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ABSTRACT: To explore the clinical characteristics of spontaneous urinary extravasation caused by primary lower ureteral cancer.
Eight cases of spontaneous urinary extravasation caused by the obstruction of primary ureteral cancer from January 2005 to June 2010 from Department of Urology, Peking Union Medical College Hospital, were reported. There were 5 males and 3 females with an age range of 56-81 years old. Six cases presented with an onset of acute flank pains and 2 cases complained of flank discomforts with a lower fever. All cases had peripelvic fluid collection of varying levels on computed tomography (CT) scan and extravasation of contrast medium was found in delayed enhanced CT. The tumors of ureter were detected in 6 cases through preoperative imaging examinations while another 2 cases had no evidence of tumor.
Unilateral nephroureterectomy was performed in 6 cases, including 5 cases undergoing retroperitoneal laproscopic surgery and 1 case with open surgery. In 5 laproscopic operations, the mean operative duration was 152 (120 - 235) minutes and the mean estimated intraoperative blood loss 130 (100 - 430) ml. The patient of open nephroureterectomy had an operative duration of 175 minutes and an intraoperative blood loss of 200 ml respectively. One patient underwent a local resection of ureteral carcinoma. A 81-year-old patient was diagnosed of tumor by uteroscopic biopsy and accepted neither surgery or adjunctive therapy. All patients had a pathological diagnosis of urotheial carcinoma. One patient received local radiotherapy and chemotherapy with gemcitabine after nephroureterectomy while another one had local radiotherapy only. During a follow-up period of 6-36 months, CT showed that five cases undergoing nephroureterectomy were free of recurrence. One patient with local lymphatic metastasis had a local recurrence, developed multiple metastases at Month 3 and died of exhaustion at Month 8 post-operation. The patient with a local resection had a local bladder recurrence at Month 6 and underwent unilateral nephroureterectomy and radical cystectomy after local radiotherapy and neoadjuvant chemotherapy. Tumor progression was found in the patient without surgery. No implantation metastasis was found.
Spontaneous urinary extravasation caused by the obstruction of primary lower ureteral cancer is rare and mostly peripelvic. Biopsy may exclude tumors for those patients with no obvious cause of ureteral obstruction. And radical operation is a preferred option.
Zhonghua yi xue za zhi 02/2012; 92(6):414-6.
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ABSTRACT: To evaluate the clinical characteristics,diagnosis and treatment for adrenal ganglioneuroma.
Thirty cases of adrenal ganglioneuroma at our hospital from 1999 to 2010 were reviewed. Their clinical, radiological, laboratory and pathologic findings as well as follow-up data were analyzed retrospectively.
There were 12 males and 18 females with an age range of 7 - 63 (23.8 ± 11.4) years old. Tumor size ranged from 2.5 cm to 15 cm. Fourteen (46.7%) cases were found incidentally without any overt symptom. And the presenting symptoms and signs of the others were paroxysmal headache and palpitation (n = 7, 23.3%), hypertension (n = 5, 16.7%) and flank or abdominal pain (n = 4, 13.3%). All cases underwent open or laproscopic operations and their diagnosis of adrenal ganglioneuroma was confirmed pathologically. An oval or crescentic well-defined mass, low or intermediate attenuation on CT (computed tomography) scan was found in most cases. Tumors partially or completely surrounded major blood vessels in 9 cases while 7 cases had discrete punctuate calcification. The 24-hours urinary catecholamine and urinary free cortisol output were within a normal range. Seventeen cases underwent a (99)Tc-octreotide scan and negative results were found in 15 cases. Seven cases had a (131)I-Metaiodobenzylguanidine ((131)I-MIBG) scan and all results were negative. Twenty-one cases were diagnosed empirically as adrenal ganglioneuroma. One case was found pre-operatively with multiple bone metastases. Among all cases, either open operation (n = 11) or retroperitoneal laparoscopic excision (n = 19) was performed successfully. All recovered smoothly. One patient with pre-operative bone metastasis developed progression. No recurrence was detected after a follow-up period of 1 - 11 years.
Mostly benign in nature, adrenal ganglioneuromas is often found incidentally without specific clinic symptoms. A relatively accurate preoperative diagnosis can be made on the basis of a detailed history and the relevant imaging and laboratory results. Surgical resection of tumor is a preferred choice with a fairy good prognosis.
Zhonghua yi xue za zhi 09/2011; 91(36):2561-3.
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ABSTRACT: To investigate the clinical characteristics of primary adult renal sarcoma.
A total of 1654 cases with adult renal tumors were treated during 1985 to 2009 in Peking Union Medical College Hospital. Of all, 17 cases were diagnosed as primary renal sarcoma and underwent radical nephrectomy. The clinical features of 17 such patients were retrospectively analyzed.
The first symptom of 10 (59%) cases in all renal sarcomas was abdominal mass. The pathological diagnosis was leiomyosarcoma (7 cases), rhabdomyosarcoma (2 cases), malignant fibrous histiocytoma (2 cases), low-differentiated sarcoma (2 cases), chromophobe renal cell carcinoma coexisting with liposarcoma (1 case), fibrosarcoma (1 case), embryonic sarcoma (1 case) and leiomyosarcoma (1 case). One patient died of tumor thrombus of the inferior vena cava during surgery. Finally, 15 cases were regularly followed up for 4 to 60 months. Till now, 1 had tumor-free survival for 9 months, and the other 14 cases died 2-38 months after the operation with a median survival time of 18 (range, 5-60) months. The median survival time of leiomyosarcoma group was 28 (range, 11-60) months, and 2 cases of malignant fibrous histiocytoma died 4 and 8 months after the operation respectively.
The primary renal sarcoma has the clinical symptom similar with advanced renal cell carcinoma and has poor prognosis. Leiomyosarcoma might have relative good prognosis.
Chinese Medical Sciences Journal 09/2011; 26(3):172-4.
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ABSTRACT: To evaluate the effectiveness and safety of the combined therapy of doxazosin and tolterodine for BPH patients with dominant storage symptoms.
From May 2009 to April 2010, 76 patients diagnosed as benign prostatic hyperplasia (BPH) by International Prostate Symptom Score (IPSS), flowmetry, ultrasound for prostate volume, residual urine and other methods were included in the study, all of them fulfilled the study's inclusive/exclusive criteria. The principal exclusive criteria were prostate volume > 50 ml, maximum flow rate (Qmax) < 10 ml/s and residual urine > 100 ml. All 76 patients had bothering storage symptoms and divided randomly into two groups:doxazosin group (n = 36) in which patients were treated with doxazosin 2 mg once daily for 8 weeks, and combination group (n = 40) in which patients were treated with doxazosin 2 mg once daily and tolterodine 2 mg twice daily for 8 weeks.
At baseline, there was no significant differences. The IPSS was significantly improved in the two groups after treatment, but the reduction of IPSS in combination group was significantly greater (18.7 ± 2.2 vs 12.7 ± 3.9) than that in doxazosin group (18.6 ± 3.0 vs 15.2 ± 3.8) (P < 0.05), and the decreased storage IPSS was the main contribution to the reduction of IPSS in combination group. There was no difference between the groups for Qmax and residual urine.
Combined therapy with doxazosin plus tolterodine for BPH patients with dominant storage symptoms can improve the IPSS, especially the storage IPSS, without any negative effects on uroflow rate and residual urine.
Zhonghua wai ke za zhi [Chinese journal of surgery] 12/2010; 48(23):1771-3.
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ABSTRACT: To investigate the clinical diagnosis, treatment and prognosis of melanoma adrenal metastasis.
A total of 48 cases of malignant melanoma from 1985 to 2007 were reviewed. And three cases of melanoma adrenal metastasis were analyzed. There were 2 males and 1 female with an age of 57, 70 and 83 years old respectively. Two cases had a history of cutaneous melanoma and another one suffered previously from anal melanoma. The disease-free interval to adrenal metastasis were 25, 37, 33 months respectively. Two presented with flank or abdominal discomfort and another one had adrenal metastasis on routine examination. The maximal diameters of metastasis were 5, 8 and 12 cm respectively. The CT value of adrenal metastasis had a range of 9 - 45 Hu in plain scan. And the maximal post-contrast value was 107.5 Hu.
One patient with concurrent lymph node metastasis received non-operative therapy with interleukin-2. The other two cases underwent complete resection of melanoma metastasis. One received adrenalectomy via retroperitoneal laparoscopic approach while another patient with tumor thrombus in inferior vena cava underwent right adrenalectomy and extraction of tumor thrombus out of inferior vena cava in traditional open surgery. When contralateral adrenal metastasis of melanoma was found 6 months later, left adrenalectomy laparoscopically was performed. The patient who was managed non-operatively died of cachexia 6 months later. Two operated patients did not accept adjuvant therapy. One had multiple metastasis in 16 months and died at 21 months. Another was alive without recurrence or new metastasis at 30 months.
Melanoma metastasis to adrenal gland is rare and it generally has a poor prognosis. Patients with adrenal metastases from melanoma, either isolated or with a limited number of additional metastases, may achieve a survival benefit from surgical resection if all visible lesions are removed.
Zhonghua yi xue za zhi 04/2010; 90(16):1123-5.
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ABSTRACT: To investigate the changes and its clinical significance of ultrasound evaluated bladder wall weight (UEBW) pre and after surgery in patients with benign prostatic hyperplasia (BPH).
The clinical data of 63 patients of benign prostatic hyperplasia and 30 of contrast control were studied. The bladder wall weight was calculated by subtracting the volume of sphere represented by the urine volume inside the bladder from the volume of the sphere representing the whole bladder (sphere with a radius = internal radius + bladder wall thickness). Bladder outlet obstruction (BOO) and bladder function was evaluated by urodynamic studies. Of the 63 patients with BPH, UEBW was (97 +/- 54) g, while the control group was only (41 +/- 14) g. UEBW was found to be significantly correlated with LinPURR grade (R = 0.47, P < 0.01) and positive residual urine volume (R = 0.48, P < 0.01), and it was negatively correlated with Qmax (R = -0.52, P < 0.01) and detrusor contraction strength (presented as WF, R = -0.4, P < 0.05).
A significant difference was found between the UEBW pre and after surgery [(99 +/- 50) g vs. (56 +/- 21) g, t = 5.05, P < 0.01)]. UEBW decreased 43.68%, and IPSS score decreased 16.81 point, while Qmax increased 8.38 ml/s.
As an non-invasive methods, measurement of bladder wall weight appears to be a useful marker in evaluating status before operation and in monitoring the effect of surgery for patients with BPH.
Zhonghua wai ke za zhi [Chinese journal of surgery] 07/2007; 45(14):954-6.
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ABSTRACT: The effectiveness and safety of the combined therapy of terazosin and tolterodine for LUT/BPH patients with dominant storage symptoms was evaluated.
The present study included 69 patients diagnosed as LUT/BPH by IPSS, flowmetry, ultrasound for prostate volume, residual urine, serum PSA and other methods, all of them fulfilled the study's inclusive/exclusive criteria. The principal exclusive criteria were prostate volume > 50 ml, Qmax < 10 ml/s and residual urine > 50 ml. All 69 patients had bothering storage symptoms after initial treatment with terazosin 2 mg once daily for one week., they were divided randomly into two groups. Terazosin group in which patients were treated with terazosin 2 mg once daily for six weeks, and combination group in which patients were treated with terazosin 2 mg once daily and tolterodine 2 mg twice daily for 6 weeks.
Sixty-nine patients with LUT/BPH were recruited with inclusive/exclusive criteria of our study, thirty-six patients were in terazosin group and 33 were in combination group. At baseline there were no significant differences between the groups, in mean age, body weight, prostate volume, IPSS, storage IPSS, voiding IPSS, Qmax and residual urine. The results showed that the IPSS was significantly improved in the two groups after treatment, but the reduction of IPSS in combination group was significantly greater than that in terazosin group (P < 0.001), and the decreased storage IPSS was the main contribution to the reduction of IPSS in combination group. There were no differences between the groups for Qmax and residual urine.
Combined therapy with terazosin plus tolterodine for LUT/BPH patients with dominant storage symptoms can improve the IPSS, especially the storage IPSS, without any negative effects on uroflow rate and residual urine. Combining with inclusion/exclusion criteria of the study, we believe that combined therapy with alpha-blocker plus anticholinergics is an effective and safe treatment for LUT/BPH patients with relatively small prostate volume, moderate impaired Q(max) and dominant storage symptoms.
Zhonghua yi xue za zhi 06/2007; 87(23):1590-3.
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ABSTRACT: To investigate the incidence and related factors of psychic symptoms in patients with chronic prostatitis.
Patients diagnosed with chronic prostatitis were selected as research objects, their course of disease, therapeutic process and psychic symptoms were inquired and recorded carefully, clinical symptoms were evaluated, expressed prostatic secretions (EPS) were examined, and many related factors were compared with psychic symptoms.
Among the 315 patients selected, 51.1% (161/315) had psychic symptoms. Psychic symptoms in patients with chronic prostatitis had nothing to do with course of disease, the incidence of psychic symptoms in patients with course less than 1 year, 1 to 2 years, and more than 2 years were 49.1%, 48.0%, and 56.1%, respectively; had closed relationship with therapeutic process, the incidence of psychic symptoms in patients to see doctors for the first times, the 2 to 3 times and more than 3 times were 35.3%, 43.5%, and 62.6%, with significant statistical difference (P < 0.05); had no relationship with severity of clinical symptoms, the incidence of psychic symptoms in patients with mild, media and severe clinical symptoms were 46.2%, 52.4%, and 55.9%; no statistical difference was noticed in patients with different degrees of inflammation, the incidence of psychic symptoms in patients with inflammatory and non-inflammatory prostatitis were 53.8% and 47.3%.
Psychic symptoms in patients with chronic prostatitis had direct relationship with times patient seeking medical care, and prolonged therapeutic process aggravated the psychic symptoms.
Zhonghua nan ke xue = National journal of andrology 09/2005; 11(9):677-9.
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ABSTRACT: 柑桔潰瘍病菌(Xanthomonas campestris pv.citri) 的XW47菌株，被溫和性，噬菌體QXW116感染後，由於原噬菌體的插入，均變成具有潛溶性，其中的85％為普通的潛溶菌株，5%為黃白色菌落的突變菌，另外10％為cysteine合成的突變菌。此等突變，也具有H2S 的產生，Casein的氫解作用，Citrate 的作用及Mannose、Xylose、Glycer-ol、Dextrin 和Trehalose 等碳水化合物分解與產酸等的變化。所有的白黃色菌落突變菌株與 cys突變菌株中，在自然狀態下或經 啶橙、高溫、紫外線照射及軟瓊脂長期保存等處理下，均不能回復；cys 突變菌株，在接種的柳丁葉片後四週內，能依平均0.0048及0.1%的比率回復且均失去潛溶性，在此等回復菌株中的一部分在H2S 的產生及Galactose、Mannitol、Dextrin和Trehalose 等碳水化合物分解和產酸等能力上，顯現有和其野生菌株不同的反應，此乃顯示QXW116原噬菌體自寄主染色體消失後發生基因重新排列的現象。此外，此等突變均顯出致病力降低，一但回復，則回復和野生型菌株相同的致病力。
