Individualized Concurrent Chemotherapy for Patients with Stage III-IVa Nasopharyngeal Carcinoma Receiving Neoadjuvant Chemotherapy Combined with Definitive Intensity-Modulated Radiotherapy / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#This retrospective study aimed to re-evaluate the effect of concurrent chemotherapy in patients with locally advanced nasopharyngeal carcinoma (NPC) in the era of intensity-modulated radiotherapy (IMRT). @*Materials and Methods@#A total of 498 patients who received neoadjuvant chemotherapy (NCT) combined with concurrent chemoradiotherapy (CCRT) or IMRT were retrospectively reviewed. The distribution of baseline characteristics was balanced using propensity score matching. Additionally, the results of NCT+IMRT and NCT+CCRT were compared using Kaplan-Meier survival analysis, and differences in survival rates were analyzed using the log rank test. @*Results@#There were no significant differences in overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and local progression-free survival (LRFS) between the two groups. Patients were further categorized into risk subgroups based on pretreatment Epstein-Barr virus (EBV) DNA cutoff values using receiver operating characteristic curve analysis. There were no statistically significant differences in OS, PFS, DMFS, and LRFS between patients who received NCT+CCRT and NCT+IMRT in the high-risk group. In the low-risk group, although there were no differences between NCT+CCRT and NCT+IMRT in OS, PFS, and LRFS, patients who received NCT+CCRT had better DMFS than those who received NCT+IMRT. @*Conclusion@#Pretreatment EBV DNA level can be used to individualize concurrent chemotherapy for patients with locally advanced NPC. Patients with low pretreatment EBV DNA levels may benefit from concurrent chemotherapy, whereas those with high levels may not. Other treatment modalities need to be explored for high-risk patients to improve their prognosis.

Clinical analysis of iatrogenic ureteral injury and bladder injury / 中华泌尿外科杂志

Objective To investigate the etiology and treatment of iatrogenic ureteral injury(IUI) and bladder injury(IBI). Methods Forty-seven patients(7 males, 40 females) with ureteral and bladder inju-ries caused as a result of any medical procedures were reviewed from 1996 to 2007. Obstetrics and gynecolog-ical, urological,general surgical procedures were involved in 38, 6, and 4 of the injuries respectively. Re-sults Sixteen cases of IUI were found during operation, including 14 cases of entire ureteral laceration, 4 cases of partial ureteral laceration. Thirteen cases received ureteral anastomosis, one case received uretero-neopyelostomy. One case of ureteral perforations during ureteroscopic procedure was indweUed of double-J after the operation was terminated immediately. Three cases received nephrectomy. Four cases of lower ure-teric suture ligation and three cases of ureterovaginal fistula were detected at 3 days～ one week of postopera-tion. These 7 cases were received ureteroneocystomy during 2 weeks after the initial surgical procedure. Nineteen cases of IBI were found during operation, the length of cystic wound was ranging from 1 cm to 3 cm. 17 cases underwent repairing, 2 eases of bladder perforation which caused by endourologic or TVT procedure received catheterization for 1 week. Five cases of vesicovaginal fistula which were found during one week--one month of post-operation, were received fistula resection and bladder repairing 3 months after of initial operation. Forty-seven cases were follow-up ranging from 5 months to 11 years after the second opera-tion,mean time were 47 months. All cases were recovered. Conclusions Intraoperative findings and effec-tive treatments can achieve good therapeutic effects and avoid injury during secondary operation. Correct treatment of urinary fistula can promote cure rate.

Effect of electrovaporization on the prostate and its surrounding tissues / 中华男科学杂志

<p><b>OBJECTIVE</b>Transurethral electrovaporization of the prostate (TVP) for benign prostatic hyperplasia (BPH) has proven to be efficacious with lower morbidity than transurethral resection of the prostate (TURP) on clinical studies. However, no histopathologic data are available to support the clinical findings in human studies. The following study was done using a canine model in an effort to evaluate these histopathologic changes.</p><p><b>METHODS</b>Nine canines received antegrade electrovaporization or resection of the prostate, via an open cystoma, using Storz series resectoscope and video equipment. The dogs were sacrificed and their prostates harvested at 0 week (immediately after operation), 1 week or 5 weeks after electrovaporization or resection. The prostates were evaluated grossly as well as histologically for cavitary defects and depth of necrosis.</p><p><b>RESULTS</b>Prostate examination revealed superficial necrosis (less than 1.8 mm deep) at 0 week following the 270 watts operation, and less than 3 mm deep necrosis with acute inflammation and focal hemorrhage at 1 week. The depths of necrosis were less than 1.3 mm and 2.2 mm at 0 week and 1 week after the 180 W electrovaporizion. And the 120 W resection resulted in necrosis 1.1 mm and 1.6 mm deep at most, which was localized in the vaporized prostate only, with no histopathologic change in the surrounding tissues. Epithelial stratification was underway by the fifth week, but with inflammation.</p><p><b>CONCLUSION</b>TVP in the canine model showed only shallow necrosis at the site of the vaporization. These data provide a histopathologic rationale for the minimal morbidity and efficacious nature of this technique demonstrated in clinical studies.</p>

Transperitoneal laparoscopic ureterovesical reimplantation (report of 17 cases) / 中华泌尿外科杂志

Objective To introduce the new technique of transperitoneal laparoscopic ureterovesical reimplantation and to evaluate its feasibility and clinical significance. Methods Overall,17 cases (5 men and 12 women) of ureterovesical obstruction (left,7 and right,10) were included.Of them,10 cases were diagnosed with simple congenital ureter outlet stricture;1 had calculi and polyp formation at right ureter outlet;2 had recurrent ureter outlet stricture after open ureterovesical reimplantation (1 of them had 2 calculi at lower part of the ureter);1 had double nephroureteral upper unit ureter outlet stricture with 2 calculi;2 had recurrent ureter outlet stricture after holmium laser section;1 with urinary TB had right ureter outlet stricture after left nephrectomy.Among the 17 cases,severe hydronephrosis occurred in 12,and moderate,in 5.Transperitoneal laparoscopic ureterovesical reimplantation was performed in the 17 cases (ureterovesical anastomosis in 15 and bladder flap ureterovesical reimplantation in 2). Results The operations were all successful in 17 cases with operating time of 90～160 min (mean, 112 min) and blood loss of 60～100 ml.The drainage tubes were removed 1～3 days after surgery without urine leakage.The urinary catheters were removed 1 week after surgery and double J stents,1 month after surgery. Six months after surgery cystography showed Ⅲ?urine reflux in 6 cases, Ⅰ?-Ⅱ? urine reflux in 5 and no reflux in 6.One year after surgery cystography showed Ⅲ? urine reflux in 3 cases, Ⅰ?～Ⅱ? urine reflux in 4 and no reflux in 10.During 3～24 months' follow-up, ultrasound B and IVU showed moderate hydronephrosis in 4 cases,mild,in 5 and no obvious hydronephrosis in 8. Conclusions Laparoscopic ureterovesical reimplantation is a feasible,less painful and minimally invasive alternative method for treatment of ureterovesical diseases.By comparison,bladder flap ureterovesical reimplantation has better anti-urine reflux effect but more complicated than ureterovesical anastomosis does.Long term efficacies of the methods need further observation.