RESUMO
Objective To discuss the lymph node metastasis of chromophobe renal cell carcinoma (chRCC) in children.Methods One case of chRCC was reported.A eleven-year-old boy was admitted to our hospital on November 2,2017 and presented gross hematuria 4 weeks.No mass was palpable in the abdomen and he felt tenderness in the left back.The ultrasound showed a solid mass in the lower pole of the left kidney.There were a lot of tortuous blood vessels in the tumor.Contrast enhanced CT suggested a mass of 4.5 cm × 6.3 cm × 4.9 cm.The left renal artery and vein were thickened.There was no enlarged lymph nodes were seen in both examinassions.During the operation,the tumor was located in the lower pole of the kidney.The frozen section diagnosis was benign renal tumor.Nephron-sparing surgery was performed.Results The pathology showed that the tumor cells had well-defined cell borders and characteristic perinuclear halos surrounded by eosinophilic cytoplasm that was positive for Hale's colloidal iron stain.Immunohistochemical studies were positive for EMA (+),Ki-67 (5％ +),CK19 (+),CK (+),CD10 (+),CD117(+),CD56(+).Fluorescence in situ hybridization showed absence of TFE3 protein,a strong immune marker of Xp11.2/TFE renal cell carcinoma.1 year after the operation,contrastenhancement magnetic resonance showed long T1 signal near the left renal hilum and the mass showed slight enhancement.ChRCC with regional lymph node metastasis hereby was considered.Intraoperatively,an approximately 2.5 cm × 2.0 cm × 2.0 cm mass was seen near the the left renal hilum.The tumor did not involve left kidney,abdominal aorta and inferior vena cava.The mass was completely removed and introoperative fast-frozen pathology revealed chRCC.Nephron-sparing surgery was performed.Postoperative pathology report chRCC local lymph node metastasis.Follow-up at six months after resection,there was no recurrence or metastatic disease identified.Conclusions chRCC is rare in children and clinical stage is low with a good prognosis.Local recurrence and distant metastasis is rare.
RESUMO
Objective To summarize the diagnosis and treatment of epispadias with complete prepuce.Methods Between January 2007 and April 2017,clinical records were reviewed for 5 patients diagnosed as epispadias with complete prepuce.The patients were 34 to 66 months old (mean age 44.3 months),who presented with short beaked penis and nonretractile prepuce.A dorsal midline gap between corpora cavernosa could be felt on palpation.There was dorsal chordee with broad spade like glans.The preputial opening was stenosed and dorsally placed urethral opening after retraction of the prepuce.Two patients were incontinent before surgery.Epispadias were coronal type in 2 cases and penile type in 3 cases.All 5 cases were repaired by Thiersch-Duplay procedure.Results The mean follow-up time was 44.5 months (ranged 3 to 98 months).The stricture occurred in 1 patient 1 month after operation,and after dilation and indwelling catheter for a month,the problem resolved.One needed a secondary preputial plasty due to redundant ventral foreskin 8 years after operation.In 3 of 5 cases,parental satisfaction was not achieved mainly due to short length.Only 1 case was incontinent after surgery and the other four achieved urinary continence.Voiding cystourethrogram (VCUG) and ultrasonography (USG) were done in 2 patients who were incontinent before surgery.One case presented right vesicoureteral reflux of Grade Ⅱ and the other was normal.The urodynamic results of 2 patients were normal.Conclusions Epispadias with complete prepuce is extremely rare and its preoperative diagnosis remains difficult.A definitive diagnosis is based upon history,physical examination and imaging tests.Fewer complications and better continence rates were achieved in the boys with epispadias and intact prepuce.Penile length is an important factor affecting surgical outcome.
RESUMO
Objective To summarize and analyze the intraoperative and postoperative complications arising from the Anderson-Hynes transperitoneal laparoscopic pyeloplasty (LP) procedure in the treatment of patients with ureteropelvic junction obstruction (UPJO).Methods There were 154 consecutive patients who underwent transperitoneal LP between November 2011 and December 2015.These patients' data were retrospectively analyzed for intraoperative and postoperative complications.All the 154 patients were primary UPJO.Of the 154 patients,124 (80.7％) were males and 30 (19.3％) were females,114(74.0％) were found in the left side,32(21.0％)were found in the right side,while 8 (5.0％)were found in bilateral.The mean age was 3.9 years old(ranged 8-180 months).28 patients(18.2％) have the history of urological infection or flank pain.Results Mean operative time was 89 minutes (ranged 42-330 min).The mean blood loss was 7.5ml (ranged 2-50 ml),and no blood transfusions were necessary intra-and post-operatively.The mean postoperative hospital stay was 5.7 days (ranged 3-28 days).The mean follow-up duration was 28 months (ranged 6-54 months).2 laparoscopic surgeries were converted into open surgeries.One patient suffered with repeated infection after removing the double J stent two months postoperatively.The ultrasound and intravenous urography showed the more severe obstruction compared to that before surgery.The second operation was performed and resolved this problem.The overall success rate was 98％.All 28 patients,who has preoperative symptoms,reported a complete resolution of symptoms after the procedure.Intraoperative complication occurred in 11 (7.1％) patients,including injury of parapyelic vessel while in 3 (1.9％),the misplacement of the Double-J stent in 6 (3.8％),conversion to laparotomy in 2(1.3％).The postoperative complications occurred in 24(15.6％) patients,including urine leakage in 10(6.5％),infectious urinoma in 7 (4.5％),infection after removing the Double-J in 4 (2.6％),temporary intestinal obstruction,recurrent UPJO were in 1 (0.6％)respectively.Conclusions Our retrospective analysis confirmed that LP is an effective and safe procedure.The most common intraoperative complications are difficulty in double-J stent insertion.The most common postoperative complication is urine leakage.
RESUMO
Objective To explore the characteristic clinical profiles and treatment modalities of Fetal rhabdomyomatous nephroblastoma(FRN).Methods A retrospective study was conducted for 14 FRN patients from Jan.2000 to Oct.2015.Their clinical data were collected including clinical presentations,pathology and treatment modalities.There were 8 males and 6 females with a mean age of 23 months.There were 3 cases at left side and right side 5 cases,bilateral 6 cases.2 patients were classified as stage Ⅰ,1 stage Ⅱ,5 stageⅢ and 6 stageⅤ.Abdominal mass was the main clinical presentation in 11 patients,and 1 case with hematuria,1 with abdominal pain,and 1 with vomit.Most tumors showed cysts or completely solid from the ultrasonography.Computed tomographic scan revealed a large inhomogeneous enhancement tumor from the kidney pole with necrotic,cystic,bleeding or calcification.Ultrasonography and Computed tomography (CT) had no different performance from Wilms' tumor.9 patients received preoperative chemotherapy,and the response was none in all of them.8 unilateral patients underwent tumor nephrectomy and another 4 had nephron-sparing surgery.Results Pathology showed that FRN contained more than 70％ of fetal rhabdomyomatous tissue.Immunohistochemistry had no specificity,most FRN shows Desmin (+) and Myogenin(+).Bilateral FRN tumors were seen in 2,one side with FRN and another side with nephroblastomatosis were seen in 3,one side with FRN and another side with Wilm's tumor was seen in 1 patient.Postoperative pathology confirmed FRN in all 14 cases.All patients received postoperative chemotheraphy:Act-D and VCR for 6 month(stage Ⅰ),Act-D and VCR for 15 month(stage Ⅱ),Act-D +VCR + ADR and radiotherapy for 15 month(stageⅢ).During follow-up of 6 months to 15 years,10 of them were alive without tumor and no evidence of recurrence.Conclusions FRN is a rare histologic variant of Wilm's tumor with less aggressive behavior.FRN usually has a huge volume and is bilateral with a poor responder to preoperative chemotherapy,but it is associated with a generally favorable outcome.Surgery and chemically treatment appears the effective measure.
RESUMO
BACKGROUND: With the continuous renewal and development of clinical repair techniques, the intraoperatie blood loss has been greatly reduced in the treatment of intertrochanteric fracture; however, no matter what kind of repair methods should be adopted, there are stil a large amount of perioperative hidden blood loss, however, there are few clinical reports for the reasons and related factors. OBJECTIVE: To study the correlation of perioperative hidden blood loss with gender and internal fixation methods in the surgery of elderly femoral intertrochanteric fractures.METHODS: Total y 121 patients with elderly femoral intertrochanteric fractures who received the treatment at Department of Orthopedics, Nanyang City Center Hospital from March 2010 to June 2013 were divided into two groups according to the condition and treatment wishes of patients, and were respectively treated with dynamic hip screw and proximal femoral anti-rotation intramedul ary nail internal fixation. The preoperative hidden blood loss, postoperative hidden blood loss, the total hidden blood loss, dominant blood loss and total blood loss of patients in these two groups were compared. The multiple linear regression analysis on the correlation of perioperative hidden blood loss with gender and internal fixation methods was conducted. RESULTS AND CONCLUSION: There was no significant difference in the preoperative hidden blood loss between these two groups (P > 0.05). The total blood loss, postoperative hidden blood loss and total hidden blood loss in the proximal femoral anti-rotation intramedul ary nail group were significantly higher than those in the dynamic hip screw group (P < 0.05), and the dominant blood loss was significantly lower than that in the dynamic hip screw group (P <0.05). There were significant differences in the preoperative, postoperative hidden blood loss and total hidden blood loss between males and females (P < 0.05), and above indexes in males were significantly lower than in females. The multiple linear regression analysis showed that gender and internal fixation methods were correlated with hidden blood loss (P < 0.05). These results suggest that the perioperative hidden blood loss in surgery for elderly femoral intertrochanteric fractures is closely related to gender and above indexes in internal fixation methods. The perioperative hidden blood loss of male patients is less than that of female patients, and the patients treated with proximal femoral anti-rotation intramedul ary nail fixation have more hidden blood loss than dynamic hip screw fixation.
RESUMO
OBJECTIVE:To explore the effects of dehydroepiandrosterone(DHEA)combined with Meloxicam tablets on thera-peutic efficacy of osteoarthritis and biochemical indicator. METHODS:104 patients with osteoarthritis were randomly divided into ex-perimental group and control group with 52 cases in each group. Control group only received Meloxicam tablets,7.5 mg/time,bid;ex-perimental group was additionally given DHEA,25 mg/time,qd,on the basis of control group. The treatment course of 2 groups was four weeks. The clinical efficacy,VAS score before and after treatment,joint function score,levels of IL-1β and TNF-α,cartilage thickness,synovial thickness and score of liquid aggregation of joint cavity were compared between 2 groups. RESULTS:The total ef-fective rate of experimental group(86.54%)was significantly higher than that of control group(69.23%),with statistical significance (P0.05). Compared with before treatment, the thickness of the synovial membrane and the score of liquid aggregation of joint cavity significantly decreased after treatment,with statistical significance(P<0.05);the thickness of synovial membrane and the score of liquid aggregation of joint cavity in experimen-tal group were significantly lower than in control group,with statistical significance(P<0.05). CONCLUSIONS:DHEA combined with Meloxicam tablets is significant in the treatment of osteoarthritis,can significantly relief the pain and decrease the levels of serum IL-1βand TNF-α.
RESUMO
BACKGROUND:Proximal femoral locking plate and proximal femoral nail anti-rotation are the two common methods for the treatment of femoral intertrochanteric fractures in clinic. However, there were few randomized control ed trials on the comparison of both methods. Most of them are retrospective case analysis, and short of systematic evaluation. OBJECTIVE:To systematical y evaluate the clinical outcomes and safety between locking compression plate and proximal femoral nail anti-rotation for the treatment of the femoral intertrochanteric fractures. METHODS:The Cochrane Library (No.2 in 2015), PubMed(1966-01/2015-06), MEDLINE (1966-01/2015-06), EMbase (1984-01/2015-06), CNKI (1979-01/2015-06), VIP(1989-01/2015-06)and WanFang Data(1990-2015)were searched by computer. Meanwhile, relevant literature from the relevant journals and references were searched by hand. Al the randomized control ed trials concerning locking compression plate and proximal femoral nail anti-rotation for the treatment of the femoral intertrochanteric fractures were col ected. The literature was strictly filtered out according to the inclusion criteria, and was strictly evaluated for the quality. Meta-analysis on the included results was performed with RevMan5.2 software from the Cochrane col aboration. RESULTS AND CONCLUSION:There were 54 potential y relevant papers, and final y, 11 randomized control ed trials were eligible for this investigation. A total of 917 patients were included containing locking compression plate group (464 cases), proximal femoral nail anti-rotation group (453 cases). The Meta-analysis results showed that there were no significant differences in Harris scores, excel ent rate, complications, fracture healing time and hospital stays after treatment between the locking compression plate and proximal femoral nail anti-rotation groups. However, there were significant differences in the time of operation [MD=15.80,95%CI(7.57-24.04), P=0.000 2], peri-operative blood loss [MD=98.01, 95%CI(58.57-137.44),P<0.01], ambulation loading time [MD=8.07,95%CI(3.02-13.12),P=0.002], the length of incision [MD=6.90,95%CI(1.07-12.73), P=0.02] and postoperative drainage volume [MD=41.85,95%CI(23.77-59.93),P<0.01]. These results suggest that the treatment of proximal femoral nail anti-rotation had shortened the length of incision and the time of operation. The treatment of locking compression plate took more time of ambulation loading time, more peri-operative blood loss and postoperative drainage volume. Because the number of cases which this study included are few, and the fol ow-up time was shorter, we should design stricter large sample randomized control ed studies in future increase the strength of the evidence by conducting medium and long-term fol ow-up.
RESUMO
Objective To investigate the effect of different pore sized hydroxyapatite for promoting bone vascularization in tissue engineering.Methods Male Wistar rats were randomly divided into three groups,named group A,B and C,which were im-planted hydroxyapatite bioceramics compositing 4 μg bone morphogenetic protein with different aperture of 200 -300,350 -450, 500-600 μm in the back subcutaneously.The size of each block was 5 mm×5 mm×1 mm in a weight about of 40.0 mg.After im-plantation,the animals were killed and the implants and the surrounding tissue were taken out at the first,second,third and forth week respectively.HE staining of histological analysis was used to detect the situation of local neovascularization.Results There was significant difference between second and third week in group A.Comparing the area of vascularization at different time points in group B and group C,there were significant difference in the comparison of intragroup (P <0.05 ).During the first week after surgery,there was only group C that had the area of vascularization.During the second and forth week after operation,the area of vascularization in group B and group C were significant higher than group A (P <0.05).The C group showed a great deal of new-born blood vessels and clear formation of bone trabeculae.Conclusion The hydroxyapatite bioceramics of 500-600 μm could better promote vascalarization of tissue engineering in bone.
RESUMO
Objective To explore the effect of Shexiang baoxin Pillls on super‐elder patients with myocardial infarction ,and observe and analyze its prognosis .Methods Two hundred super‐elder patients with myocardial infarction were selected in the hos‐pital from December 2013 to November 2014 ,they were randomly divided into control group(n=100) and observation group(n=100) .The control group used conventional drug treatment ,and the observation group treated with Shexiang baoxin pillls on the ba‐sis of the control group .Three months wasr a treatment period .To observe the clinical therapeutic effect ,echocardiography was used to detected the left ventricular wall thickness ,left ventricular end‐diastolic diameter (LVEDD) ,left ventricular ejection fraction (LVEF) before and after treatment .Observed 6 minutes walking distance .Total cholesterol (TC) ,blood lipid ,low density lipopro‐tein (LDL‐C) ,c‐reactive protein (CRP) ,and other indicators were detected .Results The total effective rate of the observation group was [72 .00% (72/100)] was higher than the control group [65 .00% (65/100)] ,P<0 .05 .The re‐hospitalization rate of the observation group was [23 .00% (23/100)] was lower than the control group [34 .00% (34/100)] ,P<0 .05 .The left ventricular posterior wall thickness and LVEDD of the observation group after treatment were(10 .12 ± 0 .40)mm and(49 .11 ± 1 .39)mm , which were lower than the control group after treatment [(11 .06 ± 0 .52)mm and (51 .36 ± 1 .46)mm] ,LVEF (% ) of the observa‐tion group after treatment was (0 .51 ± 0 .12)% ,which was higher than the control group after treatment (0 .47 ± 0 .11)% ,all P<0 .05 .TC ;LDL‐C and CRP of the observation group after treatment were (5 .19 ± 0 .32) mmol/L ,(2 .83 ± 0 .30) mmol/L and (54 . 11 ± 4 .83) mg/L ,they were lower than the control group after treatment [(5 .48 ± 0 .37) mmol/L ,(3 .10 ± 0 .33) mmol/L and (62 . 38 ± 4 .36) mg/L] ,all P<0 .05 .6 min walking distance of the observation group after treatment was (376 .38 ± 19 .41)m ,it was higher than the control group after treatment(331 .04 ± 22 .18)m ,P<0 .05 .The complications of the observing group[38 .00% (38/100)] was lower than the control group after treatment 47 .00% (47/100) ,P<0 .05 .Conclusion There is better clinical effect on super‐elder patients with myocardial infarction by Shexiang baoxin Pillls ,which can reduce hospitalization rates again ,improve left heart function and blood lipid levels ,reduce complications .
RESUMO
Objective To assess the safety and feasibility of CT-guided percutaneous argon-helium cryoablation in the treatment of adrenal tumors.Methods 1 7 patients with adrenal tumors were treated with CT-guided percutaneous argon-helium cryoablation. Three of these patients were retreated second cryoablation three months later due to the lager tumor diameters.Percutaneous tran-scatheter arterial embolization was performed in four patients because of rich blood supply before cryoablation.Continuous arterial blood pressure monitoring was performed in eight pheochromocytoma patients.Results Technical success was achieved in all pa-tients.There were no serious complications.Eight pheochromocytoma patients experienced a significant increase in systolic blood pressure and diastolic pressure when compared with the basic values (P <0.05).There were no enhancement on enhanced CT and/or up-take on FDG PET-CT in the ablated zones during the follow-up period (3-24months).Conclusion It is safety and efficacy of CT-guided percutaneous argon-helium cryoablation for adrenal tumor.It might be initial treatment of choice for the patients who were not suitable for resection.
RESUMO
0.05). The mean ADC value obtained in poor group was significantly lower than that obtained in satisfactory group (t = 4.81,P