Clinicopathologic features of the ureteral neuroendocrine tumors.

BACKGROUND: Neuroendocrine tumors of the ureter are extremely rare. There are only a few case reports in the past decades. Their clinicopathologic features, therapy and prognosis are not that clear. METHODS: 5 cases of ureteral neuroendocrine tumors were collected and reviewed of the literature. Histomorphology, immunophenotype and ultrastructural features were observed by HE, immunohistochemistry, special staining and electron microscopy. The clinical pathological data were retrospectively analyzed and followed up. RESULTS: Among the 5 patients, 1 was female and 4 were male, aged 62-82 years. 2 cases manifested intermittent hematuria, 1 had lower abdominal pain with frequent urination and dysuria, 1 with hydronephrosis, and 1 had no manifestations. All the 5 patients were treated with nephroureterectomy, 3 of which were also treated with excision of bladder cuff, 1 also had lymphadenectomy. On presentation, 2 cases in T2N0M0 (stage II), 2 cases in T3N0M0 (stage III), and 1case in T3N2M0 (stage IV). 2 cases were small cell neuroendocrine carcinoma, 1 was large cell neuroendocrine carcinoma and 2 were atypical carcinoid. The tumor cells were positive for neuroendocrine markers (CD56, CgA, Syn). 1 case of vimentin-positive small cell neuroendocrine carcinoma has a very good prognosis. Grimelius stain and electron microscopy observation showed numerous neuroendocrine granules in the cytoplasm. CONCLUSION: Ureteral neuroendocrine tumors are extremely rare. Neuroendocrine markers (CD56, CgA, Syn) and epithelial markers (CKpan, CK7) are usually helpful. Grimelius special staining and electron microscopy observation can help to make a final diagnosis. Radical surgery together with postoperative adjuvant chemotherapy can improve the survival of patients. Vimentin may play a role in predicting the prognosis.

[Analysis of anesthetic methods for tracheal resection and reconstruction with artificial trachea: a report of 25 cases].

OBJECTIVE: To analyze and discuss the anesthetic methods and processes for the operations including long-segment resection of the trachea and one-stage anastomosis or reconstruction with artificial trachea. METHODS: The clinical data of 25 cases from January 1987 to August 2007 with trachea diseases were analyzed retrospectively. There were 10 cases with benign diseases and 15 cases with malignant diseases. All cases represented tracheal stenosis. Some cases represented severe dyspnea. The length of the tracheal lesions was from 2.5 to 7.5 cm. The longest resection of the trachea was 8.0 cm. Direct reanastomosis were carried out in 14 cases. Reconstruction with artificial trachea were carried out in 7 cases. Thirteen cases underwent general anesthesia with endotracheal intubation only, while 2 cases were assisted with artificial cardiopulmonary bypass. Eight cases were intubated via existed tracheotomy. Two cases received bedside tracheotomy with local anesthesia. Two cases were assisted with high frequency jet ventilation. During the operation, a tube was inserted into the distal trachea or contralateral main bronchus to maintain anesthesia and ventilation after the trachea resection. RESULTS: All of the 25 patients had good outcome. There was no death caused by anesthesia or operation. However, transient lower SaO2 was found in 2 cases because of the difficult intubation of left main bronchus after the resection of the trachea. One case was ventilated with only lower lobe because of the extra-deep intubation of the left main bronchus. Anastomosis dehiscence happened in 1 case when the non-balloon trachea tube was used immediately after the operation. CONCLUSIONS: The mortality of anesthesia for tracheal operation are quite high. Therefore, individual treatment with carefully-designed anesthetic and operative protocol, and good communications and cooperation between anesthesiologists and surgeons is the key factor for the success of anesthesia and operation.

[Anesthesia and operative approach of resection of the trachea].

OBJECTIVE: Review and discuss anesthesia and operative approach of resection of the trachea for different tracheal diseases, especially for the resection of long-segment of trachea. At the same time to introduce the method of reconstruction of long-segment of trachea with Zhao's (two-stage procedure with memory-alloy mesh) artificial trachea. METHODS: Retrospective study of 18 cases of tracheal resection, analysis of the relation between the choice of anesthetic and operative approach. RESULTS: General anesthesia through cut open the trachea with local anesthesia in 2 cases, general anesthesia through previous tracheotomy in 2 cases, extracorporeal circulation in 2 cases, general anesthesia through endotracheal tube in 12 cases. There were no anesthetic or operative death. Local resection in 3 cases, segmental resection in 15 cases. The longest segmental resection was 8.0 cm. Primary anastomosis after segmental resection in 8 cases, Reconstruction with Zhao's artificial trachea in 7 cases. Postoperative follow-up was 5 months to 8 years. Four cases died from systemic metastasis or other reasons at 4, 11 and 12 months, respectively. CONCLUSIONS: Different methods of anesthetic and operative procedures should be used for different patients. Extracorporeal circulation used for patient with highest dangerous condition, or, for which could be inserted endotracheal tube by tracheotomy with local anesthesia. Conservative local resection performed only for patients with very bad general condition. Segmental resection less than 5 cm long could be reconstructed with primary reanastomosis. Resection longer than 5.5 cm could be reconstructed with Zhao's artificial trachea.

[Replacement of artificial tracheal prosthesis by two-stage procedure with memory-alloy mesh].

OBJECTIVE: To design an artificial trachea which can totally heal with the native trachea. METHODS: Using memory-alloy mesh as the skeleton to construct an artificial trachea by two-stage operation. After 2-year animal experiment we successfully performed the operation in a patient with recurrent carcinoid of the trachea, radically resected the tumor and primarily reconstructed the trachea. RESULTS: The inner side of this "sandwich" artificial tracheal prosthesis was coated with skin and outside the memory-alloy mesh was muscle and vessel pedicle with good blood supply. The upper and lower anastomosis completely healed with recipient's trachea with a full recovery of trachea. Six-month follow-up showed that the patients resumed their normal life. CONCLUSION: The artificial trachea completely healed with the native trachea and became a part of the human trachea. The inner side of artificial trachea is coated with intact native skin tissue with ample blood supply, totally alive without rejection. Therefore, the pedicled artificial tracheal prosthesis is an real artificial trachea.

[Results of unilateral lung volume reduction surgery in twenty-five patients with chronic obstructive pulmonary disease].

OBJECTIVE: To evaluate the effectiveness of unilateral lung volume reduction surgery (LVRS) in patients with chronic obstructive pulmonary disease (COPD). METHODS: The follow-up data of 25 patients with COPD who had underwent unilateral LVRS between January 1996 to December 2002 in department of thoracic surgery, China-Japan friendship hospital were analyzed retrospectively. The operative target was determined by pre-operative CT and pulmonary ventilation-perfusion (V/Q) scintigraphy. LVRS was performed in 21 patients through video assisted thoracoscopy surgery (VATS) or VATS with adjuvant small lateral thoracotomy. In 4 patients LVRS was performed through posterolateral thoracotomy. Destroyed pulmonary tissue was resected by liner stapler or Endo GIA. To evaluate the effectiveness of unilateral LVRS, the changing of dyspnea score, pulmonary function and the quality of life were analyzed. RESULTS: The postoperative follow-up interval range was 2 years. The mean postoperative FEV(1) increased by (35 +/- 9)%, and six minute walking distance (6MWD) increased by (88 +/- 22)%. For dyspnea score, among 16 patients with a preoperative grade of IV, 4 patients improved to grade I, 12 improved to grade II; among 9 patients with a preoperative grade of V, 1 improved to grade I, 1 improved to grade II, 4 improved to grade III, and the other 3 improved to grade IV. Karnofsky score increased by (44 +/- 10) in average. One and two year survival rates was 96% and 92%, respectively. There was no perioperative death in this group, and the total postoperative morbidity was 32%. CONCLUSIONS: Unilateral LVRS shows significant clinical benefits for the majority of patients with COPD. It is associated with lower operative mortality and morbidity, and has a wide range of indications. The key points of the operation are to resect dysfunctional lung tissues as much as possible and to prevent pulmonary air leak. Preoperative and postoperative breathing training plays a very important role in the postoperative recovering of lung function.

[Late-stage emphysema treated with lung volume reduction: report of 22 cases].

OBJECTIVE: To Summarize the clinical experience in the treatment of late-stage emphysema by lung volume reduction (LVR) in 5 years. METHODS: We retrospectively studied the indications, contraindications, operation procedures and complications of LVR in 22 patients. RESULTS: Before operation, the average FEV(1) was 24.5%, RV 196.8%, and TLC 130.5%; after operation they were 27.8%, 148.8% and 112.5%, respectively. 16 patients needed inhaling oxygen before operation, and 5 after operation. 16 patients finished 6-minute walking test with an average of 198 m, all patients walked much longer with an average of 256 m after operation. 3-degree lung function was observed in 14 patients, and 4-degree before operation in 8 patients; but 2-degree lung function in 5 patients, 3-degree in 13, and 4-degree in 4 after operation. CONCLUSIONS: Heterogeneous type emphysema with clear target area, especially bullous emphysema is the best indication for LVR. Lung function and life quality could be much improved postoperatively. Homogeneous type could also be treated with LVR in highly selected cases. TLCO < 20% is not an absolute contraindication, others standards need further investigation. Video-assistant thoracoscopic surgery (VATS) with subaxillary small incision for LVR is safe, reliable and effective. Application of stapler buttressing with bovine pericardia could decrease air leakage postoperatively.