Objective Based on recent personal experience, we presented a detailed description on how to perform orthotopic liver transplantation in rat with two-cuff technique, including many improvements to the original technique, to facilitate the beginners to acquire this model. Methods 136 male SD rats were randomly divided into 2 groups, i.e. donor group and recipient group. On the basis of Kamada's cuff technique, some modifications were made. The donor liver was first perfused through the abdominal aorta with cold Ringer-lactate solution and then harvested. After removal of the recipient liver, the liver graft was then placed orthotopically in the abdomen. The donor suprahepatic vena cava was anastomosed end-to-end with the recipient suprahepatic vena cava, using a 7-0 running suture. The continuity of infrahepatic vena cava and portal vein was accomplished by cuff technique. The end-to-end bile duct anastomosis was performed by tying the two ducts over a tube stent, with fixation both sides. Recipient survival rate and causes of death were observed after the transplantation. Results The time for liver procurement, graft preparation, anhepatic phase, and bile duct reconstruction were 23-35 minutes, 8-13 minutes, 16-19 minutes, and 2-3 minutes, respectively. 48-hour and one-week survival rate of recipients was 95.5% and 89.7%, respectively. Main cause for death within 48 hours after operation was bleeding. Biliary tract obstruction, bile leakage, and liver lobe necrosis were the main causes for mortality after one week. Conclusion The results show that the modified model is highly reproducible, and it provides a stable and practical experimental model for the basic study on liver transplantation.

Objective To investigate the histological features of papillary renal cell carcinoma, and to explore the relationship between nuclear grading and prognosis. Methods The pathological slides and clinical data of 13 cases of papillary renal cell carcinoma were reviewed. The pathological features were scrutinized and nuclear grading was conducted according to Fuhrman grading system. Immunohistochemical staining for CK7, EMA, and vimentin was also respectively done. The correlation between nuclear grade and prognosis was analysed. Results The age range of the patients was from 35 to 67 (average 53) years. 10 were male and 3 were female. Most of the tumors were located in the upper pole (5cases) or lower pole (5cases). Three were located in the middle part of the kidney, with some inclination to either pole. All the tumors were well circumscribed with a size ranged from 2cm to 6.3cm (average 3.5cm) in diameter. Hemorrage and cystic change were obviously seen in large tumors. Microscopically, the tumors were composed of papillary or tubular structures, with hemorrhage, foamy macrophages and cystic change as prominent features. 6 cases were multifocal. Fuhrman nuclear grade Ⅰ or Ⅱ was made in 6 cases, and Ⅲ or Ⅳ in 7 cases. All the tumors were positive for CK7, EMA and vimentin. The patients were followed up for 28 to 102 months (average 52 months). 3 patients died of tumor recurrence or metastasis after the operation at 36, 41 and 50 months, respectively, while others survived without tumor up to now. The three dead patients were graded Ⅲ or Ⅳ by Fuhrman nuclear grading system. Conclusion Papillary renal cell carcinoma was different from other renal carcinoma variants in that they, usually have a better prognosis.

Objective To study the application of native pelvis and ureter in kidney transplantation. Methods Between 1977 and 2001, 1 364 kidney transplantations were performed in our institution. 18 cases of ureteral complication after kidney transplantation were treated with native pelvis and ureter. The mean age of the patients was 42 years. In 10 patients with urine leakage, 3 cases underwent pyeloureterostomy using native ureter, 2 cases ureteroureterostomy using native ureter and 5 cases pyelopyelostomy using native pelvis. Five cases due to short ureter underwent ureteroureterostomy using native ureter. Three cases of ureteral stenosis were subjected to ureteroureterostomy using native ureter.Results Two grafts were rejected. Sixteen patients developed a normal function of kidney postoperatively (follow up: 3 months to 8 years). Conclusion Application of native pelvis and ureter might be a therapy of choice when secondary reconstruction by re-ureteroneocystostomy is not possible.

Objective To determine the definite effec ti ve therapy for localized prostate cancer. Methods A data -base of 317 patients with prostate cancer treated with different therapies be tween 1969 and 1999 were analyzed.Overall survival and disease specific survival rates for patients with different stage,grade,and regimen were analysed by Kap lan-Meier method.Predictive factors impacted on disease specific survival were also analyzed by using log-rank test and Cox proportional hazards model. Results Overall survival rates at 5-,10- and 15-year were 7 3.1%,51.8% and 35.3%,corresponding disease specific survival rats of 85.1%、72.9 % and 72.9%,respectively.Disease specific survival rate at 10-year was 100.0% i n 36 patients treated with radical prostatectomy,78.0% in 57 patients treated wi th local radiotherapy.Multivariate analysis by Cox model showed that stage ( RR =2.17,CI 1.43～3.28, P =0.0000) and grade( RR =2.54,CI 1.37～4.68, P = 0. 0003)were significantly impacted on disease specific survival. Conc lusions Radical prostatectomy and local radiation provide effective treatment for patient with organ-confined prostate cancer.Adjuvant hormonal the rapy may effect on patient’s survival.Clinical stage and grade of prostate canc er are independent factors impacting on survival significantly.

Objective To evaluate the differentiation and diagnosis of benign renal tumors and tumor-like lesions. Methods The data of 49 cases of benign renal tumors and tumor-like lesions were retrospectively analyzed.All the 49 cases underwent B-ultrasonography and CT;14 cases underwent MRI.The clinical manifestation,imaging features and the pathological results were evaluated.21 cases of benign renal tumors and tumor-like lesions were misdiagnosed as renal carcinoma and underwent nephrectomy.28 cases underwent nephron-sparing tumor excision. Results There was no specificity of the clinical presentation in all the cases.CT and MRI showed that angiomyolipoma had imaging features of intra-tumoral fat.Color Doppler ultrasonography showed the specific features of renal arterio-venous fistula and renal artery aneurysms.The other imaging features of benign renal tumors and tumor-like lesions had no specificity.28 cases who underwent nephron-sparing surgery were followed up for 1 to 9 years and had no relapse.Their renal functions were normal. Conclusions Bulltrosonography,CT and MRI are contributive to the diagnosis and treatment of benign renal tumors and tumor-like lesions.Using nephron-sparing surgery for indeterminate renal masses may reduce misdiagnosis and unnecessary nephrectomy.

Objective To study the clinical features,the diagnosis and treatment of left renal entrapment syndrome. Methods Four male patients with left renal entrapment syndrome were reported.Their age ranged from 16 to 22 years.The clinical features were characterized by recurrent episodes of gross hematuria,and 1 case had left varicocele concomitantly.Cystoscopy showed hematuria from the left ureter orifice.B-ultrasonography and CT scan showed that the left vein was clearly compressed at the included angle of abdominal aorta and superior mesenteric artery and the proximal vein was dilated in all the 4 patients.The characteristics of onset and imaging, and treatment of left renal entrapment syndrome were reviewed and discussed with the relevant literature. Results The diagnosis was established in the 4 cases based on B-ultrasonography and CT scan.Left renal vein reconstruction was performed on them.The patients were cured and discharged,with renal vein outflow being normal and no hematuria occurring.At 6 and 9 months after operation,CT and ultrasonography showed that the kidney contour was normal,the reconstructed veins were patent,and the routine urine test results were normal. Conclusions Left renal entrapment syndrome clinically results in high pressure of renal vein,hematuria and left varicocele.Autotransplantation of the left renal vein is an effective treatment option.

Objective To evaluate and recommend the use of appendix anastomosed to umbilicus as the outlet of urinary reservoir. Methods The procedure has been conducted in 17 cases underwent total cystectomy from Jan 1995 to May 2000 and the outcome has been studied. Results Continence has been achieved in all.Neither difficulty in catheterization nor acute pyelonephritis was noted.There has been slight bilateral hydronephrosis in 2 patients. Conclusions The use of appendix anastomosed to umbilicus as the outlet of continent urinary reservoir is a good alternative for urinary diversion.

Objective To evaluate the safety and clinical efficacy of photoselective vaporization of the prostate(PVP)for the treatment of benign prostatic hyperplasia(BPH).Methods Under caudal block,650 patients with BPH received PVP.By using the pointer,vaporization was started at the 6 o'clock point at the bladder neck and then extended to the 5 and 7 o'clock points,afterwards,the bilateral lobes of the prostate was involved deep into the prostate capsule.Results Five of the cases(8%)were converted to open surgeries because of large prostate or massive hemorrhage.In the other 645 cases,the mean operation time was(45.6?17.3)min,mean blood loss was(56.3?15.2)ml;none of them received blood transfusion.Urethral catheter was indwelled for(1.8?0.5)d after the operation in 504 cases.All the patients were followed up for 3 to 36 months.Three months after the operation,the IPSS and QOL decreased from(29.8?5.2)and(5.2?0.8)to(8.4?2.3)and(1.4?0.5)respectively in the patients(t=37.635,P=0.000 and t=39.084,P=0.000),RUV decreased from(168.0?22.5)ml to(24.6?5.8)ml(t=42.281,P=0.000),Qmax increased from(5.6?2.8)ml/s to(24.7?3.2)ml/s(t=-28.430,P=0.000),respectively.No urinary incontinence and TUR syndrome occurred in this series.Conclusions PVP,which can yield short operation time,little blood loss,and rapid relief,is safe,simple,and effective for patients with BPH,especially for elder patients.

Objective To investigate the state of microchimerism after kidney transplantation, and to evaluate the relationship between microchimerism and long term survival of transplanted kidney. Methods Leukocytes were collected from peripheral blood of 70 female recipients having received kidneys from males for the identification of microchimerism by means of amplifying the single copied sex determine region Y gene (SRY) by nested PCR. Results Half to 10 years after renal transplantation, the positive percentage of microchimerism in 70 female patients was 58.6%(41/70). These 70 patients were categorized into three groups according to the duration after the transplantation: Group 1(n=25), 0.5 to 2 years; Group 2 (n=27), 2 to 5 years; and group 3 (n=18), over 5 years. The positive rates of microchimerism for three groups were 68%(17/25), 44.4%(11/27) and 72%(13/18), respectively. The positive rates in both group 1 and group 3 were significantly different compared with that in group 2 (P

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