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 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 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 effect of the new biodegradable paclitaxel-eluting stents in treatment of traumatic urethral stricture.Methods Twenty-five adult New Zealand rabbits were divided into study group (n =20) and control group (n =5) according to the random number table.In study group,rabbit models of traumatic urethral stricture were developed by self-designed explosive devices.All the stents were inserted under direct vision.Reparative results were evaluated by urethroscopy,retrograde urethrogram and histological examinations at postoperative 4,8,and 12 weeks.Results In study group all the stents were smoothly inserted into the strictured urethra without the occurrence of stent migration and lithogenesis.Urethroscopy showed that the stents in study group were partially degraded at 8 weeks,mostly degraded at 12 weeks and discharged with the urine.And from the naked eye,there was no distinct difference between the repaired and normal urinary mucosa.Retro~ade urethrogram demonstrated the stents restored urethral patency.Histological examinations showed the stents minimized stent-related inflammatory reactions,uroepithelial hyperplasia and scar formation.Conclusion New biodegradable paclitaxel-eluting stents exhibiting good biocompatibility are more effective to repair urethral stricture in rabbits.

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.

This stued examined the effects of nutritional support in 56 patients suffer from COPD. The influence of nutritional support on lung function and arteny blood gases after infusion of an amino acid solution (7% Fan Ming) were observed. The results suggested theft PaO2, FEV1. FVC levels were increased significantry compared to the control group. PaOz decreased significantly in Fan Ming infusion group compared 100 control group.

BACKGROUND: At present, common therapies of obstructive sleep apnea syndrome (OSAS) are uvulo-palato-pharyngoplasty and nasal continuous positive airway pressure (N-CPAP). The effective rate of surgical treatment was 50% and the prostecdtive efficacy is decreased gradually. As to treatment with breathing machine, some of the patients can not adapt to it.OBJECTIVE: To investigate the effects of auricular acupoint pressing therapy on clinical indexes of patients with OSAS and its clinical effect,and analyze the possible mechanism.DESIGN: Randomized control observation.SETTING: Department of Acupuncture and Department of Respiration,Second Hospital of Hebei Medical University.PARTICIPANTS: Forty-five outpatients with OSAS between April 2001 and April 2004, who were diagnosed as OSAS in the room of sleep-monitoring of Department of Respiration, were selected from the Clinic of Respiration, Second Hospital of Hebei Medical University, including 44 males and one female. All subjects were randomly divided into treatment group (n=30) and control group (n=15).METHODS: ①Patients in the treatment group were treated by auricular acupoint pressing therapy, acupoint-locating: shenmen, sympathesis, subcortex, heart, lung, spleen, kidney, anterior ear lobe. Each acupoint was pressed about 10-20 times with 3-5 times every day and 10 days as onecourse. Patients in the control group were treated with placebo and orally took 100 mg of Vitamin C three times a day. Patients in both groups were detected by 7hour nocturnal polysomnography before treatment and 10 days after the treatment, and the curative effects were evaluated.②Criteria of the curative effects on clinical symptoms: Effective: clinical symptoms such as dizzy,somnolence, oppressed chest and obstructing etc. were significantly ameliorated with nocturnal times decreased from 4-5 times to once or none and awake times decreased from 4-5 to once or none. Valid: clinical symptoms were improved. Invalid: no amelioration was found in clinicalsymptoms.MAIN OUTCOME MEASURES: Changes of clinical symptoms before and after the treatment and hypopnea index (HI), apnea index (AI), apnea hypopnea index (AHI), minimum blood oxygen saturation as well as the longest apnea time detected by polysomnography were observed.RESULTS: A total of 45 patients with OSAS were involved in the analysis of results, and no one withdrew from the study.①The clinical symptoms in auricular acupoint treatment group were significantly ameliorated than control group. In the treatment group, 17 patients were effective (56.7%), 12 patients were valid and one patient was invalid. The clinical symptoms in the control group were not improved before and after the treatment, and there were significant differences between the treatment group and control group (P ＜ 0.05). ②Comparison in each inspecting indexes by polysomnogram: those in the auricular pressing therapy group were remarkably different from those in the control group after treatment (P ＜ 0.001). There was no significant difference in all indexes of the control group between and after the treatment (P ＞ 0.05).③The differences in AI, HI, AHI, minimum blood oxygen saturation as well as the longest apnea time of the auricular pressing treatment group after the treatment were markedly different from those before treatment [(65.25±7.44), (53.69±10.80) times/hour; (72.40±7.92), (59.22±10.55) times/hour; (9.46±2.6), (6.5±2.9) times/hour; (73.3±4.8)%,(77.67±3.78)%; (90.16±33), (45.33±24.69) s,P ＜ 0.001]. Among them, the maximum decrease of AI was 19.3 times/hour, the maximum decrease of AHI was 17.8 times/hour, the maximum decrease of HI was 12.9 times/hour and the maximum increase of blood oxygen saturation was 7% CONCLUSION: Auricular acupoint pressing therapy, in the treatment of OSAS, can significantly ameliorate the AI, HI; AHI, minimum blood oxygen saturation as well as the longest apnea time with better curative effects.

Objective To analyze the relationship between thyroid function and grades of diabetic nephropa-thy (DN).Methods One hundred and twenty patients with definite DN were classified into the four groups,and forty patients with non-DN diabetic was NDN group.Their serum albumin,blood hemoglobin,serum potassium,functional parameters of thyroid and dependability to DN were analyzed.Results The plasma albumin ofⅢ,Ⅳ and Ⅴ group were (41.3 ±3.6)g/L,(30.5 ±4.8)g/L and (28.3 ±5.9)g/L,which were lower than those of NDN group (F=11.36,P<0.05).24h urine protein ofⅢ,Ⅳ and Ⅴ were (0.48 ±0.29)g,(1.86 ±0.54)g and (1.69 ±0.67)g, which were higher than those of group NDN (F=7.12,P<0.05).Triiodothyronine(T3)ofⅢ,ⅣandⅤgroup were (0.98 ±0.38)nmol/L,(0.75 ±0.41)nmol/L and (0.60 ±0.28)nmol/L,which were lower than those of NDN group (F=7.64,P<0.05).Tetraiodothyronine(T4)of III,IV and V group were (6.06 ±1.76)nmol/L,(5.31 ±1.98)nmol/L and (4.65 ±1.87)nmol/L,which were lower than those of NDN group (F=6.83,P<0.05 ).Free Triiodothyronine (FT3)ofⅢ,Ⅳ and Ⅴ group were (4.37 ±2.12)pmol/L,(3.33 ±2.30)pmol/L and (2.91 ±1.82)pmol/L, which were lower than those of NDN group (F=7.14,P<0.05 ).Correlation analysis indicated that FT3 was an independent predictor for the severity of diabetic nephropathy.Conclusion In the patients with DN Ⅳ and Ⅴ,DN has attained a very severe status and the treatment of DN should be intensive.

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 summarize the first 16 eases in mainland China and to discuss the cli-nical experience of robot-assisted laparoseopie radical prostateetomy(RLRP). Methods Sixteen pa-tients with localized prostate carcinoma underwent RLRP with da Vinci S surgical system (Intuitive Surgical Inc.). The age of the patients was 62-76 years, average 69 years. The preoperative t-PSA level was 0.2-79. 2. Ng/ml. The volume of prostate was 9.8-232.9 ml. Fifteen patients were with biopsy-proven prostate cancer, the average Gleason score was 7(4-9). Three were T2a. N0 M0, 4 were T2b N0 M0 and 8 were T2c N0/M0 by clinical stage. One was prostatic intraepithelial neoplasm-Ⅲ. The level of t-PSA in serum and the result of urinary continence were followed up after RLRP. Results All the operations were accomplished successfully. The mean preoperative set-up time of the da Vinci surgical system was 64(60--90)min;the mean operation time was 236(190--390)rain;the mean esti-mated blood loss was 231(50-500)m.L The patients were ambulant between the 2nd and 3rd postop-erative days. Foley catheter was sueeeasfully removed on day 10 to 14, and mean hospital stay was 13 (6-19) days. Two eases had positive surgical margins, the pathological stages were both pT3b N0 M0. The average serum t-PSA was less than 0. 1 ng/ml during a median follow-up of 9(6-12) months. By the conventional definition of urinary continence (0 to 1 pads daily), 94%(15/16) and 100% (16/16)of patients were continent at 3 and 6 months, respectively. Of the patients, 75% (12/16)and 88% (14/16)had no urinary leakage(0 pads daily). Conclusions RLRP is small incision and safe. It is the direction of minimally invasive urologic surgery.