Objective:To investigate whether the risk of intravesical recurrence increases in patients with upper urinary tract urothelial carcinoma (UUT-UC) and diabetes mellitus (DM) after radical nephroureterectomy (RNU) with bladder cuff excision. Methods:We ret-rospectively analyzed the clinicopathological data of 282 UUT-UC patients with no history of bladder neoplasm and who underwent RNU with bladder cuff excision in the Second Hospital of Tianjin Medical University from January 2005 to December 2013. The recurrence-free survival (RFS) and cancer-specific survival (CSS) were compared between the non-diabetic (233 patients) and diabetic (49 patients) patients. The factors influencing intravesical recurrence in patients with UUT-UC after RNU were analyzed. These factors included age, DM, pathologic grade, and stage. Results:Among the 282 patients included in the study, 80 (28.4%) patients developed intravesical recurrence during the median fol ow up of 41 months, and the median time to recurrence was 11 months. Non-diabetic patients had a significantly longer duration of bladder neoplasm RFS than diabetic patients (P=0.013). Multivariate analysis using Cox's regression model indicated that DM (P=0.014), renal pelvis and ureter tumor (P=0.001), and postoperative chemotherapy (P=0.024) were independent influential factors for intravesical recurrence in patients with UUT-UC after RNU with bladder cuff excision. Conclusion:DM posed an increased risk for intravesical recurrence after RNU with bladder cuff excision in patients with UUT-UC. Therefore, these patients need to be closely monitored, and their blood glucose must be controlled.

ObjectiveTo explore the early diagnosis and effective treatment of redundant colon,and to reduce the misdiagnosis and shorten the medical treatment time before the diagnosis.MethodsClinical data of twentyseven patients with redundant colon from February 2005 to December 2011 were retrospectively analyzed in General Surgery Department of 117th and 322th People's Liberation Army Hospital.ResultsThe clinical symptoms of 27 patients nainly as early recurrent intractable constipation,bloating,abdominal pain,weight loss and other symptoms,were likely to be in a misdiagnosis.In addition to three patients with redundant sigmoid colon concurrent reverse came to hospital emergency with surgery,twenty-four cases' symptoms persisted and came to many hospitals with medical treatment up to 32 years,diagnosed by the out-patient barium enema.After surgical resection disease bowel,7-11 months follow-up,patients abdominal distension,abdominal pain,constipation,weight loss and other systemic unwell symptoms disappeared.ConclusionThis disease is rare,we must raise the medical staff's awareness of this disease.X-ray examination with barium enema is the best way to diagnose this disease.After diagnosis,surgery is the most effective treatment.

Objective To study the efficacy of sacral nerve stimulation combined with tolterodine in patients with female idiopathic overactive bladder (IOAB).Methods A total of 200 female patients diagnosed with IOAB from January 2005 to January 2011 were included in the study,and according to random number table method were divided into treatment group and control group with 100 cases in each.Each group was divided into 3 subgroups according to urinary frequency and urgency,urge incontinence,and both of them together.In the treatment group,patients received percutaneous sacral nerve stimulation and tolterodine 2 mg orally,1 time/d,while in the control group,only given tolterodine 2 mg orally,1 time/d,treatment for 3 months.The voiding diary and urodynamics parameters were observed between the two groups before and after treatment and application of self-rating depression scale (SDS) and self-rating anxiety scale (SAS) to evaluate the psychology of concomitant depression and anxiety score.Results After treatment,the average number of urination,daily average unit urine,the single biggest urine and urine feel capacity (FDV),the maximum capacity of the bladder pressure (MCBC),maximum urinary flow rate (Qmax) in two groups were improved,and the daily average unit urine,single biggest urine and FDV,MCBC,Qmax in treatment group after treatment were higher than those in control group [daily average unit urine:urinary frequency and urgency (248 ± 46) ml/times vs.(150 ± 77) ml/times,urge incontinence (249 ± 69) ml/times vs.(144 ± 81) ml/times,both of them together (247 ± 69) ml/times vs.(170 ± 46) ml/times; the single biggest urine:(320 ± 87) ml/times vs.(212 ± 44) ml/times,(315 ± 65) ml/times vs.(211 ± 56) ml/times,(333 ±59) ml/times vs.(201 ±66) ml/times;FDV:(176 ±64) ml vs.(142 ±44) ml,(190 ±69) ml vs.(142±55) ml,(188 ±60) mlvs.(138 ±49) ml;MCBC:(265 ±46) ml vs.(203 ±50) ml,(288 ±48) ml vs.(197 ± 41)ml,(287 ± 43) ml vs.(189 ± 44) ml],there were significant statistical differences (P ＜ 0.01).The SDS and SAS scores were reduced in two groups after treatment,and the SDS and SAS scores in treatment group after treatment were significantly lower than those in control group [SDS scores:urinary frequency and urgency (33.0 ± 6.2) scores vs.(44.0 ± 5.9) scores,urge incontinence(31.1 ± 6.2) scores vs.(41.6 ± 6.1) scores,both of them together(33.4 ± 7.2) scores vs.(44.5 ± 5.0)scores;SAS scores:(30.3 ± 4.4) scores vs.(41.3 ±4.4) scores,(33.3 ±5.8) scores vs.(42.5 ±6.4) scores,(31.9 ±4.7) scores vs.(43.5 ± 5.6) scores],there were significant statistical differences (P＜ 0.01).Conclusions The combined treatment of tolterodine and sacral nerve stimulation can not only improve the voiding dysfunctions symptoms but also the concomitant depression and anxiety in patients with female IOAB,thus improving the patient's quality of life.

OBJECTIVE: To evaluate the effect of femoral and sciatic nerve block in total knee replacement of elderly patients under general anesthesia. METHODS: From July 2017 to July 2019, 60 patients with unilateral total knee replacement were selected, including 35 males and 25 females; aged 66 to 74(70.2±10.3) years;BMI 18 to 25 (21.3 ± 3.5) kg /m;course 2 to 3 (1.2±0.3) days. The patients were divided into general anesthesia group (G group) 30 cases and general anesthesia plus nerve block group(GNB group) 30 cases. In GNB group, the femoral nerve sciatic nerve block was guided by ultrasound before anesthesia induction, 20 to 25 ml was injected into the femoral nerve puncture point with 0.5% ropivacaine, 15 to 20 ml was injected into the sciaticnerve puncture point, and the total volume was no more than 40 ml. Postoperative intravenous analgesia (PCIA) was performed in two groups. The dosage of propofol and remifentanil was recorded. Forty-eight hours after operation, the incidence of postoperative nausea and vomiting (PONV) and postoperative farsightedness were recorded. When VAS>3, tramadol 2 mg / kg was injected intravenously, and the additional times of tramadol were recorded. Forty-eight hours after operation, patients' satisfaction score was used to record the length of stay. RESULTS: Compared with group G, the dosage of propofol and remifentanil decreased, the incidence of PONV and the number of additional tramadol decreased, and the patients' satisfaction increased (<0.05). There was no significant difference in the length of stay between two groups (>0.05). The ROM and HSS scores of two groups after treatment were higher than those before treatment (<0.05), and the VAS scores were lower than those before treatment (<0.05). There was no significantdifference in ROM, VAS scores and HSS scores between two groups before treatment (>0.05). The ROM and HSS scores of the GNB group after treatment were higher than those of the G group (<0.05), and the VAS scores were lower than those of the G group (<0.05). CONCLUSION The application of femoral sciatic nerve block in total knee replacement under general anesthesia in elderly patients has good postoperative analgesic effect, and can reduce the dosage of general anesthesia, reduce PONV, and increase patient satisfaction.
Aged ; Anesthesia, General ; Arthroplasty, Replacement, Knee ; Female ; Femoral Nerve ; Humans ; Male ; Nerve Block ; Pain, Postoperative ; Sciatic Nerve