. Metastasis and aging predict poor prognosis.
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Objective To summarize the clinical experience of primary bladder lymphoma.Methods From September 2012 to May 2019,8 cases of primary bladder lymphoma treated in our institute were analyzed retrospectively,including 4 males and 4 females.The mean age was 50.5 years old,ranged from 15 to 85.There were 3 cases of localized bladder lymphoma and 5 cases of metastatic bladder lymphoma.Three cases presented with painless gross hematuria primarily and 5 cases suffered from abdominal pain and bloating.Imaging examination showed the bladder tumor or pelvic mass with maximum diameter ranged from 3 to 22 cm,with 11.3 cm on average.Preoperative diagnosis of bladder tumor in 3 cases,and pelvic malignant tumor in 5 cases.Two patients underwent TURBT and 6 cases underwent pelvic mass resection and partial cystectomy.Results Postoperative pathological diagnosis showed 6 cases of diffuse large B-cell lymphoma,1 case of mucosa-associated lymphoid tissue lymphoma,1 case of anaplastic large cell lymphoma.Follow-up after surgery ranged 3 to 60 months,with 28.1 months on average.Two patients can not tolerate radiotherapy or chemotherapy for postoperative complications of vesico-vaginal fistula and intestinal fistula,and both were alive at the last follow-up.Six patients underwent CHOP regimen (cyclophosphamide,doxorubicin,vincristine,prednisone),3 cases were addd with rituximab.Three patients died during the follow-up.One 85-year-old patient died 10 months after surgery.Two cases of metastatic bladder lymphoma died 3 or 6 months after surgery respectively.Three cases were alive after chemotherapy,including 2 young patients undergoing chemotherapy with DICE regime and one patient undergoing pelvic radiotherapy.Conclusion The primary bladder lymphoma has no special clinical symptoms,and TURBT and needle biopsy are critical for the diagnosis,based on the pathological and immunohistochemical examination.The most common pathological type is diffuse large B-cell lymphoma.RCHOP chemotherapy is recommended,which can be followed by DICE regime for young patients.Metastasis and aging predict poor prognosis.
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Objective To explore the effects of TMPRSS2 promoted suicide gene CD-5-FC combined with phytochemicals on the proliferation and apoptosis of prostate cancer (PCa) specific cell-line 22RV1.Methods From March 2016 to October 2016 TMPRSS2-VISA-CD/UPRT'vector was used to deliver pro-drug 5-FC (5-Fluorocytosine) in to PCa specific cell-line 22RV1.Transfection effect was verified by Western-blotting.5-FC,5-FU (5-Fluorouracil) and four phytochemicals epigallocatechin gallate (ECGC),Genistein,Daidzein,and Equol were selected in this study.MTS assay was performed to select dosages,which can kill 10％-40％ of 22RV1 cells,from their pre-set drug concentrations,respectively.According to their select concentrations,either 5-FC plasmid or 5-FU in combination with one of four phytochemicals were added in 22RV1 cells in orders,and then cultured them together.Besides,these four phytochemicals were added in 22RV1 cells individually regarding their selecting concentrations and cultured at the same time.Cell viability was detected by MTS assay on 24hrs,48hrs and 72hrs.Comparing the cell killing rates between the combination groups and each single drug groups on cell-line 22RV1.Results TMPRSS2-VISA-CD/UPRT'plasmid with 5-FC was transfected on PCa specific cell-line 22RV1 successfully.The most obvious transfection occurred on 48hrs.The selected concentration of the pro-drug 5-FC were 83.32 μmol/L and 833.20 μmol/L,5-FU were 76.87 mol/L and 768.70 μmol/L.The concentrations of four phytochemical agents were 2.00 μmol/L,10.00 μmol/L and 20.00 μmol/L.In term of the cell killing numbers,results showed that the combination treatment of 83.32 μmol/L 5-FC/ 76.87μmol/L 5-FU and 10.00 μmol/L/20.00 μmol/L four phytochemicals compared with 10.00 μmol/L/20.00 μmol/L single treatment of four phytochemicals,respectively,there was no significant difference (P ＞0.05),while the combination treatment of 833.20 μmol/L 5-FC/768.70 μ mol/L 5-FU and 2.00 μmol/L/10.00 μmol/L four phytochemicals compared with 2.00 μ mol/L/10.00 μmol/L single treatment of four phytochemicals,respectively,there was a significant difference (P ＜ 0.05).In addition,this study proved that 83.32 μmol/L 5-FC and 76.87 μmol/L 5-FU,833.20 μmol/L 5-FC and 768.70 μmol/L 5-FU reached the same cell killing effect,and there was no statistical difference (P ＞ 0.05).Thus the suicide gene transfection was successful,and its function was the same as the effect of cytotoxic drugs.Conclusions This study has proved that this plasmid with 5-FC suicide gene system can be successfully and efficiently transfected into PCa cells 22RV1.As the pro-drug of 5-FU,5-FC got similar treatment effect with 5-FU,and inhibited cell proliferation.There was no synergistic reaction of enhancing cell apoptosis after combined phytochemical drugs EGCG,Genistein,Daidzen,Equol with suicide gene therapy on 22RV1 cell-line.
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Objective To explore the clinical efficacy and indications of kyphoplasty with movement and secondary en?largement of balloon for the compression fracture of vertebral body with ruptured posterior wall. Methods A retrospective analy?sis was carried out on the data of 29 patients (10 males, 19 females;age range:55-86 years old;mean age:71 years old;29 verte?bral bodies in total) who suffered from compression fracture of the thoracolumbar spine and below, and underwent kyphoplasty through the movement and secondary enlargement of balloon within the vertebral body and were followed up from January 2011 to November 2014. These patients had backache, accompanied by lowered support, limitation of movement, no symptom of nervous lesion on both lower extremities and no past history of balloon kyphoplasty. All fractured vertebral bodies were at T 11 or below, in?cluding 1 case at T11, 4 cases T12, 11 cases L1, 9 cases L2 and 4 cases L3. The causes of injury included fall (19 cases), car accident (8 cases) and unknown reasons (2 cases). All patients underwent kyphoplasty with the movement and secondary enlargement of bal?loon within the vertebral body. Photos were taken immediately after the surgery, at 1 month, 3 months, 6 months and 12 months, and these patients were assessed and analyzed in terms of vertebral height, Cobb angle, visual analogue score (VAS) and Oswestry disability index (ODI). Results The operation time (including the formation and solidification of bone cement) of 29 patients was 40 to 65 min and the mean time was 55 ± 7 min;the blood loss during operation was 2 to 15 ml and the mean blood loss was 5 ± 2 ml;the injected volume of bone cement was 2.5-7.5 ml and the mean volume was 5.5±0.5 ml. Post?operative pain was relieved and ambulation was performed under the protection of lumbar orthosis brace. Statstical analysis was conducted on VAS, ODI, vertebral height and Cobb angle before operation and at 1 month, 3 months, 6 months and 12 months after operation, showing statistically significant differences. X ray examination found that there was no alternation or displacement of bone cement location, and no change in vertebral morphology, the vertebral height and cobb angle remained the post?operative status, and posterior wall rupture of the vertebral body was recovered well. CT revealed that the morphology of bone cement was irregular and closely integrated with bone substance, and no cavity or fissure was seen. Conclusion Kyphoplasty with movement and secondary enlargement of bal?loon within the vertebral body has a good, definite clinical efficacy in treating compression vertebral fracture with incomplete pos?terior wall of the vertebral body without obvious displacement of fractured bone and symptom of nervous lesion on both lower ex?tremities. This surgery is easy to operate, and has an immediate analgesic effect, which could recover vertebral height as well as re?duce kyphosis deformity and improve patient’s prognosis.
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Objective To evaluate the clinical efficacy of percutaneous endoscopic lumbar discectomy (PELD) on treatment of far lateral lumbar disc herniation (FLDH). Methods We retrospectively analyzed 27 patients with FLDH underwent percutaneous endoscopic lumbar discectomy from June 2014 to September 2015, age from 41 to 64, average 52.3. The average operation time, intraoperative blood loss and length of hospital stay were collected. The lumbocrural pain perception of patients before and after surgery was assessed by visual analog scale (VAS) and postoperative lumbar functional recovery after surgery by modified MacNab criteria. Results Average operation time was 69 min (58~109 min), intraoperative blood loss was 18 ml (11~40 ml), and length of stay was 5.0 d (3.0 ~ 10.0 d). VAS score from (8.12 ± 1.25) preoperatively improved to (2.80 ± 1.12) at the 3rd d after operation, (1.59 ± 1.06) at 3 months after operation, and (1.31 ± 0.89) at the last follow-up after operation; There was a statistical difference between preoperative scores and postoperative scores (P < 0.05). Modified MacNab criteria was a ratio of 88.9%. Conclusions PELD on the treatment of far lateral lumbar disc herniation have small area of trauma, faster postoperative recovering and several other advantages,which is a safe and effective minimally invasive surgery.
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Objective To evaluate the clinical effectiveness of double balloon dilation in percutaneous kyphonplasty on curing vertebral?compression fractures. Methods From January 2009 to September 2013, 84 patients (94 vertebral bodies) with vertebral compression were treated by percutaneous kyphonplasty. All were fresh fractures and were injured or obvious low back pain 1 month, accompanied by local tenderness, kowtow attack painful, lumbar mobility, but no lower extremity injury numbness, activities and defecation disorders. After randomization, the double balloon dilation in percutaneous kyphonplasty method was used to treat 44 patients (49 vertebrae). In the process of performing percutaneous unilateral pedicle puncture and balloon dilata?tion of the vertebral body, the balloon has been moved some distance in the vertebral body. Then completed the perfusion of bone cement, vertebral body forming. 40 cases (45 vertebrae) were used conventional unilateral percutaneous kyphonplasty to vertebtal compression fractures. Recorded the operation time, amount of bleeding, bone?cement injection volume. Used visual analogue scale (VAS), the height of the vertebral body and Cobb angle to evaluated the curative effect. Results All 84 patients completed the operation, follow?up time was 22 months (18-24 months). In two mobile open expansion group, the operation time was about 48 min. The amount of bleeding was 8-15 ml. The average bone?cement injection volume was 5.1 ml. No patients quit the study and no bone cement?leakage cases or other side effects were observed , and no clinical accidents occurred. In a single stretching group, 40 cases (45 vertebrae) completed conventional vertebroplasty, the time of 44 min, bone cement average injection rate 3.2 ml, bleeding 10-15 ml. In two mobile open expansion group, the VAS score was 8.5 points, the height of the vertebral body height was 2.1cm, and the Cobb angle was 34°. After operation, the VAS score 2.9 points, the height of the vertebral body 2.8 cm, and Cobb 20° . In the other group, the pain was significantly relieved and the relief was satisfactor after operation.Vertebral height of 2 cm turned to the last follow?up of 2.4 cm. The Cobb angle was 32°, and the last follow?up was 27°. The VAS score, operation time and bleeding volume of the two groups were not statistically significant, and a statistically significant difference of the average bone ce?ment injection volume, postoperative vertebral height and cobb angle improved with statistical significance. A single open group were 2 cases of bone cement leakage and leakage, 1 cases of bone cement tail, the complication rate was 5.6%. Conclusion The application of double balloon dilation in percutaneous kyphonplasty to vertebral?compression fractures improve relocation of verte?bral compression fractures, increase recovery of vertebral height, and more effectively strengthen and stiffen pathological vertebral bodies, while improving kyphosis. Moreover, it can reduce pressure during bone?cement injections, minimizing the chance of over?flow and leakage, as well as the related side effects, but it will also result in an increase of bone cement?injection volume.
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Objective To compare the kidney injury in diabetic patients undergoing liver cancer resection performed under different methods of anesthesia.Methods Sixty diabetic patients of both sexes,aged 40-64 yr,weighing 48-75 kg,of ASA physical shatus Ⅱ or Ⅲ (liver function Child-Pugh grade A),scheduled for elective liver cancer resection,were randomly divided into 2 groups (n =30 each) using a random number table:total intravenous anesthesia with propofol group (group P) and combined intravenous-inhalational anesthesia with sevoflurane group (group S).In group S,8％ sevoflurane was inhaled (FGF 8 L/min),and sufentanil 0.4 μg/kg and cisatracurium besylate 0.2 mg/kg were injected intravenously after the patients lost consciousness.In group P,propofol 1-2 mg/kg,sufentanil 0.4 μg/kg and cisatracurium besylate 0.2 mg/kg were injected intravenously.The patients were tracheally intubated and mechanically ventilated.Anesthesia was maintained with inhalation of 2 ％-3 ％ sevoflurane (FGF 2 L/min) in group S,or with iv infusion of propofol 0.5-0.8 mg· kg-1 · h-1 in group P,and with iv sufentanil 10 μg and cisatracurium 0.1 mg/kg when needed in both groups.BIS value was maintained at 40-60 and PET CO2 at 35-45 mmHg during operation.Before induction of anesthesia,at the end of operation,and at 24 and 72 h after operation,blood samples were collected from the central vein for determination of the levels of serum creatinine,blood urea nitrogen,serum cystatin C and 24 h.urinary microalbuminuria.Results Compared with group S,the levels of serum cystatin C at 24 and 72 h after operation and 24 h urinary microalbuminuria were significantly increased,and no significant changes were found in the levels of serum creatinine and blood urea nitrogen at each time point in group P.Conclusion The kidney injury is reduced in the diabetic patients undergoing liver cancer resection performed under combined intravenous-inhalational anesthesia with sevoflurane as compared with that under total intravenous anesthesia with propofol.