To evaluate the clinical value of NMP22 for the diagnosis of urothelial cancer. Urinary NMP22 was determined with enzyme linked immunoaorbent assay (ELISA) in 50 patients in whom 24 patients were suffering from cancer of urothelium, and 20 cases of cancer of other origins, and 6 cases of artificial bladder after total cystectomy for cancer. The median NMP22 value of urothelial cancer was 37 49U/ml, which was significantly higher than those of other patients (4 33U/ml, P

Objective To explore the value and efficacy of retroperitoneal laparoscopic adrenalectomy.Methods From August 2002 to December 2007,a total of 401 cases of retroperitoneal laparoscopic adrenalectomy were performed in our hospital.Among the cases,nonfunctioning adenoma was diagnosed in 151 patients;hyperaldosteronism was detected in 139,Cushing’s syndrome in 37,pheochromocytoma in 19,myelolipoma in 13,and other diseases were found in 42.Results Among the cases,5 were converted to open surgery because of difficulties in the operation due to a huge tumor(1),extensive adhesion between the tumor and the inferior vena cava(2),or massive bleeding(2).The other 396 cases of retroperitoneal laparoscopic adrenalectomy were completed successfully with a mean operation time of 105 minutes(30 to 270 minutes),and a median blood loss of 45 ml(20 to 1000 ml).Two of these patients had massive hemorrhage(1000 and 800 ml respectively),and received red blood cells transfusion(2 U) during the surgery.The rupture of the inferior vena cava or diaphragm occurred in two cases,and was repaired under a laparoscope.Follow-up was available for up to 1 to 64 months(mean 23.9) in 364 patients;none of them had long-term complications or recurrent benign tumors.Conclusions Retroperitoneal laparoscopic adrenalectomy should be used as the first choice for benign adrenal neoplasms,since the procedure is safe,effective,and minimally invasive,and the patients recovery quickly after the surgery.

Objective To evaluate the clinical experience in the treatment of the bladder cancer with holmium laser. Methods From June 2001 to June 2002, a total of 34 cases of transitional cell bladder carcinoma, including 30 male and 4 female, with clinical stage T 1 to T 2a and grade I to Ⅱ, were treated with holmium laser. A 550um end firing fiber was delivered through 21 Fr cystoscopy and power(1 to 1.5 J) was delivered at 15 to 40 pulses per second. Results Bladder tumors were resected easily in 26 cases with holmium laser. In 7 cases it was supplemented with TURBT. Only in one case, holmium laser treatment was given up because of continuous bleeding. The patient was then treated with partial cystectomy. Laser operating time ranged form 5min to 60min, mean 20min. Side effects such as uncontrollable bleeding, perforation of bladder, and obturator nerve reflection were not found. 30 cases were followed up for 3 to 12 months, and tumor recurrence were found in 3 cases. Conclusion Holmium laser resection of bladder tumors is a safe, effective, simple method with less side effects. But the field of vision will be obscure unless continuous irrigation is given during operation.

Objective To evaluate the feasibility and clinical efficacy of laparoscopic nephron-spring surgery for renal tumor.Methods From September 2004 to November 2006,29 patients with renal tumor underwent laparoscopic nephron-sparing surgery without hilar clamping or with temporary hilar control in our hospital.The retroperitoneal approach was used in 25 patients with 4 trocars.During the operation,the renal artery was exposed and then the vessel bundles were pulled out of the abdominal cavity through one of the trocars,passing by the renal artery without clamping it.Afterwards,fatty cysts surrounding or on the surface of the tumor were resected.Tumor excision was then performed using ultrasonic shears.An incision was made at the point 0.5 cm away from the margin of the tumor,and was extended deeply to completely cut the tumor.Meanwhile,bleeding was controlled with bipolar diathermy.The renal artery was occluded when necessary so that the tumor could be cut within a limited time duration.And the occlusion could be re-opened after controlling the bleeding.After the procedure,the renal incision was compressed with gauze,sutured with 2-0 absorbable sutures,and covered with fibrin sealant.In the other 4 patients,trans-peritoneal approach was used.The ureter was exposed near the lower pole of the kidney and separated towards the renal hilum to find out the renal artery.The following steps were similar to the above mentioned. Results In all the patients,the procedures were done without conversion to open surgeries.In this series,20 operations were completed without clamping the renal artery;and in the other 9,the mean time of renal artery occlusion was 14 min(5-20 min).In our patients,the mean operation time was 165 min(105-240 min),and the mean blood loss was 90 ml(20-800 ml).Two of the patients received blood transfusion during the surgery.The mean postoperative hospital stay was 9 d(7-17 d).No complications,such as urine leakage,occurred after the operation.Eighteen patients were followed up for a mean of 9 months(1-26 month),no recurrence of tumor was found.Conclusion Laparoscopic nephron-sparing surgery without hilar clamping or with contemporary hilar control is feasible and safe for patients with peripheral renal tumor not involving the renal collecting system.

Objective To approach the correlation between histology manifestation or Ki-67, p53 expression and superficial bladder cancer. Methods 54 cases of superficial bladder cancer were classified into two groups(with and without recurrence). The histological morphology was reviewed according to the 1998 WHO/ISUP classification. The expression of both Ki-67 and p53 was detected with immunohistochemical method, and a comparison was made between with- and without recurrence group. Results The average duration of follow-up survey for the patients was 32 months. Among the 54 patients, 28 got recurrence. Of the recurred cases, 5 were papillary urothelial neoplasm of low malignant potential (PUNLMP), 14 were low grade papillary urothelial carcinoma (LGPUC), and 9 were high grade urothelial papillary carcinoma (HGPUC). While among the 26 cases without recurrence, 4 were papilloma, 12 were PUTLMP, 8 were LGPUC, and 2 were HGPUC. The recurrence rate was 29.4% (5/17) in PUTLMP, 63.6% (14/22) and 81.8% (9/11) in LGPUC and HGPUC, respectively. There was a significant difference in Ki-67 and p53 expression between the recurrence and non-recurrence groups, the positive rate in recurrence group was significantly higher than that in non-recurrence group (P

Objective To report the initial experience and results of the laparoscopic radical cystectomy (LRC) with ileal conduit. Methods Seven male patients with invasive bladder carcinoma confined to the organ underwent LRC with ileal conduit. The mean age was 61 years (range, 53 to 74 years). The procedure included radical cystectomy with prostatectomy. A 7 cm suprapubic incision was made to remove the organs. Ileal conduit was done routinely. Results Operating time was 7 to 10 hours (median 9.2), and blood loss was 200 to 400 ml (median 264). None of 7 patients needed blood transfusion. 2 to 10 months after surgery, intravenous urography showed no evidence of ureteral reflux or ureteral obstruction. Conclusions With the improvement in the surgical technique, laparoscopic radical cystectomy with small incision, resulting in rapid recovery, may become an alternative method for patients with localized bladder cancer with invasion to muscular layer.

Objective To discuss three managements of bladder tumors under cystoscopy.Methods Of all the patients,1174 were injected compound aluminum sulphate in tumor pedicle,and 700 cases were treated with transurethral resection of bladder tumor (TURBT) and 34 cases were treated with holmium laser.Results The first management,without obturator nerve reflex and tumor recurrence in situ,was easy and economical but not fit for big tumors without pedicles.With the requirements for related techniques and equipments,TURBT might be accompanied by bleeding,obturator nerve reflex and tumor recurrence in situ.Of the 34 cases treated with holmium laser,there were 3 ones with ectopic recurrence and no one with recurrence in situ.With the requirement for holmium laser equipment,the third management was the most expensive one.Conclusion All of the three managements have their advantages and disadvantages.The doctor should select the right management or perform cross application according to the condition of the patient.

Objective To present the preliminary experience with laparoscopic ureteral reimp1ant for distal ureteral stricture without everted ureteral nipple or submucosal tunneling. Methods Six patients with distal ureteral stricture underwent transperitoneal laparoscopic ureteral reimplantation.The ureteral was reimplanted into the bladder without everting the ureter or without a tunnel.The seromuscular wall of the ureter was anastomosed eircumferentially to the bladder muscle layer by continuous suture. Results All procedures were successfully performed without any intraoperative complications or need for open conversion.Intravenous urography showed normal drainage without obstruction or reflux during follow-up. Conclusion Laparoscopic ureteral reimplantation might be technically simple and feasible.

Objective To analyze the effect of mesporous calcium silicate (m-CS)/calcium sulfate cement (CSC),m-CSC for short,in bone defect repair.Methods Setting time and compressive strength of the m-CSC (15 m-CSC as group Ⅰ and 30 m-CSC as group Ⅱ) were tested.CSC was used as the control.Cement samples were immersed in Tris-HCl solution,andin vitro degradation of the m-CSC was measured.Cell morphology and cell proliferation as well as differentiation on the samples were assessed.The cements were implanted into the traumatic femoral defects in rabbits,and the in vivo degradability and osteogenesis of the cements were investigated by histological evaluation after implantation for 4,8 and 12 weeks.Results Addition of m-CS into CSC prolonged the setting time (7.8 min in group Ⅰ and 10.5 min in group Ⅱ),obviously longer than 3.7 min in control group and did not have obvious effect on compressive strength of the cements.Weight loss of m-CSC solution was obviously lower (61.8 wt％ in group Ⅰ and50.3 wt％ in group Ⅱ),compared to70.4 wt％ in control group,pH value in group Ⅱ decreased from 7.40 to 7.26,while decreased from 7.40 to 6.86 in control group,m-CSC could promote cell proliferation and differentiation compared to CSC.At postoperative 12 weeks,histological sections showed massive new bony tissue (55.2％) in group Ⅱ,obviously higher than 25.6％ in control group.Conclusion m-CSC exhibits good biocompatibility,degradability and osteogenesis,and can promote bone regeneration in bone defect repair.

Objective To investigate the pathogen distribution and risk factors of pulmonary infection after acute cervical spinal cord injury (ACSCI) in an attempt to offer reference for early antiinfection therapy.Methods The study comprised 223 cases who were admitted from October 2011 to October 2014.There were 149 males and 74 females,at (43.3 ± 13.5) years of age.Species of pathogens identified were gram-positive,gram-negative and mixed.Effects of age,gender,injury types and tracheotomy on pathogen distribution were analyzed.Results Gram-negative infection was found in 114 cases (51.1％),with tracheotomy accounting for 7.0％ of the cases and death accounting for 1.8％ of the cases,and the main causative pathogens were Klebsiella pneumonia,Escherichia coli,Pseudomonas aeruginosa and Acinetobacter baumannii.Gram-positive infection was found in 41 cases (18.4％),with tracheotomy accounting for 12.2％ of the cases and death accounting for 7.3％ of the cases,and the main causative pathogens were Staphylococcus aureus and Streptococcus pneumonia.Mixed infection was found in 68 cases (30.5％),with tracheotomy accounting for 22.1％ of the cases and death accounting for 13.2％ of the cases.Gender had no significant correlation with pathogen distribution.For the cases of complete spinal cord injury and tracheotomy,the ratio of mixed infection increased significantly (P ＜ 0.05).For the cases younger than 30 years,the pathogens were mainly gram-positive bacteria (P ＜ 0.05).Conclusions Main pathogens of pulmonary infection after ACSCI are gram-negative bacteria.The cases younger than 30 years are associated with higher risk of grampositive infection,while the cases with complete injury or tracheotomy are associated with higher risk of mixed infection.