Objective To evaluate the use of LHRH A for treating prostatic cancer with the occurrence of metastasis or recurrence after castration. Methods LHRH A has been instituted to 9 cases of pathologically verified prostatic cancer with the occurrence of metastasis or recurrence after castration.The therapeutic results were studied. Results Ideal improvement was noted in 4 with all the parameters turned normal.These 4 patients have survived well for 7,3,2 and 1 year respectively.Marked improvement occurred in 2 with part of the parameters turned normal or markedly improved shortly after the treatment.The condition of 1 patient became stable with drop of blood PSA and shrinkage of the prostatic mass.In 3 patients,the metastatic lesion became stable.with the use of LHRH A,the penis became markedly atrophic. Conclusions LHRH A is markedly effective in most cases of prostatic cancer with the occurrence of metastasis or recurrence after castration.The therapeutic efficacy depends on the sensitivity of the prostate cancer cells to the drug.Drug resistance may issue as time goes by.

Objective To assess the value of caval-atr ial venovenous bypass technique in resection of tumor thrombus for renal or adr enal carcinomas with inferior vena cava involvement. Methods From Mar.to Aug.of 2000,4 patients with renal or adrenal carcinoma extendi ng into inferior vena cava were admitted and evaluated.Radical nephrectomy and v ena cava thrombectomy were performed with the use of caval-atrial venovenous by pass technique. Results There was no significant change of hemodynamic parameters during vena cava thrombectomy.A part of tumor thrombu s in 1 case was left in situ because of its compact adhesion to the wall of infe rior vena cava.The tumor thrombus in inferior vena cava were completely removed in the other 3. Conclusions Caval-atrial venovenous byp ass technique is a simple and safe method during vena cava thrombectomy.

Objective To investigate the clonal origin of malignant cells in multifocal urothelial carcinoma. Methods p53 protein expressions were detected by immunohistochemistry in 22 pieces of tumor tissues from 10 patients with urothelial neoplasms.Mutation in p53 was inferred on the basis of immuno staining . Results The p53 protein expression of various tumors in the same patient completely matched, reflecting that the gene status of the multifocal tumor being the same. Conclusions The results strongly support the view that multifocal urothelial tumors are derived from the monoclonal cell.

Objective To explore and analyze effect of heparin combined with urokinase therapy on lower limb venous thrombosis.Methods 90 cases with lower extremity venous thrombosis were chosed and divided into control group of 45 cases and experimental group of 45 cases according with random number table method.Control group was given pure low molecular heparin treatment, experimental group was treated with small dose of urokinase static drop on the basis of control group, 7 days for a course, a total of 2 course of treatment.Compared two groups before and after treatment of lower limb venous patency rate changes, blood coagulation function index, adverse reactions and the recurrence rate.Results Compared with control group post-treatment.patency rate of posterior divisions, popliteal vein and posterior tibial vein of experimental group were significantly better (P<0.05).Experimental group post-treatment compared with control group post-treatment, PT, APTT, TT time had significant difference ( P <0.05 ).Patients incidence of adverse reactions were significantly lower than control group ( P <0.05 ).Patients were followed up for 1 year recurrence rate was significantly lower than control group ( P <0.05 ).Conclusion Effect of low molecular heparin combined with urokinase in the treatment of venous thrombosis of lower limbs significant and its prognosis is well.

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 evaluate the technique and efficacy of retroperitoneal laparoscopic simple enucleation for renal angiomyolipoma(RAML).Methods Between June 2005 and December 2006,11 patients with RAML underwent simple enucleation of the tumor by retroperitoneal laparoscopy.During the operation,the renal capsule was incised along the edge of the tumor by using spatula or harmonic scalpel,and then the whole tumor entity was removed,and the rest rich-fat tumor tissues were sucked with attractor.Finally,the surface of the wound was cleaned with gauze;the hemorrhage was controlled by bipolar coagulation.Fibrin sealant and hemostatic gauze,and absorbable sutures were used to close the surgical wound in the kidney.Results All the procedures were completed without conversion to open surgery.The mean operation time was 84.5 minutes(60-110 min),the mean blood loss was 51 ml(20-100 ml),and the mean postoperative hospital stay was 8.8 d(6-14 d).No intraoperative complications occurred in this series.The renal function was normal in all the cases after the operation.The patients were followed up for 7-23 months(mean 13.4 months).During this period,radiological examination found no local residual tumor or recurrent tumors.Conclusions Retroperitoneal laparoscopic simple enucleation is superior in less trauma and blood loss,quick recovery,and shoru period of hospitalization.

Objective To evaluate the clinical efficacy of laparoscopic radical prostatectomy.Methods A total of 11 cases of laparoscopic radical prostatectomy were enrolled in this study.Among the cases,transperitoneal approach was used in 4 patients,and extraperitoneal approach was employed in 7.The prostate,seminal vesicles,and ampulla ductus deferens were resected,and then the bladder was anastomosed with the urethra.Results The operation was successfully performed in all the patients with a mean operation time of 304 min(180-390 min),and a mean blood loss of 520 ml(300-1200 ml).The postoperative catheterization time and hospital stay were 12-28 d(mean,19.8 d)and 12-24 d(mean,20 d)respectively.No injuries to the rectum,urinary incontinence,or urethral stenosis occurred in this series.The patients were followed up for 1-36 mon(mean 11 mon),during this period,no local recurrence or distant metastasis were found.The postoperative PSA level was 0-0.05 ?g/L.Conclusion Laparoscopic radical prostatectomy is safe and effective for the treatment of prostate cancer.

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 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 evaluate the direct deleterious effect of immunosuppressive agent to human islets, and to explore the suitable immunosuppressive protocol for human islet transplantation. Methods Human islet cells cultured in vitro were exposed to various therapeutic concentrations of four immunosuppressive agents for 72h respectively. Glucose-stimulating insulin secretion during incubation was measured using the ultrasensitive human insulin ELISA kit. The assessment of islet cell viability was studied with acridine orange (AO)-propidium iodide (PI). Results In vitro, low therapeutic concentrations had no deleterious effect on insulin secretion or viability of islet, but high concentration of the drugs was deleterious to ?-cell survival as well as insulin secretion. The effect of medium concentration varied significantly, and sirolimus tacrolimus demonstrated stronger deleterious effect on human islets than mycophenolic acid. Conclusion The direct deleterious effect of immunosuppressive agents to islet cells is dose-dependent, therefore immunosuppressive agent must be optimized after islet transplantation.