Objective To investigate the levels of inflammatory cytokines in children with low absolute lymphocyte count (ALC).Methods 56 patients with low ALC as the patients group and 20 children with healthy physical examination as the control group were enrolled.Several inflammatory cytokines,namely IL-1,IL-6,IL-8 and TNF-βwere measured with enzyme linked immu-nosorbent assay(ELISA)kits.High sensitive C reactive protein(Hs-CRP)was measured by the immunoturbidimetry(ITM)kit with the automatic biochemical analyzer.Results The concentrations of IL-1,IL-6,IL-8 and TNF-βin the patients were(0.096±0.012) ng/mL,(0.118±0.026)ng/mL,(0.388 ±0.069)ng/mL and(1.256 ±0.245 )ng/mL respectively,which had no statistical differ-ences as compared with the control group(P >0.05);the concentration of HsCRP in the patients group was(5.7±2.8)mg/L,while which in the control group was(4.8±2.6)mg/L,showing no statistically significant difference between them(P >0.05).Conclusion The levels of the cytokines in low ALC patients are not increased,which may be related with the other factors.Actively using tra-ditional Chinese medicine treatment is beneficial to the recovery of disease.

The improving brain circulation is the most important aspect in protecting brain from the ischemic trauma. This frauma on pathophysiology includes the two stages which are related to different treatments. The paper induced some therapeutic progress, such as thrombolytic therapy, the use of anticoagulation agents, antiplatelet drugs, neuroprotectine agents, intracerebral transplantation, antiedama, and reducing intracranieal pressure.

Objective To investigate the application value of urine excrement shunt surgery for the treatment of severe metabolic disorders after Sigma rectum pouch of bladder cancer.Methods From July 2011 to December 2013,4 male patients (mean age 72±10 years old,ranged from 58-82 years old),who received radical cystectomy and Sigma rectum pouch due to bladder cancer,were admitted in our hospital.Within four years after the operation,all patients complained about the recurrent fatigue,anorexia and even unconsciousness.The hyperchloremic metabolic acidosis,hypokalemia and renal dysfunction were diagnosed by blood gas analysis and biochemical tests.One week before urine excrement shunt operation,the arterial blood pH,HCO3-,serum potassium,chloride and creatinine were (7.15±0.08),(7.8±4.7)mmol/L,(3.1 ±0.2) mmol/L,(110.3±4.7) mmol/L,(314.8±66.4) μmol/L,respectively.They received urine excrement shunt surgery.The lower abdominal mid-line incision was made and the pouch was isolated from intestinal tract.The abdomen ostomy was made and the sigmoid colon and rectum were re-coincided in order to recover the intestinal continuity.The results of blood gas analysis,electrolytes and renal function after surgery were compared with those before surgery.Results The average operation time was (256.3±26.9) min and the mean volume of bleeding was (147.5±111.2) ml.There was no surgery related complication.Blood bicarbonate was (19.1±4.8) mmol/L one week after surgery,which was significantly improved than that before operation (P＜0.05).One month later,blood pH level descended to (7.38±0.05),potassium level was (3.9±0.3) mmol/L,creatinine was (208.8±50.8) umol/L.All of them were significantly improved,compared with those results before surgery (P＜0.05).Blood chloride was significantly reduced to (102.4±5.8) mmol/L (P＜0.05) after 6 months of operation.Nobody developed severe acidosis and electrolyte disturbances during 6 months to 3 years' follow-up.Conclusions Urine excrement shunt surgery can effectively corrected the acidosis and electrolyte disturbances due to the radical cystectomy and Sigma rectum pouch.It might be a alternative method to treat such kind of severe complications.

Objective To evaluate the occurrence of antiandrogen withdrawal syndrome in patients with advanced prostate cancer treated with combined androgen blockade. Methods 24 cases of advanced prostate cancer (10 in stage C and 14 in stage D) were retrospectively studied. All the patients have been treated with combined androgen blockade (bilateral orchiectomy and flutamide). After initial beneficial response to hormonal therapy (duration 7 to 36 months), the disease became progressing.Flutamide was then discontinued. Serum prostate specific antigen (PSA) levels and symptoms alterations were observed. Results Following withdrawal of flutamide, 8 patients showed a decline in PSA (mean 75%).In 6 the PSA declined more than 50%. Clinical symptoms improved in 4 patients and the prostate mass became smaller in 2. The mean duration of improvement was 4.3 months. Conclusions In patients with hormone refractory prostate cancer after initial combined androgen blockade, a trial of "antiandrogen withdrawal" is a reasonable therapeutic management prior to other more toxic therapies.

Objective To study the diagnosis accuracy and the treatment sequelae of adenocarcinoma of urinary bladder. Methods 41 cases of urinary bladder adenocarcinoma have been encountered from 1980 to 2000,all of them had undergone operation and the diagnosis being assessed on histopathology studies.There are 18 cases of primary bladder adenocarcinoma,among which 8 had undergone radical cystectomy and 10 partial cystectomy.Among 12 cases of urachal adenocarcinoma extending to the bladder,11 received extended resection.All the 11 patitents with metastatic focus in the bladder underwent local ablation. Results Urinary bladder adenocarcinoma comprised 3.2% of the bladder cancer.Thirty seven patients have been followed up for five months to ten years.The 1 year survival rate was 51.3%(19 cases),the 2 year survival rate 43.2%(16 cases) and the 5 year survival rate 21.6%(8 cases). Conclusions Radical total cystectomy is the treatment of choice for primary adenocarcinoma of bladder and extended partial cystectomy seems to be the best for urachal adenocarcinoma. Comprehension therapy should be undertaken for patients with metastatic adenocarcinoma or tumor recurrence so as to improve the survival rate.

Objective To evaluate the modified Stamey bladder neck suspension for female stress urinary incontinence. Methods 52 cases with an average age of 46 and an average stress incontinence history of 7.5 years underwent the modified Stamey procedure,18 cases being degree Ⅰ,21 degree Ⅱ and the other 13 degree Ⅲ. Results 32 cases were treated before 1994 and the outcome was evaluate at 3.6 years and 9.6 years postoperatively.There were 3 failures because of operative complication.The cure rates and failure rates at 3.6 and 9.6 years were 87.5%,68.8% and 6.2%, 21.9%,respectively.20 cases were treated after 1994 with a follow up of 4.3 years.The cure rate has been 90.0%. Conclusions The Stamey procedure yields high initial cure rates yet the latter declines with time.

ObjectiveTo study the diagnosis and therapy of circumcaval ureter.MethodsFifteen cases of circumcaval ureter were studied retrospectively.The cardinal symptoms include discomfort over the back and loins,nephrocolic and bloody urine.The diagnosis mainly depends on IVU and retrograde urography.12 patients underwent ureteroureterostomy,2 ureteropyeloneostomy and 1 nephrectomy.ResultsAll the patients have been follewed up from 1 to 15 years by IVU and ultrasonography,and no nephrohydrosis or stenosis of the anastomosis site has been noted.All the patients have been free from any complaints.ConclusionsIVU and retrograde urography are the cardinal means for the diagnosis of circumcaval ureter,and operation is indicated in order to improve the renal function.It is important to choose a proper time and an adequate surgical technique.

Objective To evaluate the diagnosis and treatment of pheochromocytoma in children. Methods Eighteen children with pheochromocytoma were diagnosed and treated from 1980 to 2000.The primary clinical manifestations included severe headache,blurring of vision,palpitation,excessive perspiration.Sustained hypertension occurred in 10 cases,sustained hypertension accompanied by episodic exacerbation in 7 and episodic hypertension in 1.The mean blood pressure was 185/130 mmHg(1 mmHg=0.133 kPa),with the highest up to 260/190 mmHg.VMA was increased in 89% (16/18) of the cases,and blood and urinary catecholamine was increased in 92% (12/13).Retroperitoneal pneumography was performed in 3 cases,CT in 14 cases and MRI in 2 cases,with all positive findings.B-ultrasonography showed positive in 94%(15/16). Results This series of 18 cases accounted for 11.6% of the pheochromocytoma cases admitted homochronously (18/155).All the 18 cases underwent surgery with the help of proper peir-operative management.The pheochromocytomas (comfired by pathology) were successfully extirpated with the tumor weight ranging from 40 to 150 g.All the cases were followed up for 1 to 20 years.Their blood pressure returned to normal in 94%(17/18).Only 1 case had relapse 2 years later with diagnosis of malignancy,and died in the following year. Conclusions Since the clinical manifestations of pheochromocytoma in children are atypical,endocrinological and imaging examinations are necessary to children with hypertension.Surgical excision is the best option,and oppropriate perioperative management is extremely important.The outcome of surgical management in children is better than that in the adults.

Objective To highlight the diagnostic and t herapeutic procedures for extra-adrenal pheochromocytoma. Methods Thirty-eight cases of extra-adrenal pheochromocytoma proven patholo gically from 1998 to 2002 were reviewed and studied.Hypertension was observed in 34 cases and intermittent macrohematuria in 4 patients.Another 2 cases were adm itted to hospital with abdomen masses through routinely physical examination.Uri nary VMA,serum and urinary catecholamine were measured in 33 cases.38 cases had B-model ultrasound examination and 34 cases took CT scan.The level of urine VMA elevated in 30 cases(91%) and serum or urinary catecholamine were elevated in 2 8 (85%).The positive rates of localization of B-ultrasound and CT were 92% and 100%,respectively.29 cases took ?-receptor blocker for at least 2 weeks preope ratively.There were 6 cases operated under epidural anesthesia and 32 general an esthesia.Six cases were operated transvesical.10 cases with lumber incision and 19 with abdominal incision.The other 3 cases operated laparoscopically. Results Tumor location,6 cases in bladder wall,7 in renal hilum, 9 in upper pole of kidney,4 in low pole,10 in anterio-lateral to the adrenal gl and,and 2 cases of multifoci.The specimens were from 2 to 9 cm in size.Among 34 cases with hypertension,the blood pressure of 26 patients return to normal and 2 cases were still hypertensive.10 cases were assayed as malignant pheochromocyto ma.There were 9 cases of recurrence or metastases and 5 patients died during fol lowed-up from 13 months to 10 years. Conclusions Urine VMA level is a useful marker to detect extra-adrenal pheochromocytoma and CT sc an is the most reliable in localizing the lesions. 131I-MIBG scintigra phy is of great value for the localization and quantitative for extra-renal phe ochromocytoma with high sensitivity and accuracy.It may be also used as a therap eutic method.Surgical manipulation of the tumor is the best management and metic ulous perioperative management is extremely important.Measuring the level of uri nary catecholamine can monitor the recurrence or metastasis of the tumor.

Objective To compare the effect of allogeneic and autologous blood transfusion on postoperative immunoreaction in patients after spinal surgeries.Methods A total of 44 patients undergoing spinal operations were randomly divided into two groups.Allogeneic (n=22) or autologous (n=22) buffy-coat-depleted red cells were used in the patients during the operations.The serum levels of IL-6,IFN-?,and TNF-?were determined preoperatively and then re-measured 1 and 7 days after the operations. Results In theautologous group,both IFN-?and IL-6 increased after the oprerations,the level of IL-6 was significantly higher than that in the allogeneic group at days 1 and 7.The concentration of TNF-?did not change after the surgeries in the two groups. Conclusions By autologous blood transfusion,the serum levels of IFN-?and IL-6 can be increased significantly after spinal operation,meanwhile the concentration of TNF-?remains stable.The postoperative inhibitory effect of the procedure on immunocytokines is significantly weaker than that of allogeneic blood transfusion,indicating that autologous blood transfuion can protect or even increase immunofunction after spinal operation.